Category: Observations

Categories
Consult-Liaison Education Informal-curriculum Medicine Nonfiction Observations Reflection

Teaching Moment.

The Chief of Service ushered me into the room, but said nothing. His staff of fifteen looked at the Chief with expectation and, upon realizing that he was looking at me and probably wasn’t go to say anything—including my name or the reason for my visit—the fifteen people joined him in looking at me.

“Hi,” I said, taking the cue and flashing The Winning Smile. This is my name, this is my title, and this is why I’m here: As a psychiatrist, I think there is overlap in the work that we do and in the patients that we see—

“Is it okay if we refer to your patients as ‘wackos’?” the Chief blurted out. Nervous laughter twittered among his staff.

“I’d prefer that you didn’t.” My voice was light; my face was dark.

“Oh. I guess another psychiatrist should have told me that.” He was still smiling.

“I hope I’m not the first one to do so.” When he finally saw the lasers shooting from my eyes, his smile dissolved and he looked down.

There are several reasons why I believe that social skills are not his forte:

  • He either chose not to or did not think he needed to introduce me to his staff.
  • As a Chief of Service he should have known better than to say such things in front of his entire staff.
  • This exchange occurred within five minutes of us meeting each other.

I think his question—“Is it okay if we refer to your patients as ‘wackos’?”—was his honest effort to connect his staff and me together. Everyone would have a good laugh, we’d share something in common, and we could move forward with greater ease. He thought his comment was benign.

It makes me wonder, though: Had he made a similar comment in the past to another psychiatrist? And had that psychiatrist laughed? Did a ridiculous repartee follow?

Did another psychiatrist reinforce this sort of behavior?

He’s not a “schizophrenic”. He’s a guy with a diagnosis of schizophrenia. Maybe he’s even a guy who is skilled guitar player, a father of two children, and has a degree in political science who happens to have a diagnosis of schizophrenia.

She’s not a “brittle diabetic”. She’s a woman with a diagnosis of diabetes. Maybe she has a knack for training dogs, has a remarkable talent for singing, and was on her way to law school when she was first diagnosed with diabetes.

People are people with various interests, talents, and potentials. They are not their medical conditions.

No one is a “wacko”.

The Chief of Service sent me an e-mail later:

Thank you for visiting us and also for your gentle way of reminding me of my crudeness and insensitivity. I am sure you hear enough negative attitudes towards your clients that you would welcome the opportunity to create a more positive attitude towards mental health issues.

I actually don’t hear many “negative attitudes” about my patients. Perhaps this is because every moment can be a teaching moment and, over time, people learn not to use such language (at least around me). As I noted several years ago:

Doc­tors, like most peo­ple, often assign adjec­tives to patients because it can be hard to iden­tify and then acknowl­edge emo­tions. It is much eas­ier to say, “She is such a dif­fi­cult patient! She is never happy with her care!” than to say, “I feel angry and help­less when I see her because it seems like noth­ing improves her symp­toms!” Leav­ing out the sub­jec­tive “I” gives the illu­sion of objec­tiv­ity and professionalism.

I can only hope that the Chief of Service shared his reflection about his “crudeness and insensitivity” with his staff.

Categories
Observations Reading Reflection

Recent Readings.

Things I have recently read (with commentary on only one piece):

The Stranger Beside Me

I have a longstanding interest in serial killers because I have no understanding why they murder people. My hope is that, upon finishing a book like this, I can make more sense out of something I just don’t get.

I didn’t realize that Ted Bundy had a history in Seattle. He was a work-study student at our local Crisis Clinic. He also worked with psychiatric patients in the clinic at Harborview Medical Center, the de facto county hospital. He murdered women in King County.

The author of The Stranger Beside Me had a friendship with Ted Bundy. She was writing the book as he was murdering women. While I did not gain a greater understanding why Ted Bundy killed people when I finished her book, I did appreciate her efforts in describing Ted Bundy as a person and her internal struggles as she wondered if her friend was the man responsible for many murders.

Solitude and Leadership

“What we have now are the greatest technocrats the world has ever seen, people who have been trained to be incredibly good at one specific thing, but who have no interest in anything beyond their area of exper­tise. What we don’t have are leaders.”

Rethinking Work

“But we care about more than money. We want work that is challenging and engaging, that enables us to exercise some discretion and control over what we do, and that provides us opportunities to learn and grow. We want to work with colleagues we respect and with supervisors who respect us. Most of all, we want work that is meaningful — that makes a difference to other people and thus ennobles us in at least some small way.”

