PGY3 is, in my humble opinion, the most fun year of psychiatry residency. I got to experience the full-spectrum of psychiatric care, including (but not limited to) the medical floor, the emergency room, a clinic office, a group therapy conference room, and a jail interview room. My attendings trusted me more, my junior residents counted on me, and my knowledge base in psychiatry felt more solid by the day, and these things built my conference over time. Perhaps most excitingly, I could finally start imagining what it might be like to be an attending (!!!). The two experiences that stand out the most from PGY 3 were my time on the consult liaison (CL) service and my longitudinal experience at the Freedom Trail Clinic (FTC). I started the year on the consult liaison (CL) service, which is a four-month rotation at MGH. Every day was different, and the kinds of consults that I got at a tertiary hospital were fascinating and complex–first-episode psychosis in patients with rare neuroendocrine tumors, complicated capacity evaluations in chronically psychotic patients, agitation management in intubated, severely burned patients.
The attendings on the service were fantastic to work with and really encouraged me to develop a sense of autonomy with my clinical management. One of my favorite aspects of the rotation was the informal discussions I had with my co-residents in the evenings after the day’s notes were done or when we had a lull in consults. We discussed philosophical questions about psychiatry and kvetched about the challenges of tough patient cases, among other topics that can never be disclosed. We were sacrosanct about “Flour Fridays,” our weekly observance of delicious pastries and lunch together. Sometimes on Friday evenings, we would walk down to the Esplanade by the Charles to drink craft beers at the Owl’s Nest and unwind. My time on the CL service was lifegiving, hard, engaging, and fun, and taught me that the best, most ideal practice of psychiatry happens when you can grow and learn with others.
My bookend experience of third year couldn’t have been more different from CL—the Thursday Freedom Trail clinic. Every Thursday for four months, my co-resident Tasha and I saw patients with serious mental illness (SMI) for medication management under the supervision of the truly remarkable Dr. Kristina Schnitzer (herself a graduate of the MGH/McLean residency program)! Most of the patients that I had previously treated with psychotic and bipolar disorders had been quite ill—on Blake 11, in the emergency room, on McLean’s AB2 unit. But FTC provided an opportunity to care for these folks in the community—to meet their families, gush over photos of their beloved pets, and see them thrive as partners, employees, friends, and students. The length of the rotation made it possible to see the entire treatment arc–relapse, hospitalization, and remission–within our PGY3 rotation, which helped consolidate what I knew about SMI. For someone like myself with a deep interest in community psychiatry and psychotic disorders, I felt profoundly energized and hopeful by doing this work with the most vulnerable in our community