The tender moments that call for true empathy are often failed by the demands of the traditional physician-patient relationship.
PORTRAIT OF A PSYCHIATRIST
–Series Chair, H. Steven Moffic, MD
Dr Isom is a recent graduate of the Yale School of Medicine, Department of Psychiatry, New Haven, CT.
After ending my appointments with the kind, elderly patients on my outpatient geriatric rotation, I often rushed to the crowded resident workstation to sit down in the weathered chairs that faced the wall computers. This frantic pace never mirrored the slow stroll of history gathering as I met with patients alongside the geriatric psychiatry fellows. It had been a wonderful rotation thus far, full of stories detailing the joys of old age juxtaposed with the grief, loss, and loneliness of some of our most vulnerable visitors. One afternoon, before I had a chance to settle into the only available seat and log into the computer, I received a text message that read, “I’m in the hospital.” It was from a patient in the VA medical emergency room who was requesting that I come down to see her.
I closed my eyes and reread the words in my head before letting out a deep groan and taking a moment to stare at the screen while debating my next steps. This patient had come in for suicidal ideation and informed me that she had ingested extra quetiapine in order to “go to sleep.” I felt a twinge of frustration as I suspected that my own words earlier that day had led to the impulsive decision. I resolved to face the music as I had already lost my focus from the medical documentation.
Knowing that I would enter the elevator as a physician in training and exit as a family member of a woman with schizophrenia and PTSD was a fact that I struggled to reconcile. With little choice in the matter, I bundled up my things and snuck away from the outpatient floor to visit my mother and her emergency department clinical team.
This shedding and assuming of varying roles, as if a chameleon prepared to adjust my colors to the context, has been a thread throughout my medical training and personal life. Growing up as a black lower income child in a military family of two boys and two girls, this ability to navigate multiple roles grew alongside the increased awareness of my mother’s unique struggles and my educational achievements. Humbly positioned as the sole physician in the family, it is no surprise that my most challenging moments in medical school and residency have centered on this delicate balancing act.
My professional life as a psychiatrist has been punctuated by intersecting crises that forced me to consider which of my multiple identities would take priority along the way. On which day am I a black psychiatrist as opposed to a psychiatrist in training? During which clinical encounter does my privilege as a Yale-trained physician overshadow my modest first-generation college student background or my daily questionable mastery of raising a headstrong toddler? Am I fooling myself into believing these identities are anything but intersectional and reinforcing in every way?
Arriving to my current state of residence three years ago as an intern was a transition filled with uncertainty and triumph. I had resolved myself to travel to the Northeast, in part, to distance myself from the weight of responsibilities in my home state where my family had settled. I had spent much of my medical school years traveling back and forth to my hometown to put out fires sowed and reaped by the complexities of a psychotic disorder and psychosocial stressors. I had experienced firsthand what impact poverty had on my mother’s ability to maintain her grip on reality and her connection to her family.
Far too often, I would leave the lecture hall after a hurried, hushed phone call exchange and drive the 90 minutes through rural towns and fast food strips to reach her home. Thinking aloud along the highways, I would run through the recently learned jargon of psychiatric medicine that I had picked up along the way in my studies. Once home, I wove this knowledge base into my family’s complicated dynamic through impromptu mediation sessions and hasty attempts at translating the terminology into words that would heal the wounds of repeated misunderstandings. Little did I know, these same skills would be relied upon in my management of crises as an intern and then resident on the psychiatric wards.
As I have progressed through my residency, I have wrestled with how little of this personal experience of the ramifications of mental illness are transmittable to my patients. I often struggle with the professional necessity of limited disclosure. The tender moments where true empathy, the kind that accompanies lived experience, would be essential are often failed by the demands of the traditional physician-patient relationship. This is never more clear than when I am knocking on a patient's door with my university hospital badge on full display. There is a certain level of pride that enters the room with me as I engage with my patients buttressed by the reputation of a formidable institution.
As a black, female psychiatry resident with a non-Ivy League background, I find this badge is a subtle reminder to suppress the nagging doubts of my imposter syndrome. There are moments, however, when that reminder is cloaked in guilt when confronted with the oppressive business practices familiar to large hospital systems around the country. These discussions on space, belonging, and community with patients and community activists have been difficult to navigate, and fortunately my residency program has created opportunities for these essential conversations to take place.
My appreciation for the value that psychiatry brings to the field of medicine had never been greater than when I sought our services during my lowest moments of residency. I had entered into my own psychotherapy as a second-year resident and often fumbled with how to use the privileged space. My comfort had grown over time and I began to appreciate the utility of a therapeutic relationship even when a particular crisis was not present. This relationship strengthened during my pregnancy when my mood began to dip and the familiar checkboxes of a depressive episode became my lived experience. I successfully navigated my pregnancy with the additional support of pharmacotherapy and deepened my love for this specialty that turns darkness into light. I am now raising a headstrong one-year-old and striving daily to model how wellness and happiness can be attained while pursuing my professional and personal interests alike.
My journey throughout training has been rife with challenges, triumphs and life’s lessons. I see and experience bits and pieces of my mother in every patient. I reflect daily on aspects of my identity that are uniquely privileged and am inspired by the portions of my identity that have produced a tenacious resilience. I end each of my shifts enveloping a new life in my arms as she beams and babbles learning the complexities of language. These intersecting experiences represent a beautiful portrait of one psychiatrist’s life.
Editor’s note: A health consent form has been signed by the patient discussed in this article.
The author reports no conflicts of interest concerning the subject matter of this article.