Month: July 2017

Categories
Education Lessons Medicine Nonfiction Reflection Seattle

It’s Good to be Busy.

It was a busy day:

There was the guy who spoke with enthusiasm about his doctrine of RUL (“Righteous Unconditional Love”); the man who stared through me after I asked him about whether he had eaten that morning; the fellow who made no efforts to hide his nose-picking while expressing his frustration with the court system; the young man who wouldn’t let me inspect the wound on his hand, though I soon recognized that he had crafted the wound out of a packet of juice crystals; the man who hadn’t taken a shower in several months, though the odor bothered me more than it bothered him; the guy who boasted about his abilities to run a mile in two minutes; the man who refused to acknowledge my existence; the fellow who advised me that he would prefer to take his medications in the morning because that’s what his nurse practitioner told him to do; the man who apologized for masturbating, but argued that he is young and “that’s what young people do”; the fellow who said that after he used “bad heroin”, he realized that his parents aren’t actually his parents; the guy who found lithium energizing and was in the process of tapering off of methadone; and the man who simply said, “I’m not sick,” when I asked him why he hadn’t been taking medication that the state psychiatric hospital had prescribed to him. Nurses paged to ask for orders for medications to reduce the discomfort of heroin withdrawal, medications that patients had asked for three days ago, medications that patients took before they entered jail. The phone rang as callers shared information about diagnosis, treatment, and next steps.

I tipped my head back in the chair, stretched my arms up, and sighed.

“You okay?”

It was my second year of residency and I was the only psychiatrist in the hospital that night. My duties included addressing any issues that occurred in the psychiatric unit and providing care for any patients that came to the emergency department with psychiatric concerns.

My classmates had warned me about a particular emergency medicine attending physician who was working that night:

  • “Last week he told me I was useless.”
  • “He rolls his eyes at me all the time.”
  • “He’s just angry. He won’t ever thank you for anything you do.”

“Hi, Dr. Angry,” I said around 7pm. “I’m the psychiatry resident on call tonight.”

After glancing at me, Dr. Angry grunted.

Well, I guess that’s how it’s going to go tonight.

Less than three hours later, after Dr. Angry referred four patients to me, he muttered in my direction, “I’ve got another one for you.”

Shortly after midnight, a patient’s husband was pulling her out of the ED while she was screaming at me.

“I’M GOING TO GET YOU FIRED FROM HERE! YOU’RE A TERRIBLE DOCTOR! I KNOW THE PRESIDENT OF THE HOSPITAL! YOU CAN’T DO THIS TO ME!”

I was shaking, but I wasn’t going to admit her to the hospital. Dr. Angry caught my eye and nodded once. I wasn’t the only person who knew I was shaking.

It was close to 3am and I had already seen seven patients.

Dr. Angry had a slight smile on his face as he approached me while I was slogging through my notes.

“Dr. Yang, there’s another one for you to see.”

please make it stop

“Thank you. Who is it?”

As I was beginning my note around 6am for the ninth patient I saw, Dr. Angry stopped by.

“Dr. Yang, you did all right. Thank you.”

“You’re welcome, Dr. Angry.”

I tipped my head back forward in the chair in the jail and dropped my arms.

“Yeah, I’m fine,” I replied to my colleague. “It’s busy, but it’s good to be busy. And when I think about my intern year, this isn’t bad at all.”

Categories
Nonfiction Observations Seattle

White Glove Treatment.

In addition to five-star accommodations and world-class spa appointments in Portland and Seattle, each [Lamborghini] owner and their guests will be treated to private meals along the Pacific Coastline and the Puget Sound. Expect white glove treatment at every encounter, and curated excursions exclusive to Giro and the region. – GIRO 2017 PNW

The first Lamborghini I saw pulling out of the driveway of the parking garage in downtown Seattle was either yellow or orange. Its engine rumbled for all to hear even though it was in low gear. I stopped walking when I reached the driveway, waiting for the sleek and shiny car to pull into the street.

A few moments passed and another Lamborghini pulled out of the parking garage into the driveway. This one, another bright color, didn’t even stop before it turned left into the street.

The pedestrian waiting on the other side of the driveway was dressed for work: Short-sleeved summer blouse, pencil skirt, dark flats, and bangles on her left wrist. She shifted her weight to her right hip and looked into the garage.

A third Lamborghini zoomed out of the parking garage and swerved left into the street. There were now three or four pedestrians on the other side of the driveway waiting to cross the entrance of the parking garage.

