When your patient has his privates hanging out and asks you to come and sit on his lap, you learn about focal neurological deficits that result in hypersexuality. When your patient insists, while in the hospital bed, that he is in a prison in Las Vegas in 1987 and whose urine is positive for nitrates and leukocyte esterase, you learn about delirium secondary to a general medical condition– or in this case– manifestations of a urinary tract infection in the eldery. When your 55 year old patient comes in unresponsive but has positive urine drug screen and a history of substance abuse you are the one that fills out the involuntary commitment papers because you have a hunch this wasn’t an accidental overdose. When your patient starts freaking out at the nurses station, screaming and yelling and thrashing, you hide behind the physically stronger while your attending calculatedly and calmly contains the patient until security arrives. After your patient strangles two of his one-to-one monitors within a span of about three hours, your attending tells you stories of serial killers with severe psychosis that will haunt your dreams for the next three weeks. How can you not love this stuff?
According to med-school-clerkship-lore, psychiatry is one of the most enjoyable clerkships you will encounter. The hours are fantastic, they are so good that they allow you to sleep like all the other normal human beings. Call nights are minimal, the staff in general are nice and seem to care about your quality of life. And the best part is, you sit around all day and– with the most compassion possible of course– you laugh at (or fine, learn from) the crazies. Psych has been at the bottom of my list for years and as much as I hate to admit it, right now it’s inching it’s way back into view.