My second rotation was Psychiatric-ER at QHC. Going into this rotation I knew I had to be more cautious and careful when seeing patients because the patients I was going to be dealing with during this rotation had a psychiatric history and were potentially dangerous. On my first day my preceptor told me to not bring my stethoscope with me and definitely to not place it around my neck as it could be used as a weapon by one of the patients. Most of the patients I encountered during this rotation were brought by EMS/NYPD and most of the time we were the first medical providers to come into contact with them. During this rotation I was lucky enough to interview multiple patients and witness different psychiatric disorders and how they presented in both adults and pediatric patients.

Every morning the staff at CPEP would have a meeting at 8:30 am and briefly discuss each patient. The attending and PAs would let the staff know which of the patients were potentially dangerous and violent and which ones were safe to conduct an interview with. Students were not allowed to conduct interviews by themselves and were instructed to always go in pairs when interviewing and inspecting a patient.

One memorable experience during my rotation at PSYCH-QHC was when I witnessed a patient with catatonia. This was a 20-year-old male patient who, according to his friends was smoking marijuana. However, when patient was brought in he was acting very bizarre and a few minutes later he stopped responding to verbal commands, was able to maintain a rigid and bizarre posture and was also showing waxy flexibility by maintain positions after being placed in them by someone else. What made this case even more interesting is that the next day the patient was totally fine. He was able to fully recover and stated that he was actually smoking K2 and not marijuana.

One challenge that I experienced during my psych rotation, especially during the first week was interviewing patients. We had some patients that would not make eye contact with you and some that would refuse to talk at all. We also had patients who would curse you out and scream in your face, however these were situations that I’m glad I got to experience because it taught me to remain calm and maintain my composure. A big part of interviewing a psych patient is collateral information. I’ve had many cases where I would interview a patient and think the patient is totally fine and most likely should be discharged. However, once I called a family member or a friend for collateral information, the whole narrative would change and the story that I gathered from friends and family would drastically change from the story I got from the patient. I believe my interviewing skills and confidence while interviewing these patients improved drastically and it’s a skill that I can apply in my future rotations.

Another element that I liked during this rotation was on-site learning. During this rotation I was exposed to a lot of different psychiatric drugs and when they were indicated. Every staff member in the CPEP unit was willing to help out students and teach whenever they had an opportunity. Whenever the providers initiated a medication for a patient they would always ask our opinion on the dosage and indication for that drug. One of the most memorable drug combinations we got to learn during this rotation was the “5 and 2”. Whenever a patient became agitated and violent toward staff or another patient, the provider would call out “5 and 2” meaning 5mg Haldol and 2mg of Ativan. This combination was administered IM and it was great because it would sedate the patients and calm them down in seconds. Overall, this was a great rotation and I’m looking forward for my next one. Going forward, I hope I get exposed to more clinical procedures and conduct more interviews by myself.

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