One good thing about doing anything for three decades or longer is that you get to see cycles and repeated events, things that fail and things that work. I hope that over the last thirty years of learning about psychiatry and mental health (and yes, I am still learning and hope to acquire that one last little piece of knowledge on my deathbed) that I have paid attention to the things that matter and have become inured to the things that don’t.
I have read many books and articles, and I have listened to great lecturers and attendings pass their knowledge on to others who come after them. I’ve been the lucky recipient of some really good training and have watched some very compassionate people, trying to emulate them as I make my own way through the medical landscape that is my working world.
My best teachers, hands down?
My patients.
She was a handsome but world-weary middle-aged woman, short bright red hair and sparkly glasses distracting the onlooker, part of her not-so-conscious attempt to keep any outsider from seeing the darkness in her soul. She sat partially slumped in the chair across from me, a nondescript sweater and well-worn jeans hinting at the casual comfort that she did not feel. When she tried wanly to smile, the corners of her mouth didn’t rise as much as the rest of her face fell to meet them.
Like so many of my patients, young and old, rich and poor, educated and not, she had been horribly, unspeakably abused throughout her life. Speak about it we did, though, and I found myself in one of those office consultations that are so horrific that nothing but excellent training can help maintain composure. Some of the stories are just too painful. Too raw. Too excruciatingly real to be true. A compassionate doctor wants to forego the promise to do no harm and hunt down the perpetrators and make them pay.
She was no better today. Well, not entirely true, because she had come back to see me, after all. My potions and elixirs had helped her imperceptibly, if at all. Like many of my patients, she did not want to hurt my feelings by telling me that I had not helped her yet. Can you imagine that? A horribly scarred woman, contemplating suicide, depressed, feeling as worthless as she’d ever felt, wanting to protect her doctor’s feelings? Some things are hard to understand.
We talked.
I talked mostly, feeling impotent, trying desperately to find the rabbit in the silk hat that I could pull out and hold up triumphantly to her and say, “See! See! There is some magic left in the world!”
Alas, there was no hat, no rabbit, no magic. She was in pain, and I was in pain, for like it or not, if you love this job as much as I do, you hurt right along with your patients. Don’t let the blank slate, silent treatment, sit behind you and never show any emotion shrinks convince you otherwise. If you’re a good doctor, you don’t rest until you’ve fixed it. It’s in your DNA. Some of us just don’t ever want you to know how hard this job really is.
We did the easy parts, the side effect inventories, the dosage reviews, the checklist of symptoms. I decided on the course of action I was going to recommend to her and put it out there. Was it going to make her better? I didn’t honestly know, but I was going to do my best.
She got up. I got up. Our time was over.
I said something that I’m sure was lame at best. I would get her back to check on her soon, and I would be optimistic that this depressive episode had reached its high water mark and would now mercifully recede.
She went through the door, started up the hall.
She turned to glance back at me.
“Thank you for seeing me today. I still have hope.”
It is springtime in my town. We are recovering from the most devastating ice storm in the last decade. In spite of the destruction all around us, trees are budding joyfully, grass is greening, and flowers are dotting the landscape with vibrant color.
It is springtime.
If we can do nothing else in this season of rebirth, we can certainly dispense hope.
Greg Smith is a psychiatrist who blogs at gregsmithmd.