Placebo Effects in Medicine

“Unfortunately, much of what is known about placebo effects has been discovered through laboratory experiments with healthy volunteers, employing deceptive techniques that are not directly pertinent to clinical practice. We need more research involving clinical interventions designed to elicit placebo effects in participants without deception and in a manner consistent with informed consent.”

Some Thoughts on the Real World by One Who Glimpsed It and Fled

“Creating a life that reflects your values and satisfies your soul is a rare achievement. In a culture that relentlessly promotes avarice and excess as the good life, a person happy doing his own work is usually considered an eccentric, if not a subversive.”

Categories
Nonfiction Observations

Border Crossing.

When we crossed back into the US yesterday, this is how the conversation went with the border officer:

Husband hands officer three US passports.

US BORDER OFFICER: So there’s three of you, huh?

HUSBAND: Yes.

OFFICER: How are the other two connected to you?

HUSBAND: That’s my wife in the back seat and this is her father.

OFFICER: Where do you live?

HUSBAND: Seattle.

OFFICER: Where did you go?

HUSBAND: To Vancouver.

OFFICER: How long were there for?

HUSBAND: Just for the day.

OFFICER: Why did you go to Vancouver?

HUSBAND: To sightsee.

OFFICER: Well, how was it?

PAUSE. HUSBAND and FATHER speak at the same time:

HUSBAND: It was fun.
FATHER: Great!

OFFICER: Are you bringing anything back with you?

HUSBAND: No.

OFFICER: Okay. (hands passports back) Have a nice day.

The car pulls away from checkpoint. MARIA exclaims: That guy was so easy on us! That was the smoothest border crossing we have ever had!

This is the conversation we had the last time we were at the border. I have not embellished it:

Husband hands border officer two passports.

US BORDER OFFICER: How are you two related?

HUSBAND: She’s my wife.

OFFICER: Where do you live?

HUSBAND: Seattle.

OFFICER: Where did you go?

HUSBAND: To Vancouver.

OFFICER: Where did you go in Vancouver?

HUSBAND: Downtown and Stanley Park.

OFFICER: How long were you in Vancouver for?

HUSBAND: Just for the day.

OFFICER: Why were you there just for the day?

HUSBAND: (pointing at MARIA) To see some of her friends.

OFFICER: Why were your friends in Vancouver?

HUSBAND: To take a cruise to Alaska.

OFFICER: Are you bringing anything back with you?

HUSBAND: No.

OFFICER (to HUSBAND): What do you do for a living?

HUSBAND: I’m a scientist.

OFFICER (to MARIA): What do you do for a living?

MARIA: I work as a doctor.

OFFICER: Where did you go to medical school?

MARIA: UC Davis.

OFFICER: Where is UC Davis?

MARIA: Near Sacramento. In California.

OFFICER: Is this your car?

HUSBAND: No, it’s a rental.

OFFICER: If you live in Seattle, why did you rent a car?

HUSBAND: We don’t own a car.

OFFICER flips through passports, scans the faces of HUSBAND and MARIA, then hands them the passports.

OFFICER: Okay. You can go.

Let’s be clear: In the grand scheme of things, this was not a terrible situation. No one asked us to get out of the car. No one searched our bags. No one got hurt.

Most of our experiences at the security checkpoint to return to the US, however, have been more like the second anecdote than the first. The officers often ask irrelevant questions (“what hotel did you stay at?” “what restaurant did you go to?”), make inquiries about the car (“where did you rent the car from?”), and never make pleasantries. In fact, as we were waiting to get to the checkpoint yesterday, we reviewed every single thing we did in Vancouver. We wanted to ensure that we knew all the answers as a group.

Why the difference yesterday? We still used a rental car, everyone in the car still appeared Asian, and we still came from Seattle.

Was it because there were three of us? (Does an algorithm suggest that trios crossing the border are less likely to cause trouble?)

Was it because we had an elder with us? (Does the US border patrol have a lower suspicion of illegal activities when a genial senior citizen is part of the trio?)

Was it because the officer we saw yesterday was in a good mood?

Does it mean anything that Canadian border officers are less intrusive and kinder to us than the US border officers when we are returning home?

Categories
Informal-curriculum Nonfiction Observations

Name-calling.

Let me start by saying that it actually doesn’t happen that often.

The yelling and screaming usually comes from men who aren’t under my care. It often happens when I’m talking with my patients or when I am just walking past a cell block.

Sometimes, it is repetitive yelling that sounds like a metronome:

WHORE! WHORE! WHORE! WHORE!

