mental exhaustion

today, one of our more vocal psychotic manic ladies was muttering, "no feelings, no feelings! they don't allow you to have feelings in this place..." as i walked out the door. she was looking at the mirror and doing her little jerky dance of madness as she said it, but i felt like she was talking to me. but now, for a short while, i'd like to share some of the feelings that i normally have to suppress in order to get through the day.

inpatient psychiatry is... challenging. we see the sickest of the mentally ill, and it ain't pretty. most of the rules of medicine and inpatient care that i've learned last year and in med school don't apply. patients' histories and diagnoses are often a mystery. most of them DON'T want to be there, and tell you so- over, and over, and over again with varying degrees of hostility. they also don't want to take medications, which is usually what landed them in the hospital in the first place. so, as you can guess, patients who don't want to be there and don't want your stinking meds also aren't interested in building a therapeutic alliance, or in giving you more insight into their psyche. they just want out, and I'M the one standing in their way. how do they know this? because i'm the one who has to go to their court hearings and testify about how they're unable to take care of themselves because of their mental illness... which means that they need to stay longer and take those goshdarn meds. some of the patients have gotten past the anger and are just there, waiting, until we can find a place for them, which depends on funding and just how crazy they seem because i have yet to hear of a living facility for mentally ill that wants mentally ill patients... then there's the scariness of it all- potentially unpredictable, crazy patients who could lash out in violence. i've already gotten over the verbal lashings- my favorite printable name that i've been called thus far has been "psych witch".

so how do we get through all this? how do i cope... well, it helps that my time there is limited- only a few more months, then i'm done. it's really important to use my sense of humor- to chuckle when my previously very sick, manic psychotic lady calls her even more manic and psychotic roommate "nuts". to smile when the very scary stocky pacific-islander male patient who mumbles to himself and stares me down suddenly breaks into song and starts doing the hula to "pearly shells". i've heard that the friday night dance is pretty amusing- the recreational department turns on some hip hop and lets the patients get down with their bad selves. sugar is also a temporizing measure- my fellow resident stocked his desk with jelly beans, which never fail to uplift (briefly) on a tough day. and i talk it out- to my co-residents, my husband, to anyone who will listen... or read ;)

but it is tough, even if the hours aren't bad, because i feel so drained most days. forget about working out- i'm pretty happy if i put some dinner on the table and do a few loads of laundry. my reading selections from the library have gotten progressively fluffier. they say it gets easier, and it's certainly better now than it was the first week... so i continue to hope that things will get better- and not at the expense of my optimism/idealism.