To me, the transition from PGY2 to PGY3 feels like the transition from childhood to adolescence. There’s parental supervision (i.e. attending support) but also an emphasis on your growing independence. Furthermore, you're expected to teach a thing or two to your younger siblings (e.g. PGY1s and PGY2s). This takes the form of being in charge of a full outpatient clinic (carrying 20-40 outpatients), the consults rotation and supervising junior residents on overnight calls.
In a word, you realize you actually have some expertise. I didn't believe it until one day, when on my PGY3 consults rotation, I was paged to care for a medical inpatient with agitation. On your consults rotation at MGH, patients admitted with medical problems who have psychiatric needs are followed by the consult service. You, as the psychiatry resident assist the primary team in managing the patient’s psychiatric issues, including psychiatric emergencies. And this was certainly an emergency, with security, staff in a flurry around a patient who was inconsolably yelling. And yet, against all the odds, I was in my element, no doubt because of overnights on PGY2 with agitated patients: I knew how to organize staff, which medications to offer, what to say to the patient. The patient calmed, and I was actually high-fived on the way out by staff: “that was amazing!”
PGY3 is full of little moments like this, which remind you that you’ve learned a lot in your three years of residency! At the same time, it also puts into focus the vast world of psychiatry yet to be explored. One thing I’m actively exploring on the consult rotation is how the same patient can be seen from different levels of explanation, from the neuroanatomic to the biochemical to the psychodynamic. It’s great!
Psychiatry is an incredible field. Within psychiatry, I have a particular connection to patients with schizophrenia and psychotic disorders. Psychosis is both intellectually fascinating and personally affecting, and there are so many unanswered questions to explore. Is schizophrenia one or many diseases? How do antipsychotics work, and how can we improve upon them? Can schizophrenia be prevented? Why does it tend to affect the most disenfranchised in society? All these questions I find compelling, and have the opportunity to investigate them during residency with faculty members from MGH, McLean, Harvard Medical School and other institutions as a member of the Research Concentration Program.
I am Canadian! Which means a couple things. I have to, by creed, end all of my essays in an apology. Sorry about that. Also, I am not allowed to make a left turn before the light turns yellow. And I always have a pair of snow pants at the ready -- just in case. But even though I'm Canadian at heart, I love the city of Boston! It has the offerings of a larger city but without all of the big city frustrations (terrible driving is an exception however -- that is a very prominent part of Boston culture). One of my absolute favorite things to do is to assemble a bunch of my fellow psych residents and eat ice cream at Toscanini's. They have something called affogato, which is ice cream bathed in espresso, which not only tastes amazing, but keeps you awake all night so that you can eat more ice cream!