On flexibility (or Emergency Psych: a post-mortem)

Today is a bit of a wacky day, with Mackenzi transitioning to night shift (6a-6p) for the next six days. So, I’ll review the end of my residency rotation, then reflect on family changes, and finally end on where I am.

The emergency psych rotation ended yesterday, without my knowledge. As an inaugural member of a new residency program, I accept that I am a guinea pig and that I am smoothing out the rough patches for the future classes behind me.

This rotation was set to be 12wks of evaluating patients who present to the Emergency Department. I interviewed and assessed the patients for level of care: whether they need inpatient psychiatric care, outpatient care, or somewhere in the middle.

However, the number of patients that presented to the ED severely limited my educational experience: my 8a-4p shifts meant that patients needed to arrive between 6a and 12noon in order to receive the proper level of medical clearance prior to my evaluation. And honestly, not many people have suicidal thoughts before lunch.

So, we are shifting the Emergency Psych rotation to next year, PGY2. This will likely accompany a second shift (1p-9p) when more patients present to the ED. Further, as second year residents we can skate by with indirect supervision, meaning I call my preceptors and verbally explain the case rather than physically rounding on the patient with the attending. This will save valuable time, as waiting for a busy preceptor can suck up most of my afternoon.

I am not upset by this shift. Instead of the next eight weeks waiting for suicidal or psychotic patients to filter into the ED, I’ll continue to see consult-liaison (CL) psych patients. Or patients who have been admitted for medical/surgical reasons and need psychiatric assessment/care.

I like this work. Over the past month, I have gone over a week without a single ED patient. CL has been filling the gap. I like the complexity of the cases. I’ll see a burn patient who had lit themselves on fire, then a patient with alcoholic pancreatitis who needs help maintaining sobriety. Keeps me on my toes. I look forward to two months dedicated to CL psych.

And honestly, I am not too sad about missing out on emergency psych patients. I understand the importance for my education, but I really dislike the lack of continuity with my patients. I interview these folks on what is usuaully a really terrible day for them, learn as much about them and their story as possible, then wave them away and move onto the next one.

I like developing rapport which yields dividends down the line. I can develop rapport quickly with my patients. But, if I only see them once, then it feels more like speed dating than a true human interaction. So, I am glad to transition from Emergency Psych to CL Psych.

Over the past two weeks, I have been very mysterious and reticent about the changes present in my home. Much of that is because it is not my story to tell. Some of that is because it is still ongoing.

Allow me to use the grim analogy of a severed limb, like an arm mangled in a car accident. Up until a few days ago, it seemed like the wound was still actively bleeding. We had been applying pressure and attempting to develop a clot to stop the hemorrhage. Full-on crisis mode while we transport to the nearest trauma facility.

As of today, it seems like we have turned a corner. The bleeding has stopped. It may resume as any time, but we have some control over the wound. Now, we need to begin examining the extent of the damage so that we can intervene surgically to remove the worst of it and close the wound to allow future healing. Yes, we’ll need to do some more damage before the healing can truly begin, but at least we are out of the woods.

This is all to say that there is a major shift in Mackenzi’s family. Her mother is living with us for the foreseeable future. Mackenzi’s sister visited from CA and just left yesterday. She was able to obtain a car for Mackenzi’s mom, to provide a bit of independence and to begin developing a sense of normalcy around this massive change.

We don’t know exactly where things are going. We don’t know when things will feel back to normal. But we do know that we are okay for now. The wound hurts. It will continue to hurt. Even after it fully heals, it will be tender and raw.

Relationally, things are better. Mackenzi going onto nights is rough, but I feel like we are in a good place between us. We will overlap in the household for maybe half an hour in the morning and an hour in the evening. Things are good, things are hard, and that is okay.

EmotionallyI am still receding into my shell. Part of that might be desensitization from what I see at the hospital day-in and day-out. Part of that is simply because I know my job is to hold down the fort, to provide support, and witness the process unfolding in front of me. Maybe I’m a bit numb.

Physically, I feel good. I went on a run with Mackenzi over the weekend. My calves are still angry about it, but in a good way. While I haven’t made movement the largest priority in the wake of these family changes, I have been utilizing this coping skill to vent a bit and reset my mind.

Spirituallyyet again, I feel inadequate. I spend time with my son outside. I care for my pooch. I love my partner. I support my mother and mother-in-law. Maybe I need to reassess my definition of spirituality. My focus has changed and my abilities to practice spirituality has changed, too. I do not feel like I have the time to meditate on this now, but I will soon.

  • Relational – 4/5
  • Emotional – 3/5
  • Physical – 3/5
  • Spiritual –2/5
  • Total – 12/20
  • 3wk running total – 34/60

Long Form Sundays

On Death Podcast

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