In the street were two women, probably no older than 25, who were wearing white polo shirts and denim shorts. With some anxiety they looked down the street, watching for oncoming traffic. They waved their hands at the garage, beckoning more cars to come forth. They ignored the pedestrians on the sidewalk.

The fourth Lamborghini had a mirrored surface. The morning sunlight gleamed off of its sides. The driver was an older man who was losing his hair. In the passenger seat was an older woman with bright yellow hair and sunglasses that covered half of her russet face. This mirrored car coasted out of the driveway without pausing.

“Oh, come on,” I muttered. The Woman Dressed for Work on the other side of the driveway rolled her eyes and heaved a sigh that was seen, not heard.

More Lamborghinis poured out of the parking garage, parting the Red Sea of pedestrians. The traffic light farther up the street was still red, though, so the parade of Lamborghinis was slowing to a halt in a single queue.

Yet another Lamborghini was approaching the exit of the parking garage. Empowered by annoyance and self-righteousness, I walked forward. Would the Lamborghini let me, a mere pedestrian, have the right of way?

The pedestrians on the other side of the driveway followed suit. The fancy car lurched to a halt as we foot commuters walked in front of it. We all heard the loud, idling engines of more Lamborghinis in the garage waiting for us to pass. Even though some pedestrians slowed their gait, everyone looked straight ahead.

Good manners go a long way. Status alone doesn’t earn white glove treatment and respect.

Categories
Education Lessons Medicine Reflection

Talking About Suicide.

I was recently asked to speak at a community event about youth suicide. Several young people in the area had killed themselves in the past few months to years. This was an opportunity for the community to learn and talk about suicide and suicide prevention.

My role was to provide a professional perspective on and information about suicide in young people. There was also a panel of people between the ages of 16 and 19 who shared their perspectives about suicide. The youth panel was the most compelling aspect of the evening.

The audience was comprised entirely of adults. Most were probably parents; others were adults who often interact with young people, such as school administrators and police. The youth panel encouraged the audience to talk to the young people in their lives about death, dying, and suicide. The panel also spoke about the importance of showing that they, as adults, care about young people. They shared their experiences in how talking about suicide with their peers has given others hope and saved lives.

One girl shared an anecdote that involved a teacher who inspected the wrists and arms of students prior to a test. He wanted to ensure that students didn’t have accoutrements on their arms that could contribute to cheating. This girl said that she felt anxious about rolling up her sleeves because of the scars on her wrists and arms from cutting. What would her teacher say or do?

When he inspected her arms, he undoubtedly saw the scars. His response? “Okay, good. Nothing on you that will lead to cheating.” And that was it. He never spoke to her about what he saw; he never asked her how she was doing or what the injuries were on her arms.

What did she take away from that? “He cared more about whether I was cheating than about me staying alive.”

The fresh candor of young people inspired some adults to comment on their own perspectives of suicide. One man, hands stuffed into the pockets of his jeans and voice deep and gruff, shared, “I’m a veteran. I also come from a generation of men who just don’t talk about suicide, even though a lot of veterans come home from war and commit suicide.”

The contrast was striking: The young people sat on the stage, the lights on their faces, and spoke about death and suicide without fear or self-consciousness. The adults sat in the shade of the auditorium and shifted with unease, gasped with sadness, or shook their heads when they heard the youth talk about their peers dying.

I do not believe that there was anything anomalous about this group of young people. Youth want to talk with adults about death, dying, and suicide. They want relationships with parents and other parental figures where they can ask questions, share their worries, and learn how to navigate the difficulties in life so that they can live another day. They also are sensitive to the burdens that adults already experience; sometimes they don’t share their thoughts, worries, dreams, and fears with us because they don’t want to cause us more distress. Because they automatically assume that any conversation about death and dying will cause distress in adults.

I created a short handout with suggestions about how to talk about suicide with young people (hint: these suggestions work with adults and older people, too). It also has phone numbers to call, online chats to access, and websites to view for more information about suicide prevention.

There is no evidence to support the fear that talking about suicide—particularly in a thoughtful, caring way—will increase the likelihood that people will kill themselves. In fact, talking about suicide directly can help people change their minds about taking their lives.

Here’s the requisite link to the National Suicide Prevention Lifeline, which is an excellent and literally lifesaving resource. However, I encourage all of us to talk with each other, within our own communities—even if it is “only” the community within our homes—about death, dying, and suicide. We don’t have to talk about it all the time; we don’t have to ask each other, “Are you thinking about killing yourself?” every day. The more comfort we have with talking about how we are doing, what we’re thinking about, and what death means to us, the more we can support each other when the difficulties, problems, and failures in life occur.