What an interesting question! Somehow, it reminded me of one of the questions I was taught early on in residency and still ask patients on intake: what is your earliest memory? The answer always sheds some light on early relationships and their influence on the patient.
The trouble with answering your question was that I couldn’t – and still can’t – recall the “best” memory. What much more readily came to mind are some of the worst memories. Maybe they are traumatic remnants. But, more importantly, maybe they reflect my most important learning experiences.
First on the memory list was an elderly patient who committed suicide by walking into Lake Michigan not long after my evaluation in my first year of residency. Right then and there, I thought my career was over. Fortunately, though, I wasn’t sued and the Residency director was supportive and educational, as were my residency classmates. There is a saying that “You’re not a real psychiatrist until you experience your first suicide”. I guess I may have become a real psychiatrist early on. Maybe that has a little something to do with not experiencing another in the next 40 years of my career, despite treating the most severely ill and high risk in the public sector and prison.
Then how about the time when I sampled Thorazine to see how it made patients feel? Not a pleasant experience, I must tell you. There’s easier ways to learn empathy. I curtailed my self-experimentation after this. Yet, I think this experience may have turned out to be beneficial in other ways. It may be one of the reasons that I’ve always refrained from treating myself with any sort of medication, nor any family members, staff, or others that would be a conflict of interest. Such a policy is indeed one of the ethical principles of the AMA, but all too frequently ignored by physicians.
I think this episode of taking Thorazine may also be connected to the time when I became emotionally distraught with horrible nightmares. Even though personal psychotherapy was expected in this time, the necessity felt humiliating and frightening. This led to some brief psychotherapy, invaluable for empathy, reducing my countertransference risks, and enhancing my long-term mental health.
A disappointing memory was not being chosen Chief Resident. In retrospect, this was for very good reasons, as our Chief Resident turned out to be Carol Tamminga, MD, who is a major schizophrenia researcher and current Chair of the University of Texas Southwestern Department of Psychiatry. This taught me some more humility and what qualities might go into leadership.
Near the end of residency, I awaited where we would be placed the two years I owed the Army. When Fort McClennan in Anniston, Alabama was announced, my wife, a teacher, had to pull down the map to see where this was located. But what unexpected reward ensued! It demystified the South. Alone with another graduating resident at this large Army base, the trials by fire were constant, forcing us to mature rapidly. Learning the Army culture was invaluable, including the expectation for war and the necessity to follow orders. It was also my first exposure to PTSD. Being in the Army helped prepare me for working in other systems where other priorities may come before healthcare, including prisons where security comes first and for-profit managed care where cost-control comes first.
The moral of these memories? Embrace and learn from your failings and undesired opportunities!