Sometimes, it is a tirade:

F-CKING SLUT, you’re a F-CKING SLUT, d-mn whore, F-CKING C-NT, YOU HEAR ME? YOU’RE A F-CKING SLUT, YOU F-CKING B-TCH, yes, YOU, you’re a F-CKING BITCH…

Other men take issue with my short hair and assert that I am a lesbian:

You’re a LESBIAN, aren’t you? What the F-CK is wrong with you, LESBO? Why don’t you like dick? F-CKING LESBIAN, you and your F-CKING SHORT HAIR…

For reasons I don’t understand, it is uncommon for men to yell racial slurs at me.[1. No one in jail has yet to call me a “chink“—at least not to my face or when I am in earshot. I did have a patient who would intersperse his sentences with musical phrases: “Ching chong ding ding ting tang…”. He didn’t do this with anyone else. He also refused to believe that I am a physician. He insisted, “There’s no way you’re a doctor. Women can’t be doctors. You’re probably just a clinical assistant. Women aren’t smart enough to be doctors.” I steered the conversation elsewhere.]

I have since learned that those men who yell synonyms for commercial sex workers at me or insist that I am a lesbian become more enraged when I ask them to stop yelling. Usually it goes something like this:

Maria: “Hi. Could you please stop yelling for ten minutes so I can talk to the guy over there? It’s hard for me to hear him.”

Inmate: [spewing more hatred at a louder volume and a greater frequency]

This response differs from other men who yell for different reasons. Often the men who scream about the crimes of the government, the arrival of the aliens, the ghosts in the machines, and the coming of the Antichrist will acknowledge my request and kindly stop yelling. Some can’t stay quiet for more than three minutes, but they try.

On occasion, the men who are my patients—and sometimes these are the same men who proclaim that they are actually machines and not humans, or they can’t string together coherent sentences—will scream past me to the men yelling malicious things: “SHUT THE F-CK UP!”

Their imperatives often go unheeded.

Hearing this vitriol doesn’t bother me too much. I mean, it bothers me enough to write a blog post about it, but such behaviors make me wonder more about the suffering of these men. Perhaps these men are screaming at me because I am on the other side of their cell doors and they feel anger with their lack of freedom. Perhaps these men don’t like the inherent power differential between them and me in a setting like the jail. In an effort to assert dominance a man may shout misogynistic things at me because he is trying to close the gap between his status and my status. Maybe women in his past have done terrible things to him.

My male colleagues have mentioned that these same inmates might insist that they are gay. Otherwise, most of the commentary these men lob against my male colleagues are death threats. This is in contrast to the threats I receive; men usually threaten to rape me. (Let’s be clear: Such threats are rare.) And it is not necessarily the men who scream hateful things at me who threaten rape.

What people say and what they do aren’t always congruent, whether in the jail or elsewhere. Consider the men in jail who have been charged or convicted many times of sexual assault. They may never shout anything at female staff. Some of these men show great courtesy; they look me in the eye; they say “please”, “thank you”, and offer gracious social smiles.

One wonders what they do not say out loud.

Some people will judge you just based on how you look. To some men, women are malignant deviants; they induce fear and loathing. Some men decide that the best course of action is to hurl hatred at women.

Sometimes, they might do even worse things.

Categories
Nonfiction Observations

Enclosed.

When the elevator doors slid open, there were twelve men inside the car. Two wore black officer uniforms; the others wore unmarked and faded tops and pants. They all looked at me in silence.

They all saw me hesitate.

“Do you want to get on?” one officer barked. It was a command phrased in the form of a question.

As I took a step forward, one officer stepped out of the elevator. The inmates, wearing not scarlet letters but, instead, red uniforms and cheerless expressions, moved towards the perimeter of the car. The second officer in the elevator took a step backwards, creating a square of space.

I took my assigned spot and the other officer stepped back onto the elevator to close the square. My eyes could only see his folded arms across his broad chest. The light breath of the other officer moved across the back of my neck. The inmates cast their glances—heavy, light, and of all shapes and sizes—at me. I heard my heart beating in my ears.

As the elevator lurched into motion, the air thickened in my chest:

  • If a fight breaks out, I can’t escape.
  • If someone touches me, I won’t know who.
  • If something happens to me right now, who will be more likely to help me…?

The elevator jiggled to a stop and the doors slid open.

“Excuse me.” My voice did not waver, though my confidence did.

Without saying a word the officer stepped out of the elevator. The inmates rearranged themselves in silence. Cool air blew past me as I walked into the elevator bay.

I exhaled.