5th week now

Dear R,

CCT has been fine. I am beginning to adjust myself to the pace, and to working alongside the case managers. I am always relieved (and surprised) to find that most people are kind people. I am also surprised to find that I can get along so easily with Anna, whose maturity reminds me of my own naivety.

I feel I am doing alright seeing patients at the clinic and joining the case reviews (though they always exhaust me physically, with different voices coming literally from different directions to me, while concentrating on grasping the main points of the discussion without knowing the patients at all). There are several types of patients in the CCT. Some clinic sessions made me feel happy, some patients made me feel stuck, some patients made me feel helpless, some patients made me feel that they are underserving of this amount of medical attention.

Perhaps it is due to my lack of experience, I find myself overthink unhealthily.  This work is triggering my obsessiveness. I can’t believe there are 4-5 versions of my clinic notes on average. I often change my mind after the patient and the case manager left the room, and I was left alone with my thoughts and my new thoughts when I was typing my impression and plans. I change my mind on some details of my assessment and plans, when I was waiting for my coffee after my clinics. And when I finally get to discuss my plans with the consultant, my previous ruminations seem unnecessary. But I also am thinking, actually there are no easy right or wrong answers especially in psychiatry. We listen to the person holding the biggest responsibility and respect their knowledge and experience.

Last week I was editing 6 MHRT reports. It irritated me to see a capacity assessment from 2023, and to see how an obvious medication change can’t be updated under the treatment plan. I dislike how the work of other people directly negatively impacts on my work. 

Most of all, I feel far away from you. I am surrounded by many people at work, I share an office with lovely A, but I also feel isolated at the same time.

I am thinking and feeling too much. This is my struggle in this new rotation. 

2

I carry with me 1.5yrs of inpatient experience (which I think most people would find hard to imagine or cope) which I value as the clinical and emotional growth stays with me. The intensity and how quickly we can do things there is what I enjoy. On further reflection, I think I could enjoy it so much the last time, was almost solely because I was working with you. I have really enjoyed my last inpatient term. I was busy but very happy. 

3
I find growing up difficult.

Moving from inpatient to CCT, is a transitionary step for me.

I am learning new things.

And I am quite amazed to find that there is a bigger world outside of the inpatient ward. And how well our patients can get.