A Day in the Life

“I’m going to cut off my head to stop the voices.
I have visions of shooting myself.
I have no income.
I’m tired of living the way I’m living.
I lost my job.
I’ve been using drugs for twenty years.
I pay for it by hustling, Doc.
Social Services took my kids last week.
I dropped out in the third grade.
Sometimes I take my kid’s Adderall.
I can’t take this any more.
My mother is in prison.
I shot myself in the face with a shotgun.
Do I look like I can afford an attorney?
On a scale of 0 to 10? How about minus five?
I will kill him. I WILL kill him. Do you understand me?
I flip out.
Maybe it’s the medicine.
Maybe I need more medicine.
I don’t need any medicine.
F—k you and your medicine.
I’m adopted. I don’t have any family history.
I don’t have any family.
You can’t help me, Doc.
Nobody can help me.”

The above short piece, entitled “A Day in the Life”, was first published several years ago after I had had a particularly hard day in the world of mental health. The comments you see there were things said to me by patients over a single twenty four hour period. One single day of stories about depression, betrayal, longing, sadness, grief, homicidal ideas, hopelessness, and resignation. Not long after the piece went up, I received a comment on Facebook from a friend.

“How do you do it?” he asked simply.

I saw a patient recently who was hurting and anxious and worried about her medical status, her mind, her ability to think and take care of herself and what would happen to her as she got older and more infirm. Her wandering narrative was punctuated by repeated questions.

“I bet I’m really bringing you down, aren’t I Doc?”

“Have you ever heard anything so sad, so awful, so terrible as my story?”

“I know you don’t care about any of this, but how do you listen to it?

“How do you do it?” she asked, echoing my friend from years ago.

I thought about that question a lot, in the context of all the misery and sadness and destructive behavior I had seen during that twenty-four hour period years ago, and in the more recent telling of my new patient’s story. I thought about what the minimum requirements for doing my job are, the ways that one can exceed those, and the ways that we must pace and protect ourselves so that we can do this job for a lifetime and help as many people as we are privileged to come in contact with.  It didn’t take me long to come up with the answer.

I had excellent mentors and excellent training.

Pharmacology professors like Richard Borison, who, notwithstanding his horrible judgment in matters financial that lead to his eventual imprisonment, had already forgotten more psychopharmacology thirty five years ago than I will ever learn in a lifetime. He had a way of making the difficult understandable, the complicated simple  and the insurmountable achievable.

Anatomy professors like Gene Colborn, who could find a muscle or a piece of cartilage or a tiny nerve in the human body by touch alone, who sat me down one day when I was struggling and overwhelmed in the early days of my first year of medical training. “ He looked right at me with clear, piercing eyes. “We don’t expect you to learn everything. Nobody can learn everything. The amount of information that we throw at you in the first year of medical school is just too much to handle. We expect you to learn how to manage everything. You can do this.” I often think about how he helped me believe in myself in a very dark time, and I use that feeling when listening and giving feedback to my own patients who might be in that same spot I was in all those years ago, not able to believe in themselves and their potential without someone helping them along.

Consultation-liaison psychiatrist Douglas Hobson who taught me about the esoteric, the strange, the interface between internal medicine and psychiatry and who introduced us to the Man Who Mistook His Wife For a Hat.

Stuart Finch, who ingrained in me the rule that a good child psychiatrist cannot and should not treat a child with severe emotional problems unless the family is all in and part of the treatment plan.

Larger than life people like my chairman Mansell Pattison, who loved life, lit up a room, ran a successful department of psychiatry out of his head, and died much too young in a tragic car accident. 

All of these and many more taught me the building blocks of my profession, drilled me on what was important,  taught by example, gave useful feedback, chastised when necessary and praised when deserved. They sent me out into the world of medicine in general and psychiatry in particular a well-trained clinician who was not afraid of hard work and who embraced lifelong learning. 

They also taught me to care. That is how I do it, even when it is so hard that I am tempted to give up. Because after all, if I didn’t care about my patients and their stories, I couldn’t do this every day.

Simple as that.

Who are your mentors? Who taught you about what is important? What lessons do you draw on every day when things get rough in your life?

Even more importantly, who is looking to you to be their mentor, their teacher, the one who pushes them to be their best, to go beyond their comfort zone.?