A Humbling Experience and Lesson for Life
What an emotional day indeed! I am currently nearing the end of my psychiatry rotation and have been enjoying many of my patient encounters. Today I had a patient catch me off guard and leaving me with some strange feelings. This patient is no different to me than the other patients I have been treating with Bipolar Disorder with Psychotic Features. Actually, he was very similar to the four other patients exhibiting similar symptoms staying in the ward that week. He was always calm, cooperative, and a generally happy fellow.
Over the last seven days, I listened as he explained the many things he has experienced in life. I touched his shoulder when he broke down crying about his wife who passed away 20 years ago. I continued to offer my condolences when he told me about the son he recently lost. I laughed as he told me stories about his "silly" granddaughter. I showed concern when he told me he could not see her anymore because he is not allowed to by his family due of his history of alcohol abuse.
The patient has been clean from substances for a five years since he was hospitalized due to liver complications that have since resolved. Unfortunately, he still did not think he will able to mend the relationship with his other children even if he has been sober for so long.
I also answered his questions. He had some misconceptions about his treatment and his diagnosis and I helped to answer them in a manner consistent with his low-level of education. I wonder how many people knew that he stopped going to school when he was 12 because he needed to help his father work? When he told me that story, I just thought that it was interesting how generations are different in the focus on education. In hindsight, I think what I say next might explain why I was even thinking about his education while I am writing this piece.
I sat down with this patient as I usually do after shaking his hand and greeting him for the morning while commenting on how empty the patient dayroom is at 6:30 AM. Keep in mind, this is a locked ward and the dayroom is the only place outside of the patient room where patients can eat breakfast, participate in group therapy, or sit idly during the periods between meals and therapy. I asked how he slept, and he replied that he has been consistently sleeping well and he feels better. The patient tells me the intermittent crying throughout the day has ceased and he feels ready to leave. I tell the patient that I had observed the changes he has made over the week, and that I too suspected he might be ready to leave. He told me of his plan to stay with his brother, and how he already called his son to start the process of making amends. I am so happy for him because of how lonely he appeared when I first met him and heard his story. Then he starts, "I want to thank you doc." and I continue to listen to him as I think to myself, "It's nothing" and "I'm just doing my job." He thanks me for explaining his medications to him and for listening to his concerns and stories. He thanks me for making him "feel like a person". The line that stopped my thoughts and grounded me in the present moment followed as "You're the first doctor in my life to ever make me feel special" and he continued to quantify that with examples of how I listened to him or provided him with good education about his condition.
I was blown away. I didn't feel as though I deserved the level of praise he provided. I did not feel as though I went out of my way for him. I provided him with what I thought was a basic level of care that any mental health patient should receive. I provided him no more or no less compassion than anyone else. His thanks left me with all these thoughts regarding what was it that I provided that no one else in his many years of life, as he was quickly approaching 70, that no one else seemed to provide him.
I left the hospital that day with these thoughts on my mind and tears eventually found their way onto my face. I didn't feel that I deserved the praise at all. I rationalized that maybe it's because, as a student, I have more time to spend with patients and I choose too. I also consistently told him what I thought was going on with him or how I thought his progression was going because of the time I had to share with him. I also thought maybe it's the eyes as there has to be some reason people tend to open up to me easily. Whatever it is, I thought to myself while sad about his perspective, is that whatever quality that made him feel special is being shown by doctors everywhere and not the minority. I sincerely thought I was basic in treating him because I am new without much experience, and relied more on human connection to help guide treatment.
Maybe the quality is in the ability to be genuine with patients that have mental health issues. This thought comes from another patient. I had a patient come to the hospital because basically they needed a night away from their partner due to some domestic problems and extreme fear of a pending divorce. This patient had nothing wrong with them in terms of mental illness, and counseling is what this patient (and the patient's partner) really need. Anyway, my preceptor asked this patient about their stay at the hospital and the care they received from the medical student. Did I mention he asked the patient this with me there? Obviously I started blushing at the question itself but the patient also answered "He needs an A plus". Of course the attending joked that the patient was already being released and did not need to say that to be discharged. We all laughed in unison and the patient then described how they felt "the medical student Sham, the social worker Autumn, and nurse Tanya" where the only three people the patient encountered in the hospital "that were genuine and didn't talk to you as though you were crazy." The preceptor thanked the patient for the feedback, and acknowledged that sometimes mental health patients unfortunately get treated as less of a person. It helped me see what the patient described more easily now since it had been pointed out. The patient was correct that some of the other healthcare workers tended to talk down to patients or treated them disrespectfully.
Sometimes we meet people that we do not particularly like after the first meeting, although we do not always understand why. For me, I have always had a natural tendency to dislike people who "come off as fake" when we talk. This is something I have known about myself but could not understand why until now. The reason people who come off disingenuous is off-putting for myself might be because being genuine is the basis for truly connecting and understanding other individuals. By not being genuine, we are preventing the ability share and relate to others in a meaningful way. Now this is all speculation, but try being genuine to a stranger you think hears voices or sees things and you might find out that you're more similar than different. Extend this thought to being genuine with people different than yourself for other reasons (like religion, race, orientation, etc.) and you might see that we are all human and trying to navigate the paths of our own lives in the best way possible. We might find more peace in our waking lives if we focus on building connections through the diversity instead of the differences readily seen and the guard we raise when we think someone is different.
