I worried about working in psychiatry but one patient taught me how to listen

In medicine, psychiatry isn’t seen as glamorous. As a student and while training, you fight with your colleagues for the sexy jobs in cardiology, intensive care or on the frontline. When the crash call goes off, it’s dramatic; chest compressions, ventilation, trying to be the hero you see depicted on television. A job in psychiatry wasn’t my first choice, if there was a crisis, what would I do? Come running with my pen and notebook? Not exactly Oscar-winning stuff.

I had my reservations as I was about to embark on 91 days as a doctor in an adult inpatient psychiatric unit.

My first patient was a middle-aged woman with chronic depression and schizophrenia. Sandra* greeted me with a look of suspicion. Abused as a child, she had lived on the streets for most of her adult life, during which time she’d been through harrowing experiences. My first task was to take bloods from her. With every attempt over the next four months, I was met with the resistance of a combat warrior.

In my interactions with patients I wondered whether I was talking a different language. I had never been rejected by so many patients so much – the common answer to most of my questions being met with a firm “No!”.

After weeks of failing at any kind of meaningful interaction with patients, I decided to change tack. I stopped being the doctor in the white coat and softened my somewhat rigid attitude. Rather than judging their resistance towards me I decided to dig beneath their exterior. Connecting with my patients on an even playing field was going to be my biggest asset – but more importantly it was going to change my understanding. With Sandra, meanwhile, I had to earn her trust. Slowly, over the weeks, I learned more about what made her the person she was and the experiences that had shaped her life. She was letting me into her world, and with time she would give me her arm to take those bloods.

At first I was perhaps too naïve. I soon began to realise that if a patient was suffering from a manic episode and running around the ward naked, it wasn’t funny, but undignified. Psychotic symptoms were no longer just a list I had memorised for my medical finals exams, but instead a detachment from reality which gave patients the powers to feel like a God – indestructible. They would jump out of a window because they believed they were a superhero. I was fighting to keep them alive and protect them from the dangers of the outside world – imaginary wings will not make you fly. They will bring you crashing down to earth, hard and fast.

I started to see beyond patients’ bizarre delusions, wild disinhibition and somewhat entertaining personalities. Instead what I saw in front of me were people whose lives were consumed by the cruel fate of mental health problems. I was seeing how such a distressing illness could leave them as an empty shadow of their former self. Disabled by these crippling illnesses, their vulnerability and risk put their lives in my hands more than ever.

One day on the ward, my bleep (or, technically, in this setting, a personal protection alarm) began sounding like a siren to draw my attention to an urgent incident. Sandra lay slumped with blood pouring out from her wrists. Self harm and suicide is talked about almost too readily in the news. Seeing it in front of you is a whole different ball game.

A lone junior medic in a psychiatric hospital, I was the most senior (year two out of medical school) and experienced medical doctor. I longed for a team to come running to my aid – as is the norm in a hospital when those alarms sound. With little equipment and assistance we were able to stabilise her and wait for the bleeding to stop. Although Sandra’s wounds in time would heal, her psychological scars remained etched even deeper.

People like Sandra have taught me a lot about myself. I’m walking out with invaluable experience.

In its own right, psychiatry is a complex integration of theories and experience. No physical test will give you an explanation for the patient in front of you. Maybe that’s why the rest of the medical profession remains baffled – as a cohort we like to work with numbers and hard evidence. Instead, with mental health you must talk, listen and observe – skills that take years to acquire.

*Not her real name and some details have been changed

• In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here
  

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