Clinical Reflection Paper

Psychiatric Rotation Clinical Reflection Paper

In December, just before beginning this current clinical rotation, I had the unfortunate experience of observing my son’s friend go through his first bipolar manic episode. I was taken aback by the incident as this young man had been in my home many times over the past year without any indication he was anything but a “normal” teenager. He had always been respectful and engaging and, by all appearances, a balanced young man with well-thought plans for the future. Among other long-term goals, he told me how he aspired to go to college to earn a four-year degree.

Then one week before Christmas, a neighbor approached my car as I pulled into the driveway. He explained that a man in camouflage gear wielding a gun had been seen walking around our street earlier that morning. The police were notified and searched for the suspicious individual, but were unsuccessful locating him. I wondered if it might have been a homeless man who was known to live in the woods nearby, but to my knowledge, he did not usually wander onto our street.

Entering my home, I met my son and his friend N. When I relayed what the neighbor had reported, N replied, “Oh, that was me.” Astounded by his revelation, I asked him to elaborate. N explained that he felt compelled to leave the house with an airsoft gun (a toy gun that looks realistic, but only shoots white plastic pellets) revealing that he was following “clues in the bushes.” This disturbing answer made no sense to me and I told him I did not understand what he was describing. He then tried to elaborate on this and many other points, but I still did not comprehend the incident.

Evidently, N had let himself into our house, outfitted himself with my son’s camouflage gear, and walked around the neighborhood following some type of clues that only he could decipher. I asked if something was wrong and all he could say was that he “got it.” Whatever “it” was, I did not know. Later that same night, my son woke me to say that N had returned, but needed to be driven back home immediately.

The next day we found out that after I had dropped him off, he had smashed his family’s Christmas decorations. In desperation, his mother brought him to the Emergency Department (ED) seeking help. He had been admitted to the psychiatric floor in Inova Fairfax because he was manic. We learned later that he had apparently been awake for seven days straight without eating much of anything.

Last Thursday I worked with the Psychiatric Liaison in that same ED as two teenagers were waiting for admission with various psych needs. Now, I was watching from the other side. While this was not my son, or my son’s friend, it was someone’s son, someone’s friend. These teenagers sought help from the same hospital and the same floor where I now worked. The reality of my recent experience with N. hit home.

Mental illness may touch all of our lives, sometimes in unexpected ways. We may encounter people with substance abuse, dependence issues, or situational crises, which push them beyond their coping skills. For these individuals, it is fortunate that facilities like Inova Psychiatric Department exist, not only to meet acute mental heath needs, but also to provide Partial Hospitalization and Comprehensive Addictions Treatment Services (CATS). Sadly, it is unfortunate that there are so many individuals in need of mental healthcare and so limited available inpatient beds.

Mental illness may touch all of our lives in unexpected, unpredictable ways. Like N, any of us might find ourselves in need. My hope is that someone will always be there to provide the compassionate care and help that is the essence of nursing.