Immersion Phase Update: Child Psychiatry Consult Sub-Intership (3/30/15 – 4/24/15)

Last month, I returned to the psych hospital for my sub-internship (sub-I).  I worked on the child and adolescent consult service and really enjoyed it–miss it, in fact.   Primary teams at the children’s hospital contact the psych consult team to assess patients for various reasons–recommendations for psychotropic medications, evaluation for management in an inpatient psychiatric setting, provision of outpatient psychiatric resources, etc.  We saw child and adolescent patients who had been admitted for suicide attempts, increased aggression, psychosis, catatonia, and more.

I feel like I learned so much from every moment of the rotation.  During my first few days, I marveled at how much I had forgotten about psychiatry and half-joked that I needed to spend my nights and weekends reading DSM-5 or studying pharmacology (something I never thought I’d be interested in doing).  I attended adult morning report and lunchtime case conferences as I had during the psychiatry core clerkship.  My attending often offered quick facts about diagnosis and treatment of various conditions while discussing patients with the team.  I was even able to give a brief, informal presentation to the team on a chosen topic (synthetic marijuana).

The team also let me take on quite a bit of responsibility during my 4 weeks with them, as if I were already a resident.  Sometimes I interviewed the patient while another team member talked to the family for collateral, or vice versa.  Other times, I saw both the patient and the family separately and presented the case to the resident, fellow, or attending afterward.  I wrote several initial consultation, follow up, and brief notes daily.  Although initial meetings with patients or family members proved awkward on occasion–due to multiple interruptions by other care providers, patients being difficult to rouse or “guarded” with respect to their personal information, or nurses confusing me for a visitor because I opted not to wear my white coat–most people eventually became very comfortable with my presence.

I still remember being slightly nervous about how I’d fare on the first day of my sub-I, but those feelings subsided fairly quickly.  The familiarity of the overall environment definitely helped.  I felt like I’d gotten to know a number of the psych residents during my rotation in June/July 2014.  When I returned last month, many of them were genuinely excited to see me–especially after I told them I was strongly considering psych as a career–and continually offered to help me with anything I needed, including the residency application.

Life outside the psych hospital was busy as well.  Due to an unexpected change in the deadlines for the research course, I ended up having to miss the annual national SNMA conference in New Orleans, which took place during the first week of the sub-I (4/1-4/5), although I did play a pretty big role in making sure others from Vanderbilt were able to represent our school and our region well.  I spent the first week writing an abstract, creating a miniature version of a research poster, and giving a “presentation” via iPad to meet course requirements.  In addition, I finished my part of the work on the information needs taxonomy project that I’d participated in during the research rotation.  I had to spend a considerable chunk of the first two weekends in April meeting with the other medical students to meet this goal–including a few hours on my birthday–but reaching the end of the list of 3000 portal messages was extremely satisfying.

I also celebrated my 24th birthday on 4/12!  My parents came up to Nashville for a few hours the day before to accompany me on a Walmart trip and grab fried fish sandwiches at one of our favorite dives.  On the actual day, I went to church (that Sunday saw the congregation all meeting together for a single service at a new time), was treated to lunch by some church friends, and went to the Chapman College end of the year party in Brentwood.  If that wasn’t enough of a celebration, a few nights later my Little treated me to dinner at Sinema, a pretty fancy restaurant in town, and gave me very thoughtful gifts.

There were still other fun events, believe it or not.  The a cappella group gave an informal concert at a senior living facility in town; we were encouraged by people ages 60-100+ who had gathered to listen to us and thanked by delicious cookies from the staff.  Also, after missing the opportunity for 2 straight years, I FINALLY got to join some members of the worship team to sing on the steps of the church for the Country Music Marathon runners and walkers (we’re around mile 8); seeing marathon participants mouth the words of the songs, record video of us, or stop and dance were some of the most rewarding moments for me.  All told, it was a month of hard work but also a month of balance and self-care.


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