stark reality

After “the interview” I talked to Dr. C about why he left his job as a therapist (presumably where he learned how to heal with words). He told me how emotion laden and energy consuming the work was, where every movement, every sound, action was scrutinized by both the therapist and the patient. So much so that he was exhausted and could work no more than 25hours a week actually seeing patients. And when managed care came along, he realized that the reimbursements would start to shrink and he would have to struggle to justify the time spent with patients so he left. He told me that he thinks if he were to go back to it now, he could only take patients who paid in cash and could justify charging $200 an hour which would result in about $250k a year but leave him very little energy for his art where he would rather focus his energy. Finally he told me that what I saw today, the time and opportunity for real “healing” in medicine no longer exists.

Medicine that makes you go “wow”

You know that feeling in life when you watch something so amazing, you get goose bumps? Like an artist painting an image, a musician playing a sad song. Today, I saw something truly beautiful in medicine.

During our team meeting, my attending psychiatrist, Dr. C interviewed a patient. The patient, Fred was a small but intimidating guy who looked like his job as a logger suited him perfectly with the stocky build, coarse dark skin, dull grey eyes and a rugged black beard. The interview with Fred started pretty regularly, “how have you been sleeping? are you feeling safe?” but then Dr. C asked about what stopped him from hurting himself the last time, then asked about his family, his wife and child in California . . . After a few exchanges about his son, Fred paused for a minute and looked down. He looked choked up. “You got choked up for a minute there Fred, are you thinking about your son?” He nodded. “Do you miss him?” He nodded again. “You want to be a good father to him don’t you?” Now there were tears in the corners of Fred’s eyes. “I know how hard it is not to be with your son” Dr. C said. “I want you to know how much I appreciate your willingness to talk to us. Its not easy coming into a roomful of people and being able to show your emotions. Thank you Fred” And with that, the interview was over.

And just like that, the interview was over. No more than 10 minutes had elapsed. Not a pill nor shot had been administered, nor a drop of blood taken for a test, and yet the entire room fell silent as Fred walked out of the door and back onto the unit. For Fred, the healing process had begun . . . and I was getting goosebumps . . .

Belated Athens pics!

Nice view of Athens from up here

Jane at the Parthenon – yes its still under construction

Hey, there ARE hot, unhairy women in Greece after all . . .

Temple of Poseidon overlooking cliffs and the Mediterranean- them greeks sho know how to build a temple

and where to put em too!

my artsy attempt

Best fish soup I ever had (in greece)

Satisfied customers of the fish? Well, until we tried it anyway . . .

These trains were pretty cool, cheap, fast, probably German

Emergency Medicine and Psychiatry

So unlike most of the people in medicine, I have developed insomnia. I think it really comes from the perpetual jet lag of being on call. On the other hand, you always get to do more stuff on call. As my psych resident tells me, the patient to paperwork time ratio is the highest on call (she happens to think this is advantage residencies where you take MORE not less call since you get to do more). For example, I got to see two patients last night. Both were depressed. The first, a gruff looking, burly 50yo gentleman who was crying and wringing his hands as we talked (kind of like a big ole teddy bear). He had developed depression and insomnia over the last few months and had some suicidal thoughts after losing both parents and having his son move away. I think he felt guilty because he cared for his mother who had a terminal illness and literally tried to kill her by illegally cranking up the morphine machine to double the rate. The second was a 16yo who slept with a 45yo for money and had been depressed and suicidal for several weeks. Both were pretty cool and I felt myself wanting to be the one helping them “explore their inner conflicts” especially the first guy. Somehow also hearing a story like that, of a guy who is usually not a whiner as he describes who had a very close family and is now dealing with two recent deaths and having trouble sleeping really struck an altruistic cord in me. I guess it must be my mom’s influence somehow countertransferred onto the patient.

Anyway, the other funny thing that happened while I was on call was I bumped into my resident Chatterjee who was running a trauma and really felt like I wanted to be doing it, doing the procedures, evaluating and diagnosing the patient. In short, it made me feel like I really wanted to be an ER doc. Plus the shift work and schedule sounds pretty sweet – 8hr shifts 3 X per week, 4 days off a week and once you leave the hospital THEY DON’T CALL YOU BACK.

I wonder if there is a psych ER residency out there?