Upon returning from winter break, I started up rotations again with psychiatry. Psych is unlike every other block in so many ways: there’s no physical exam, you spend tons of time with patients, and we have basically no idea why any major treatment works. Really.

I need to qualify the rest of this post, as usual when I say untoward things about people or fields where I’m working: patients here are clearly sick and need intense treatment, and there is nothing funny about people who are seriously mentally ill.

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Okay, I take that last part back. If you can see past the disturbing and horrible decimation that mental illness does to a person, what you see in the psych hospital is the definition of low-hanging fruit for humor.

On my first day – the very first day – the other med student on the team was assigned a patient who had multiple psychiatric problems, including many different kinds of delusions. When we met him, he had tucked his paper pants into his paper socks and was wearing bicycle gloves, because he “knew about the Ebola” and didn’t want to catch it during his stay.

While we were interviewing him (and learning about how there was a big FBI investigation into his past as a secret hacker), another patient finished a phone call, nonchalantly unhooked the phone cord from the wall, and walked into his room with the cord tucked into his pants.

I almost lost it.

As we exited the locked ward that morning, I noticed a sign on the door that read,

TODAY
HIGH ELOPEMENT RISK
USE CAUTION

Elopement!? Is that what they call it nowadays? There is no risk of “elopement” in the insane asylum. There is a very real risk of escape!

Allow me to clarify. This is elopement:

And this is what these patients try to do:

Escaping. That looks like escaping to me. I suppose it just isn’t polite to use the word.

The scariest part is for the most part, these patients are wearing street clothes. The only thing really separating them from us is our badge. Never have I been more aware to wear my badge in an extremely visible place, lest I end up in a real-life version of One Flew Over The Cuckoo’s Nest.

My face already makes me look like I’m on antipsychotic medication.

Elopement/prison break risk aside, psychiatry is actually kind of fun. Later in the week, we admitted a bipolar patient who came in manic, thinking he was possessed by God. You know when you are cracking jokes and you think of something witty to say about ten seconds too late? The brain of a manic person is running at warp speed, and they nail every single pun, witty remark, and joke with impeccable timing. It’s a real effort not to laugh.

Our deity-possessed patient had attempted to make his way to California – some would say he, uh, eloped from his mother’s house – with $20 and a backpack containing only bite-sized Snickers bars, a baseball, and a copy of Rainbow Fish. Seriously, Rainbow Fish. He spent most of the intake interview talking about how the Holy Spirit had grown his heart to tremendous size, and how he could heal people by touching them. He had given his car away to a total stranger because she “looked like she needed it.” Interspersed in the interview, he would drop in nonsensical Bible verses:

“Why do you think your mother brought you here?”

“God is the pot and we are the clay. He presses us down into dirt and we rise up luminous and filled.”

Yep. I don’t think that’s a line in Rainbow Fish, but it has been awhile since I’ve read it.

When it came time to do a physical exam, the intern I was with said, “Do you mind if I listen to your heart?” Without missing a beat and with a deadpan seriousness, he replied, “Are you ready to have your mind blown?” Because of, you know, his huge heart. “Literally, listening to my heart will blow your mind. Be careful,” he said, obviously concerned for my intern’s sanity.

I lost it. I had to leave the room.

With my badge.

A few days later, I developed the facial paralysis I talked about yesterday. Let me tell you – having a messed-up face while interviewing psychotic, paranoid patients does not go well. That morning our Ebola-avoiding patient went around the room, pointing at everyone on the treatment team, saying “I like you… I like you, and I like you…” but when he got to me he stopped and announced to the ward that I had an “ulterior motive.”

I tried to smile. Mistake.

Suddenly, I no longer simply had an ulterior motive – I was an FBI agent sent to investigate him for dealing crack cocaine. Motive exposed. He threw his hands under his hat and ran away down the hallway, yelling about false prosecution and Seroquel. Everyone looked at me.

“What? Oh, my face. Yeah.”

Just your typical Monday in the insane asylum.