Psych

We see a lot of psychiatric problems in our emergency department. Most commonly, patients come in accompanied by police for suicidal ideation or an attempt. Occasionally, we have floridly psychotic patients brought in by family members. The last rotation where I saw psychiatric patients was during my third year of medical school. But the plan is actually fairly straightforward: we send off a pretty comprehensive laboratory panel to make sure there's no medical etiology or ingestion that explains the presentation. Then we call psychiatry. But I've found that it's really fascinating talking to these patients. One gentleman with known schizophrenia has an ongoing conversation with himself (or rather, the entity that possesses him). He speaks in one long, convoluted sentence:

I'm possessed. No, you're just delusional. Yes, my delusion is you, you don't exist. Your delusion is that you're in control. I am in control, I'm speaking these words, aren't I? But you're also speaking these words, are you making yourself speak these words? No, I am, watch this, lalalalalala. Stop it! I hate you. You love me! You can't live without me. You and I are the same--. No, we're completely different, get away from me. You're obsessed with me, you don't really want to get rid of me, you think you do, you think you want this doctor to help you, but. I do! Help me, doctor. I'm going to kill you, doctor, and then kill everyone else in this building. I didn't mean that, he spoke through me, he's possessing me.

And so the conversation continues. It's quite scary for an openly psychotic person to point at you and say they want to kill you, but luckily, security always accompanies these patients. This is a reminder of the burden and severity of mental illness, and through seeing these patients and talking to my psychiatry colleagues, I learn a little more about these conditions and how to treat them.