Precious Human Life

During my emergency room rotation a few weeks ago one of my supervisors in the emergency room commented: "As a PA-Student, you have to be either really smart, or really entertaining."

I waited.

"You," she said, "you, are entertaining."

We both laughed. I'm pretty sure I'm a bit of both but if I had to choose between being entertaining and being really smart, I'm not sure which I'd choose...

That was weeks ago. Since then I feel my world has spun, stopped, spun. Roughly two weeks ago I walked into the rotation that I craved since all of this PA school madness began. The rotation in the speciality that I felt I was bound to belong too, grow old in, become a master of. 

When I moved out here I heard stories of what it's like to work at the University of Washington's  Harborview Medical Center, or "HarborZOO". I have to say that most of what I've heard is probably true. Harborview Medical Center is a bit of a chaotic madhouse, which is also why it's such an iconic institution in the Pacific Northwest. And also such a fun and world-renowned place to work. The first Washington "county" hospital founded in 1877, it is also the only Level 1 trauma center in a several state region including Idaho, Montana, Wyoming, Alaska and Washington. Level 1 means the big stuff - what you see on TV. At first, I was surprised to find out that quite frequently patients are put on a med jet in Alaska and flown to Seattle if their injuries or the complexities of those injuries is critical or bad enough. From Alaska! 

Harborview Medical Center, on the shores of Puget Sound, Seattle. 

Right now, at Harborview, I'm in a dream state, working in a dream rotation, in my dream specialty: Inpatient psychiatry. There are a few immediate things I absolutely love about inpatient psychiatry. First, and foremost, are the patients. Many of the patients are, quite simply, astounding. With unique insight, sometimes with no insight, with extremely bizarre and curious delusions, with beliefs that, in moments, seem disarmingly believable. Some have extremely horrific stories of abuse. Some we can't quite figure out. For still others, it is hard to know what to believe.

The creative energy of some of my patients is equally curious. As witnessed last week when an impromptu poetry slam ensued after I happened to mention a quote by a favorite poet of mine, Mary Oliver. After the words uttered from my mouth..."tell me, what is it you plan to do with your one wild and precious life"....(from Oliver's, The Summer Day), I had three of the most diversely imaginable patients conglomerate around me in one of the patient's rooms wanting to recite poetry of their own! And hear some of mine! A complete hour passed--we took turns, we oohed and ahhed, encouraged one another. A gentleman patient I barely knew--whom I had never heard utter an intelligible thing--wandered by whispering words from Walt Whitman's "Leaves of Grass." Where am I, I thought for one brief moment. Who are these people? 

Second, I absolutely love the time. I am still reeling from my 20+ patients a day during some of my other rotations. Where I had ten minutes to sort out the most significant problem in a person who may have many problems. I have to choose what to treat, when I often want to treat everything. My ER rotation was excellent for many reasons, one of which was that it taught me I can't fix everything. Not in one visit. So I would patch someone up, give them a pat on the back and send them off into the world knowing that quite a few of them would be right back because the crux of their problem wasn't necessarily medical. For many, it was more emotional, and often when any of us are feeling emotional or off-kilter we seek out others, for listening, perhaps kindness, perhaps simply attention. A ten minute window in which to offer a struggling soul attention is almost never enough. 

In inpatient psychiatry, I have hours with patients if I want. Hours. Hours to accompany them outside for a 20 minute window of "fresh air", hours to get to know them, who they are, what they like, and what happened--what went wrong, how did they get here. Having that kind of time with patients is practically unheard of in medicine. But, similar to neurology (another favorite speciality), more than 90% of the diagnosis of mental illness comes from one source: a detailed history. And to get a good history, one needs to listen. 

Last Friday night--the summer solstice, on the cusp of 2013's super MOON--I had my first experience in Harborview's Emergency Room, a vast maze littered with medical personnel, patients and stretchers. I was working in the "PES", or psychiatric emergency service area of the ED that night. I could tell some of the psychiatric patients apart from the others being triaged and waiting for a bed. The  psychiatric patients often looked a bit more disheveled, some restrained to their stretchers. Several looked just like you or me, but something had gone wrong in their life, maybe just in their day, and whatever that something was they came to us because they didn't feel they had the emotional or psychological wherewithal to withstand the feeling alone. 

Oh, and that brings me to the last thing I absolutely love about inpatient psychiatry. After a few days, or weeks, or sometime even months of staying on the inpatient wards, a person begins to heal, and a new being emerges. Sometimes a drastically different being. Sometimes not. But I have seen the miraculous  emergence of a few "healed" patients in my short time thus far. They wake up one day, like lazy butterflies, shaking off the hard earned remnants of sleep, before bursting up into the light of a second chance at their own life. 

Here is to hoping that they keep gaining strength, find someone to listen--and believe--and never have to come back.