WHY PSYCHIATRISTS ARE PHYSICIANS FIRST
Mat was big, blonde, and a bully. She was also a Buddhist who didn’t eat meat or drink beer. She called herself Mat, short for Matilda, using a gender-neutral name long before it became fashionable.
Mat was the proverbial “Big Nurse” who bulldozed residents, attendings, and even ward chiefs. Her concern for patients distinguished her from the diabolical Nurse Ratched—although some med students compared her to Nurse Diesel from Mel Brooks’s spoof, High Anxiety (1977).
Had Mat told me that she secretly called herself “Brunhild” rather than “Mat,” and dressed like a Valkyrie in private, and imagined herself leaving her day job and auditioning for an operatic role in the Ring Cycle, I would have believed her. But, to us, she was Mat, the head nurse. It is she who is the star of this story, more than I, and more than the unfortunate patient, the piccolo player, whose preliminary diagnosis surfaced through our combined efforts.
Nick, as I shall call him, was a youngish male who was sent “upstairs” from the emergency department (ED). The ED doc called, and said, “it’s probably just drugs. You know how they are . . . I couldn’t send him home in his condition, so I sent him upstairs to psych. At least he’ll be safe there, till everything wears off.” Nick had started sobbing uncontrollably in an all-male dance hall near the hospital. “He should have been happy,” said the ER doc, who parroted the words of Nick’s friend, who said that Nick was thrilled by his Lincoln Center audition and would soon graduate from a conservatory upstate.
We assumed that Nick had been medically cleared in the ED. But there’s a reason why we should never assume, and there is no need to repeat that reason here. The timing was also telling. It was the early eighties, before medicine knew much about the plague brewing in the West Village and in San Francisco. All we knew was that Nick was too inconsolable to relate a coherent story.
Unable to speak without sobbing, he pulled out his wallet, and showed his school ID. He was indeed about to become a professional piccolo player. He was not someone who set up shop on the subways, or street corners, waiting for tourists to drop tips into his hat. Hoping to learn more about him, I asked to speak with someone from home. He nodded “yes,” so I asked him to call his brother on the phone.
Dr Packer is Assistant Clinical Professor of Psychiatry and Behavioral Sciences at Icahn School of Medicine at Mt Sinai, New York, NY.