Hot chocolate vs the avalanche

My internship has been getting underway, each day building on the one before. I like the hospital setting with all the people, possibilities and bustling. 25,000 people work at Duke hospital, to give you a sense of its size. If I try multi tasking while walking I quickly find myself exploring new units, wings and floors, as I try to wander my way back to where I was going.

I hesitate to say much for reasons of confidentiality about my internship. If you were locked on a psych ward ( or your loved one was) what would you feel comfortable having the social work intern posting about it on the world wide web?

I'll try to paint a generalized picture of what we do. I think i can best describe mental health struggles as an avalanche. Some people have the resources, skills and people to see the warning signs and avoid getting caught in an avalanche, others get caught in small snow banks, but have family, Drs and tools to get out, or be quickly retrieved when crisis overtakes them .

I spend my 30 hours a week, listening to many people discuss, share observations and solutions of 18 patients who have been catapulted, swept out of the control and safety and buried in an avalanche ( in some cases for years) of the most terrifying, debilitating crisis of life.

If they have made it to us, the adult acute care psychiatric locked ward, they have tried to kill themselves and failed, or are acting in bizarre enough ways that their family, friends or law enforcement fear they are a danger to themselves or others. This sounds intense and dramatic, and in one sense it is that extreme. But by the time they reach us they are sedated, or soon will be, so mostly the patients spend their time eating, watching TV, attending activities- taebo, crafts, life skills groups ect... and sleeping while on the ward.

I see us as trying to find them admist the snow of jumbled, tightly packed, sometimes vast field of symptoms and variables. We poke, questions, analyze and try to create an air hole so they know which way is up. The goal of their stay is for the treatment team to find a medication that can give them enough of their mind and function back to make them capable of being in society and making sure they have someone on the outside who can continue to assist them once they leave.

We stabilize, not heal. We do not delve into thier past, do therapy, or discuss the pros and cons of thier choices and its outcomes. Someone else comes in and does DBT ( a form of therapy directed at changing behavior). Duke is known for its advances in ECT treatments ( electric shock therapy) so they are sometimes sent for this. If we do our Job, we offer an airhole, a way to know which way is up, a glimpse of hope when it seemed the crushing weight of the mental illness that coccooned you into this state, is all life will ever be.

As my supervisor puts it, if we didnt do this who would?. It sounds like a disservice, when someone is suffering so much that all we do is offer meds, but in reality, this is a solution they can afford and maintain.

I have very little contact with the actual patients at this point. I go in and listen to the Dr's and med students when they interview them daily, I help contact resources in the community that can be helpful for them when they leave. Some stay for a day, others for a month, rarely more than 3 weeks. Average is about a week and a 1/2.

It would be easy to be depressed seeing such hopeless, hurting people and knowing my role, or what I can do it so minimal given the size of their struggle, but When we are dealing with these basic of life issues, the need for love and the way to provide it seems pretty clear. I see my role as kinda like the one who hands out hot chocolate to the rescue team on the avalanche rescue, it doesn't do much directly for the one we are searching for, but every small things can make a difference. What I have to offer them is a smile, support to the nurses- the ones digging in the snow day in and out, while the Dr's observe and direct, make suggestions and with the client's offer eye contact, respect as people even in their crazyness.

If I wanted the glory and control, I would have become a psychiatrist, ( ive defenintly been contemplating if Ive made the right choice in this mileu) but I know i make some pretty good hot chocolate, and its not what I do, but how and why I do it, that can make all the difference in the world.