Categories
Nonfiction Observations

Boundaries.

A bus approached the curb and I looked up from my book. It took me a few seconds to realize that he was talking to me.

“Dr. Chang? No, Dr. Wang. It’s Dr. Wang, right?” he called. He slowed the pace of his walk. In one hand he clutched a plastic bag filled with loose papers. A backpack bounced against his shoulders. Though it was a crisp autumn day, he wore only a tee shirt one size too large for his frame and had tied the arms of a jacket around his waist. The hems of his jeans were frayed.

“Hi,” I greeted, trying to recall his name. I hadn’t seen him in nearly six months. He stopped and extended his hand to shake mine. His skin was softer than I had anticipated.

“Dr. Wang, I don’t like how they’re treating me at The Clinic,” he began. “They don’t know what they’re doing and I’m done with them. I think they’re working with the FBI, Dr. Wang, but I can’t do anything about that. I don’t feel safe in my apartment and they know this. They’re bugging my apartment. I don’t know what the FBI is looking for, but would you want to live somewhere that is bugged? I don’t. I’m done with The Clinic, Dr. Wang, I really am. What do you think I should do?”

He stood still, waiting for an answer.

Pedestrians filed past. Buses roared along the street. An occasional yellow-orange leaf fluttered to the ground. A dozen people looked down the avenue, looking for their bus to whisk them away.

I opened my mouth, still uncertain of what to say—

“I’m sorry,” he interjected. “You’re not here to provide psychological help right now.”

Before I could reply, he began to turn his body away from me.

“I’m sorry, Dr. Wang.”

He began to walk away as the bus I wanted approached the curb. Before stepping towards my bus, I looked back at him.

“Have a good day, Dr. Wang!” he called, waving at me. I waved back.

As I boarded the bus he looked back as he continued to walk forward. Over the heads of the people between us he shouted: “Thank you, Dr. Wang! THANK YOU!”

Categories
Observations Reflection

12 Hours.

He sat in the chair and swung his legs out every few minutes, though he never stood up. He had not stood up for over 12 hours.

His calloused fingers picked at the hems of his jeans. He dug a thumbnail near the outseam and tried to scratch out a loose thread. Unsuccessful, his fingers travelled farther down his pant leg.

His left hand tugged on his earlobe. The size of his pupils fluctuated as his eyes darted around the room.

“Do you want anything to drink?”

“In a minute.”

When presented with a sealed water bottle, he laughed. It was a fearful laugh, quivering and choking.

“Someone could’ve poked a hole in that water bottle,” he said, waving it away. “No, I don’t want any of that.”

Then came a can of soda.

“It’s metal. There might be something wrong with the metal.”

His head swiveled on his neck, his eyes searching the ceiling.

“Can you tell them that I want to surrender?” he blurted.

“Who?”

“The police. Tell them that I will surrender. I don’t want them to fire a taser at me or shoot me with their guns.”

“There are no police here. No one will shoot you.”

“Uh huh. Right.” His eyes glimmered with tears as he sucked in a breath.

“I’m really scared, I’m so stressed out,” he said, rubbing his face. His legs twitched as he kicked them back under himself.

When we made any move to leave, he’d beg us to stay. When we offered him anything, he’d implore us to leave him alone.

What happened over the past 12 hours? Was his paranoia there all along, but he had enough “cognitive reserve” to mask his symptoms when we first met? Was it the lack of sleep? the lack of food and drink? Or was it something someone said? the way someone looked at him?

What happened that broke his mind? How was he fine one day—anxious, but smiling, talking, eating, resting—and not the next? How did reality walk away from him while he remained rooted in the chair?

Categories
Consult-Liaison Education Informal-curriculum Lessons Medicine Observations

Informal Curriculum: Lesson 1.

It’s been over a year, but I haven’t forgotten about the Informal Curriculum.

The first recommendation in the informal curriculum in medicine, which I still believe is “paramount, the most difficult to define, and often challenging to implement”[1. It is no coincidence that a topic that is “paramount, … difficult to define, and … challenging to implement”, is also difficult to write about.] is to be a person.

What does this mean?

Be the best professional person you can be. Be a person who actively listens to patients, who shows empathy and emotions. Be courteous. Show humanity. Be a person.

Non-psychiatrist physicians seem to have an easier time with “being a person” than psychiatrists. Psychiatrists, as a population, can be weird. We can demonstrate exceptional skills at not being people. Sometimes we come across as intrusive, awkward, and odd.

I get it. I’ve had peculiar interactions with psychiatrists who knew I work as a psychiatrist. That might explain why the conversations were even more uncomfortable than expected. (Those are stories for another day.)

Do note that this recommendation exhorts you to be a professional person. This doesn’t mean that you tell your patients about your relationship or health problems, how crappy of a day you’re having, or why your political views are correct. That stuff makes you a person, too, but that doesn’t make you a professional person.

If patients are telling you things that worry them, be a person and acknowledge their worry. If they tell you something funny and it’s not inappropriate to laugh[2. Being a person does not mean that you toss clinical judgment and boundaries away. There are times when you shouldn’t smile and laugh, even if you want to. That topic is beyond the scope of this post.], smile and laugh. Talk with them like they’re people, not diseases or case studies.

Be a person.

Patients often want to share a connection with their physicians. Patients suffer and worry. They want to know that you care about their suffering or worry. That’s what actual people[3. Yes, there are anecdotes that people will share their woes with and find comfort in a computer program.] do: They care about the suffering and worry of others.

Be a person.

Why is this paramount? Why is this my first recommendation in the informal curriculum?

Because relentless forces exist in medical training and work that can transform you into a non-person.

You use words that most people don’t use. Most people don’t talk about MELD scores, Glasgow Coma Scales, or HIV classification systems. You see a lot of emotional and physical anguish. You see people who are ill. Sometimes they cry. Sometimes they scream. Sometimes you see parts of them that they will never see. Sometimes you see them die.

These are the things that can make you turn into a non-person.

So make an effort every day to be a person. If you’re not, none of the other suggestions in the informal curriculum will matter.