Still Like Psych

So my four weeks at [Other School] are over, and I have a week off before starting up on inpatient child psych. I'm ready for a break, at this point, but part of me is already missing my rotation. I liked my residents, I liked the other med students on the team, and I liked my attending, who kind of reminded me of my mother in some ways. I took some calls in the Psych Emergency Center, which were always entertaining, if a little bit shockingly cynical at times (a story for a different day, perhaps). At the end of the rotation, I'd earned a letter of recommendation from my attending, help with my personal statement from one resident, and the other resident's "blessing" should I ever want to attend their residency program. Since I felt like a huge goober much of the time, it was really nice to know I hadn't blown it all month.

I learned how much I like personality disorders this month. Patients with borderline or narcissistic personality are extremely difficult to work with by nature of their disorders, but I find them fascinating. We interviewed a young woman who had injured herself during a fight with her boyfriend; she'd not intended to really harm herself, but had to come to the hospital. Her story involved years of depression and suicidal thoughts, repeated cutting and burning of her skin, anxiety and panic attacks. No, she'd never suffered any real trauma, she said; a few minutes later, she calmly mentioned childhood abuse which had landed her in foster care through high school. She was totally detached from the abuse and made no connection between it and her violent mood swings or her need to cut her skin to release anger. It's easy to see the scary borderline patient, fear their manipulation and lies; it's more meaningful for me to learn their story. This girl was classic borderline, but she's young enough and willing to seek help that I have hope she may improve.

I learned I can control my emotions better this month. Even when I feel myself tearing up while a patient cries, or reveals a tragic history, I can hold it back. I feel the emotion, I acknowledge it, but I'm able to avoid crying with the patient. This was something I was really afraid of when I entered medicine, so I'm rather proud that I can do this.

I went to a talk on perfectionism in physicians during this rotation. It was like watching my most private thoughts and feelings be displayed in front of a room of people. Most people hear "perfectionism" and think high performance or success; one website I Googled said "The root of excellence is perfectionism." In psychological terms, though, it's a never-ending drive for an unachievable goal, which leads to constant low self-esteem and failure. One thing mentioned which I didn't realize was common was the feeling of fraudulence: it's common to feel that one is a fake, that everyone has been fooled so far into thinking one is smart, and only one small misstep will reveal the real, stupid self. This kind of compulsive, negative thinking and behavior can contribute to burn out, depression, substance abuse, and suicide; this frightens me, as I've already experienced the first two.

I realized I enjoy psychiatry passionately. There are things I hate as well as things I love, but fortunately more of the latter. This decision feels so right, and yet it is SO HARD to explain in my pitiful little personal statement, which has been revised by at least 5 people and is still inadequate. I'm going to be a very stressed out TS until March 2008 when the Match results are published. Until then, it's one deadline after another, CV's going everywhere, applications on various websites, money money money, checking on letters of recommendation, scheduling interviews, ranking programs... It's a wonder any of us get through all this!

Tonight, though, I watched a healthy dose of "What Not to Wear", cleaned my kitchen, cared for post-neuter kitty (he's doing well), and will now go to bed, because I love to sleep. Man, do I love sleep.