Geriatric psychiatry from a geriatrician's viewpoint

Abstract

I can vividly remember my first exposure to psychiatry as a medical student in the USA. By drawing the short straw, I won the privilege of night call on my first day on the service. It was February and by early evening it was black and cold outside. To avoid the night, I took a seldom travelled tunnel between the hospital and the state mental facility. Alone, and frequently passing broken-down equipment from a bygone era, I felt as if I were entering another world. I took an elevator to the sixth floor. The elevator was operated by a middle-aged pale woman who wore a calf length skirt that blew around in the wind generated by the elevator's ascent. She said nothing. To this day I remain unconvinced that she was not an apparition. My patient was a severely cognitively impaired woman who was said to have neurosyphilis. My task was to replace her nasogastric feeding tube, which she had pulled out despite wrist restraints. Her nose was bleeding and she was spitting blood between attempts to bite anyone who came near her. It was a sad and dehumanising interaction for both of us. When the psychiatry resident came to help, at my request, she displayed only callousness and incompetence. The night nurse was certain to tell me this after the house officer had left. This event, among others during my training more than a decade ago, froze the worst stereotypes of psychiatry into my mind. Subsequent positive experiences in out-patient psychiatry were too weak to thaw the negative perceptions.