Editor's Note: which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Ramin Rajaii, a medical student at the University of California, Irvine School of Medicine and MBA candidate at the Indiana University University Kelley School of Business. The views expressed in these blogs are those of their respective contributors and do not represent the views of or UBM Medica.
I stepped into the room, a wary medical student on the second day of my psychiatry rotation. My task: interview three patients, present their stories at morning rounds to my attending physician. Simple, I thought to myself. But I was already so jaded and disillusioned.
FURTHER READING: Putting process over patient care continues to hurt healthcare
I was considering a nonmedical career. Medicine was broken, insurance companies were thieves, providers were superficial in their care, patient-centered care was anything but. Throughout three years of medical school, I had been hospitalized for depression three times, once placed on a 51/50 psychiatric hold, confined to a mental rehabilitation facility, been diagnosed with bipolar disorder, experimented with seven medications and am now pursuing TMS (transcranial magnetic stimulation) as a last resort for treatment-resistant depression. I was emotionally and spiritually broken—frozen—yet ironically the poster child for the very rotation I was embarking on.
My expectations for this experience were slim, at best. I had myself been a patient too many times. I knew exactly what it was like to show up in the ED so anxious you’re deemed psychotic. I knew exactly what it was like to wake up in a hospital bed in rehab with a roommate—a middle-aged disheveled man—who was constantly crying and threatening to kill himself if you left the room. I knew exactly what it was like to be stared at, poked and prodded, your symptoms thrown into the gears of clinical analysis, evaluation and deduction, then churned out as a generalized diagnosis that seemed to check the appropriate boxes.
Called unstable, unorganized and irrational by the treatment team—mere steps outside of your room. Involuntarily held indefinitely, forced to participate in group therapy with heroin addicts, ex-prostitutes, victims of domestic abuse; take mandatory “smoking breaks”; be “tweaked” with antidepressants and antipsychotics until you were numb to all around you. Depression and anxiety had taken so much from me; all efforts to help me were futile and superficial. I cringed at the thought of serving as a provider in the very system that had let me down.
I placed my hand on the bed, with the patient—let’s call her Amanda—turned away from me. I introduced myself. “I’m Ramin, the student doctor, it’s a pleasure to meet you.” I waited. Nothing. I tried again. “Could I get your name?” Still nothing. The nurse shook her head in resignation. I walked a few steps to face Amanda, reclined in her bed—a frail, pale middle-aged woman stabbed with multiple IV lines, gripping a bible tightly to her chest. Did she not hear me? Was she angry? Was she mute? Had I already done something wrong? As questions and insecurity seethed within me, the nurse whispered, “She’s catatonic.” With utter confusion, I excused myself to the hallway to hastily Google the word. “Catatonia: an abnormal neuropsychiatric condition that results in unresponsiveness in someone who appears awake, characterized by stupor, mutism, negativism and posturing.” According to Psychology Today, it could apparently be caused by any number of situations—severe vitamin B12 deficiency, infection, exposure to toxins, extreme trauma or schizophrenia.