The phone calls physicians make in the middle of the night

I don’t miss making the phone calls in the middle of the night.

“Hi, this is Dr. Yang calling from the psychiatric emergency service. May I speak to Mr. or Mrs. Doe?”

“Yeah, this is Mr. Doe,” he’d reply, his voice thick and slow with sleep.

“I’m sorry to call so late. Your son is here at the hospital.” Take a breath and slow down for the next part. “He’s alive and doing OK at this moment” — I quickly learned that it is important to say these words at the start of the call — “but I hope to get some information from you about him.”

I have marveled at the grace people have extended to me during these conversations. Sometimes family members have grown accustomed to these 2 a.m. calls and their voices sound not only physically sleepy, but also psychologically exhausted. Sometimes family members have never received this phone call, but their voices remain calm with only the occasional quiver while they talk.

These days, it’s “Dr. Yang calling from the jail.” Though I’m not making these phone calls in the middle of the night, it is questionable that these are better phone calls.

It is a blessing when family members are still involved, when there’s someone I can call. The person in question is usually a male in his 20s. He often has reached desirable milestones: Maybe he just graduated from high school or is in college. His primary health issue is the mental health condition — often bipolar disorder or schizophrenia — and he’s otherwise healthy. He is often able to tell me about a family member who loves him, even if what he tells me doesn’t make a lot of sense in the moment.

For so many others under my care, there’s no one to call:

“They died.”
“I don’t want anything to do with them.”
“I don’t know where they are.”

Sometimes the person in question is much older. In some ways, these phone calls are more tragic:

“I’m in my 70s now and I’m the process of moving my wife into a memory care facility …”
“My husband has already died and I worry who will take care of my son when I go. He still needs a lot of help.”
“Thank you for calling, Doctor, but it doesn’t seem like anything will change. I’ve been doing this for almost thirty years now.”

I marvel at the grace people have extended to me during these conversations, too. For some of these family members, they’ve had dozens of these conversations with many other doctors, nurses, counselors, and social workers. They know what questions I will ask; their answers are succinct because others have interrupted them in the past; they have lists of information already prepared to send.

Almost without fail, after I thank these family members for their help and then comment on the difficulty of the situation, they cry. Sometimes the sobs that escape their throats surprise them.

“I’m sorry,” they mumble. I can hear them wipe the tears from their faces with haste.

I’m sorry that we can’t do better for your son. I’m sorry that the science hasn’t advanced enough that we can prevent this from ever happening to your son ever again. I’m sorry that your son is in jail when he should be in a hospital. I’m sorry that your hopes and dreams for your son haven’t come true. I’m sorry that few people know the depth of the worry you have for your son. I’m sorry that these systems fail you and your son. I’m sorry that your love for your son isn’t enough to save him from these systems.