I’m one week into my psychiatry rotation and it has exposed me to a setting I thought only truly existed in movies and on TV. Larue Carter Hospital is the state psychiatric hospital in Indianapolis, and it’s where I’m fortunate enough to spend these 4 weeks.
For anyone unfamiliar with Larue Carter Hospital (I had never heard of it before this week either), it’s an older hospital located in Indy where the severely mentally ill patients are cared for. It’s a massive place, a pretty old building, and somewhere that is unlike any other hospital in the city. The patients at Larue are the sickest of the sick when it comes to psychiatric conditions. It’s a temporary, and sometimes long term, home to many schizophrenic, major depressive disorder, bipolar, personality disorder, and substance abuse patients. A lot of our patients have violent criminal pasts. Many of them have extensive histories of hallucinations, suicidal behaviors, substance abuse, an array of psychotic episodes, history of depressions lower than any of us could imagine, and periods of mania in which they transform into completely different people. Think of any type of odd, unusual, or strange behavior you could imagine a person doing. Whatever you’ve thought of is probably pretty normal compared to what we see at Larue.
So now I’ve painted a picture of this place in your head and you probably think its absolutely awful and the worst place on earth. Thankfully, thats not true. There’s no doubt it can be depressing at times to see these patients struggle, and sure, its not the newest or fanciest of facilities, but it really is a place where these patients are sent in an effort to provide healing, or at a minimum, care for their sometimes lifelong ailment. There is no other place for these people to go. Many have been in jail or thrown out of nursing homes. Some have been abandoned by their families and left on their own. Without Larue these patients would be at loss for care. The work that the staff and physicians put in to helping treat these patients is really impressive and inspiring and makes it a invaluable part of the medical system.
All of this being said, the 1st week there has been a challenge for me, personally, and very thought provoking. A lot of my foundation for going into medicine was based on religious beliefs. I see all of us as creations of God, and like most things that are built, at times we can “break” and need to be fixed. This goes back a bit to seeing my future physician-self as an engineer for the human body, but essentially it means that I try to see God in every patient I work with. That feedback of being able to see and feel that presence in a person and truly view them as this unique creation with a soul and a “being”, whatever that might be, is a lot of what motivates me each day in this field. Sure, sometimes it’s hard to appreciate this in a person who is rude, or angry, or we might not like very much. But behind all of that you can often still see the individual and the fact that however much you might not like someone, they are still an existing person who can interact with you and help establish some human connection. However, what do you feel with the patient who won’t speak to you or anyone else, simply staring off all day? Or the patient who paces around talking to themselves and is convinced of their delusions?
I’ve asked myself this question many times this past week. I’ve sat with patients and asked them how they are, or if I can help them with anything, and they look back at me seemingly unaware of my existence. Or they respond with nonsensical phrases totally off topic. Or sometimes they even yell at me thinking i’m someone there to harm them. We all go into medicine because we want to help other people. But why? Probably because we enjoy the human interaction and relationships that can be formed. That sense of gratification from helping someone who is then able to be grateful for the help, or who can give us some sense of appreciation. With many of my patients at Larue, this interaction simply doesn’t exist. So it makes me wonder at what point, if ever, does a person stop being themselves and transform into something else entirely? At what point, if ever, does a person’s mind transform in such a way that the identity they were given at their creation ceases to exist and becomes something entirely new, as if they had been created all over again?
I don’t think I’ll ever know the answers to these questions, and I guess it really doesn’t matter. At the end of the day they are all still people who are living and breathing and have a need for care and healing. Regardless of these questions I ask myself, I still try to work with my patients every day having the hope and belief that the soul and being God created is still somewhere in them, tangled up in a web of confusion that can possibly be unraveled with time and care. But meanwhile, I can’t help but wonder everyday when I talk to them, what is really going on behind the eyes looking back at me.
