That's what drew me to psychiatry as well. I feel as though I'm calm person on the outside, and can handle myself in stressful situations (patients screaming , agitated, etc). But on the inside, I become tachy. I wanted to know any skills / suggestions to cope with something like this. With exposure, will I get used to something like this? That is literally my biggest fear with going into psych. And, I'm also terribly afraid I will bring it home with me and displace it to my friends and family.
A few thoughts on this:
1. One of the other residents in my program never runs, walks briskly, or takes the stairs to a behavioral code. He does this to keep his heart rate as low as possible before entering the room with a hostile patient. He reasons that since he will not be putting hands on the patient (other staff does that), he does not need to arrive there first and he wants to be as calm as possible when he gets there.
2. Regardless of where you work, there will be a core group of hostile patients who frequently visit the ED and inpatient unit. Over time, you will learn who is potentially violent and who is just a yeller. This takes away a bit of the scary uncertainty that can go along with hostility. Spoiler alert: the vast majority are just yellers.
3. Even with some of the most hostile patients you can develop some level of rapport once they have seen you enough and you have demonstrated reliability and predictability:
You: John, dude, look! You know how I work. I want to help you out, but I can't have you throwing stuff at people.
Patient: Well, she came in here and started giving me a bunch of attitude like she's better than me!
You: I hear you, John. I got it. But we've been through this before together and you know this makes it hard for us to work with you.
Patient: I know. Sorry doc, she just really got to me...
You: Okay, talk to me. What's going on? What happened?
It doesn't work every time, but these verbal de-escalations become possible when you and a patient get to know each other well.
4. At our program we always have two residents on at night. When we get to a lull, we'll often vent to each other over particularly difficult patient interactions.
5. Your heart going tacky is your body's way of trying to help. There's no shame in that. I may be dating myself here, but it reminds me of Clippy, who was an animated feature for Microsoft Office back in the 1990s (you can Google it if you're unfamiliar). Everybody hated Clippy. He would always pop up and try to be helpful, but he was usually just a total nuisance. Your sympathetic nervous system can be a little bit like Clippy.
Hey, it looks like you're running from a wild animal. I can help by automatically making you sweaty, anxious, and tachycardic! A certain amount of this is unavoidable. I'm a six-foot-tall man, but even when a five-foot-tall woman starts to scream at me my heart will pound and I'll feel the nervousness in my throat. I just remind myself that I'm not being chased by a wild animal (
I am not trying to write a letter, Clippy! Go away!).
Welcome to psychiatry, by the way. We're thrilled to have you!
