Category: Nonfiction

Categories
Nonfiction NYC

East vs. West: So Serious!

When I was a medical student in California, many of my classmates expressed relief that we weren’t in a medical school on the East Coast.

“Everyone is so serious over there,” they said.

The stories we heard about medicine back East!

  • “The medical students have to give all of their patient presentations from memory during rounds!”
  • “You have to wear a coat and jacket all the time! It doesn’t matter if you are on call! You change into scrubs after 9:00pm and then, before rounds in the morning, you clean up and put your suit back on! The attendings never see medical students or residents in scrubs!”
  • “If attendings ask you a question you can’t answer, they throw you out of (rounds, the operating room, the cafeteria)! They scream things like, ‘DON’T COME BACK UNTIL YOU KNOW THE ANSWER!!!’”
  • “They have to keep their white coats buttoned all the time! ALL THE TIME!”

These stories must have trickled down from the interns and residents who attended medical schools on the East Coast. Funny, though: I did not hear these tales directly from them.

During my surgery rotation, one of my residents attended a medical school in New York City. This surgery resident had olive skin, dark brown hair, and manicured fingernails. He smiled only once during the month-long rotation.

“Medical students don’t have any respect for the attendings here,” he once complained to the chief resident. The chief was a young man who was almost bald, had grey-purple bags under his eyes, and always carried a travel mug full of coffee.

“Back where I went to medical school,” the resident continued, “everyone called the attending surgeon ‘sir’. We all stood up when an attending walked into the room. If the attending asked us a question, we always finished our sentences with ‘sir’. You only spoke when you were spoken to. And our white coats were always buttoned.”

My classmates and I shot knowing glances at each other.

We then shoved our presentation notes for rounds into the pockets of our short white coats that were hanging open over our green scrubs.

During my time in New York City, I rotated through three different hospitals as a fellow. I visited many wards as the roving consult psychiatrist: I noticed the internists rounding in the hallway, saw the obstetricians rushing to labor and delivery, observed the surgeons dashing down the stairs, peeked at the radiologists staring at films on computer screens, spotted the pediatricians cooing at toddlers, and glanced at the internists still rounding two hours later.

From my observations at these three hospitals in New York City, I can say the following with confidence:

  • The medical students do not give presentations from memory. They read from their notes. Their voices are infused with anxiety and self-doubt. They are just as nervous as medical students out West.
  • I never saw any medical student, intern, or resident wearing a suit. If they were post-call, they were wandering around in their wrinkled scrubs and sneakers. If they were not on call, many men did not wear neckties! The occasional attending would wear a suit to work, but that was an uncommon sight.
  • Though I saw many floundering medical students, I never witnessed an attending throw a student out of rounds or the cafeteria. (I can’t comment about the operating room.)
  • Many physicians, regardless of their position in the hierarchy, did not button their white coats.

Nonetheless, I do believe medical training and medicine is more formal on the East Coast. More to follow.

Categories
Education Nonfiction

Termination (I).

In mental health, termination is the word used to describe the process of ending psychotherapy. Note the word “process”: Termination should not be an anvil falling from the sky. Under ideal circumstances, patient and therapist address termination during their initial meeting.

Think of termination as an exit interview for psychotherapy that spans several appointments. Patient and therapist review what the patient learned about herself, her accomplishments and goals (did she reach them? did they change during the course of therapy? if so, why? etc.), her reactions to and opinions about treatment, and how she might use the experiences in therapy to help her in the future.

In this way, termination facilitates closure, that “often comforting or satisfying sense of finality”.

Termination can be a Big Deal because, for many people, the end of meaningful relationships is difficult. People can experience emotions that are not only distressing, but also compel them to behave in ways that are neither helpful nor effective. Think about a relationship you had that you believe ended poorly: The girlfriend or boyfriend who dumped you. The unexpected death of a parent or sibling whom you both loved and disliked. The dear friend who drifted away, purposely or not.

Sometimes, even for those uncomplicated relationships that end “well”, we feel conflicting emotions about them. Loss is difficult for most, if not all, people. It’s hard to say good-bye.

Thus, ideally, termination is neither abrupt nor unexpected. Both patient and therapist may recognize that the patient has achieved the goals of therapy (determined at the outset of treatment and adjusted accordingly, right?). In this instance, termination makes sense. Nevertheless, patient and therapist may still feel powerful emotions while going through this exit interview.

In reality, termination can be both abrupt and unexpected. Patients move; therapists move; the Stuff of life interferes with and prematurely ends the therapeutic relationship. If the patient feels connected to the therapist, the patient may then activate old habits of dealing with loss and strong emotions. These habits may have been the very things that brought the patient into treatment. Many therapists therefore believe that termination is the most important aspect of psychotherapy.

In the next few posts, I will write more about the reactions people—patients and therapists—may have during termination.

Categories
Nonfiction

Leaving New York.

My first visit to New York City happened when I was eleven years old. My memories from that trip are hazy, though I clearly remember the taxi ride from the airport to midtown Manhattan. The sun had already set. All the windows of the taxi were rolled down. The warm evening air, honking from car horns, and twinkling city lights flooded the interior of the cab.

I was squashed between my parents in the back seat. They said nothing. The taxi swerved around cars, stopped suddenly, and blew through red traffic lights. Sitting stiffly, heads jutted forward, and hands balled into fists, they were terrified that they were going to die.

I looked out the window. Sleek buildings loomed above us. People swarmed the sidewalks. Carts selling fragrant foods were parked on street corners. Rows of shop signs illuminated the night.

I was thrilled. I decided that, one day, I would live in New York.

Three years ago, I was blessed with the opportunity to do just that.

My time here is coming to an end. I was recruited for a job in Seattle. Though I state with pride that I am a “West Coast person”, I have mixed feelings about leaving New York.

For the next few months, more posts than usual will focus on New York City. Recording these stories will help me remember my time here. I don’t want to forget.