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.?

You Matter

Image

I had one of those life experiences yesterday that is not pleasant but is not altogether unpleasant at the same time. I went back to my hometown and said goodbye to a woman who used to keep me in her home when I was just a little kid.

Ms. G. A. Hayes, otherwise known as Ethel, died on Monday at age 106. She would have been 107 if she had lived to see November. I learned one thing about Ms. Hayes yesterday that I don’t think I ever knew before. She had a twin who died at around one or two years of age all those years ago. Imagine that. One twin dying so very young in the very early twentieth century, and one living well into the next century.

We told stories yesterday, tales about Ms. Hayes as well as stories about ourselves and how she had fit into our lives. We all remembered the things that stood out with her. Her love of children, her rock solid faith and church life and her commitment to helping others. Oh, yes and that one defining characteristic that everyone was reminded of as soon as they set foot in her little mill village house on First Street in Shannon, Georgia. One glance to the right at the television told you that she was the biggest Atlanta Braves baseball fan who ever lived. Dale Murphy was her man. She also doted on Tom Glavine. She never cared much for Greg Maddux. If some of the baseball players had names she could not pronounce, she made up her own.

One minister, then another, then two young men whose family she had been intimately involved with for years all told of her courage, her resilience, and her compassion for others. They laughed about her stock phrases, remembered her proffered pieces of cake, recalled the radio sitting on her lap playing at full volume, and marveled at how she kept taking care of herself and living alone for many years after other mere mortals would have been packed off to the nursing home and called it a life.

It is not lost on me that Ms. Hayes started caring for me and had her first influence on my life when she was the age I am right now. She had already lived many decades, but she was constantly reinventing herself.

I often write about changes in mood, suicidal ideation and giving up, hopelessness, drug and alcohol use and misery in these blog posts. Just like other media and other writers, it is easy sometimes to write about the sensational, the awful, the shocking and the negative. It gets attention. It hits hard and shocks people, if for just a moment.

It is much harder to write about the quiet, day-to-day heroism and influence of someone like Ms. Ethel Hayes. Someone who taught generations of young girls in the GA program in the Baptist church. Someone who would sometimes have up to eight or nine kids at a time in her little house, paying attention to them, feeding them and loving them through their young lives, shaping them to be the adults of today. It is also easy to forget the influence these kinds of people have on each one of us as we grow and mature. We may not know, consciously, how much we glean from them, but it is a tremendous amount. It has staying power. It is woven into the fabric of our young lives, and it is the bedrock of who we are.

You may get up today and wonder how you’re going to impact the world. You may wonder if anyone will hear anything you say or think any of your opinions matter. You may sometimes wonder if you ever make an impression on anybody else at all.

You matter.

Just like my friend Ethel Hayes mattered to so many of us.

Don’t wait until one hundred and six years have gone by to find out whether or not you touched someone else’s life.

Go out every day and make sure that you do.