2nd mid term

谢谢你的温柔
谢谢你的小心翼翼 
谢谢你认真读了我的rambling，还记得内容的次序。

谢谢你安静地看穿 和包容。

在你面前，我不需要用力和假装。

我知道有些东西不属于我
但是幸福的感觉却太深刻。

22 Oct

10月才刚到，又突然要结束了。这个term每天感觉有点sluggish但却过得很快。11月，然后就12月。12月R要离开了。1月我正在准备自己离开，我有一个礼拜的night shift，然后2.5 week的假期。下个礼拜是我自己要来的twilight week。twilight其实是压力的，当然。但我居然这么想逃离。也或许，这只是我的histrionic act。当我平静下来，想想过去的3个月，其实觉得我不知不觉又学了很多。学习adjust medication，学习自己看病人，学习work with case managers。

10月要结束了。我每天都在担心我的MCQ exam。我的obsessiveness是我必须要study something才能do the questions。我不喜欢do questions blindly的感觉。上个周末H without me asking和我share了他的precious/secret folders。我手上突然有了all the resources，我其实只要克服自己的time and stress management。

Walking away

Dear R,

A asked how twilight shifts can make me feel happy if CCT can't. I was looking at the term preference list and A concluded that I will never feel satisfied.  Our previous intern Y once said I am a dramatic person as many little things can upset me. When I feel unhappy there must be even the subtlest reason. I talked to the case managers yesterday to put words to my experience. I can now after some information gathering say that I do not enjoy working with our consultant. I do not like to disagree with him, but his comments or decisions always remind me of a long-forgotten feeling of astonishment. I do not like to often have different or strong opinion, as I can be arrogant or prejudiced myself. I can't agree with managing an acutely deteriorating patient in the community/his decision to not switch paliperidone to alternative depot for a 30yo lady with persistent >1k prolactin and amenorrhea/re-titrating clozapine in the community for a patient who can't be honest about his clozapine use, and do weekly review for one particular patient for weeks because this is not even a HITH. I can't face conflict gracefully. I guess I also have not understood what recovery practice is after many weeks in CCT. I feel frustration when seeing patients who can't be happy and can't move on. I have just recently told myself that I can't be an avoidant person, but I still choose to walk away.  

after 2 months.

Dear R,

I don’t have any major difficulty or issue in CCT. 

I like how my phone has stopped ringing all the time, how I can attend lectures in peace, how I can finally have lunch breaks without interruption.

Seeing patients at the clinic is alright. Certain types of patients make it enjoyable.

 

I still often feel confused, with the medications that never seem right.
Patients can be stable mentally but have side effects.
They can be stable mentally, but don’t wish to continue with the medications, with or without good reasons.
They can have residual symptoms despite our best effort, and we call it their baseline.
We often go back and forth with medications, with the doses or the route.
Why can’t our patients be happy? Why can’t they accept that they need to be on certain medications, just like aspirin or statin for metabolic disease.

Sometimes we can’t do enough. Some patients are stuck, with psychosis and alcoholism or other substance use that they can’t stop.

Things can go wrong when every small step seems right. They can relapse when they have done nothing wrong, when they take no substances and take their medication religiously.

 

Every day I think and feel too much. I am working with many people but I’m on my own at the same time. Some people and the MHRT reports they barely drafted annoy me. I’m often interrupted by mostly non-urgent things. Case reviews physically exhaust me. There are many voices, relevant or irrelevant to the topic. There are never ending script requests.

When I feel unhappy, I have an impulsive thought to pick up a week of night shifts to escape from people and the tedious chaos, to be on my own and to experience acute psychiatry again. But I can’t be immature and avoidant all the time. I know we can always learn something new wherever we are, or from whomever we work with. I have just realised that the world of psychiatry is big. I can’t be confined to my comfort zone. My relentless self-criticism which has just creeped in again is also what erodes me at the same time.