Hello again! I hope everyone's summer is off to a good start and that this massive heat wave that seems to be hitting much of the country doesn't last too much longer! Since the last time I wrote, I have completed 5 of the 6 weeks of the psychiatry clerkship at the Veterans Affairs hospital, which has been quite the change of gears from ob/gyn at the main hospital.

I started with two weeks of a program called HIOT, or High Intensity Outpatient Program (I'm not sure I've figured out the acronym yet!), which is a sort of intermediate between inpatient and outpatient therapy--the patients don't sleep at the hospital, but they come in every day for several hours of individual and group therapy. Many of the patients in this program have substance abuse problems, and a good percentage also have post traumatic stress disorder, or PTSD, which I have come to realize is all too common in individuals who have seen combat. My favorite part of these two weeks was having the opportunity to observe some of the different support groups that are offered to the veterans, such as anger management, mindfulness, and AA-type meetings. It was eye-opening to see the way in which group members share incredibly personal stories, advice, and encouragement with their fellow members, and I came to appreciate the role that this form of therapy plays in the recovery process.

Another highlight of this rotation was my week of child psych at the U, which was an amazing, though emotionally-trying week. As difficult as it is to see adults suffer from depression or psychosis, I found it even more challenging to see pre-teens and teenagers who are afflicted by these debilitation illnesses at such a young age. However, that is not to say that there is not a lot to be optimistic about on the child psych unit. The doctors, social workers, and teachers trained in this field are wonderful with these children, and they have found an impressive balance between a structured hospital setting and an environment where the patients can just be kids.  In my five short days on the unit, I got to see a few of the patients clearly making progress toward this transition of just being a kid again, and I can't think of a more satisfying medical outcome than that.

I next moved onto a week of consult psychiatry, and then this past week completed half of my inpatient psych block. As I approach the end of psychiatry, I realize that I had a somewhat skewed perception of  this clerkship prior to its starting. Among many med students, psychiatry is known as one of the "easy" clerkships, and I am now not sure that I entirely agree with this description. I certainly won't deny that the hours are nice, and not having to work weekends—especially during these summer months—has been amazing. However, some of the patient encounters I've had in these five short weeks have been frustrating, upsetting, and even downright chilling.  The elderly patient with severe dementia and depression who wanted nothing more than to go home made my heart break for his loss of memory and—worse—independence. And sitting across from the ghost white faces of two parents as they described finding their son after his failed suicide attempt was unlike anything I've ever experienced.  I've found myself thinking about some of these encounters well after I've gone home for the day, and I wonder if any other clerkship will have quite this effect on me.

Outside of the hospital, I've been finding plenty of time to enjoy the summer and sunshine, which has been a nice surprise. I have also been making sure to stock up on sleep these past couple of weeks, as I start internal medicine next Monday and anticipate having a little less free time on my hands!