This one goes to Shravan, who constantly asks me when I am updating this….
Over the last 6 months, I have found that there is one question related to medicine that I dread answering. In fact, I dread this question so much that I get antsy meeting new people. Inevitably, every conversation related to medical school and 4th year leads to the following: “What specialty are you thinking about going into?”
Ugh. What a terrible question to be asked when you don’t have a clear, defined answer. Whether or not it actually exists, there seems to be a stigma attached to not knowing what you want to do with your life at this stage in the game. Often times this question is followed up with statements like…”Shouldn’t you know by now?” or “It’s ok, it will come to you.” On one hand the whole process is comical. You apply to medical school with the intentions of being a physician. You get in or eventually get in and start learning about the nitty gritty of the body. After Step 1, you wipe you brain clean of that knowledge and start learning clinical medicine. At this point, for many people, you look back on your medical school application and realize that you had no clue what you were writing about when you were explaining why you wanted to be a doctor. In fact, much of the medical school experience was probably a strong departure from what we were expecting.
Despite my hatred for being asked about what I am doing with myself in the future, I have found that my favorite person to be with when I am asked that terrible question is a friend from high school, Wendy. She is always quick to interject that my lack of a decision means that psychiatry is still on the table and that I will potentially become her clinical collaborator when she is the PI (principal investigator AKA top dog) in a psych research lab.
After doing a psychiatry rotation, I can honestly say that psychiatry and I were not destined to spend more than 6 weeks together. (Sorry Wendy!) That short time, however, was filled with many interesting people. I’d like to tell you about my favorite patient.
Mrs. B was a 64 year old, heavy-set African-American schizophrenic who was admitting to the inpatient unit because she was acutely psychotic. Simply, she was convinced that she could communicate with Jesus – they would communicate through what seemed like a sneeze. Although he wouldn’t give her commands, he did answer her yes or no questions. Should I go to church? No. Should I trust this man/woman? No. Should I take my medications? No. Should I pay my rent? No. Should I let my social worker, who is concerned about me, into my apartment? No. As you can guess, this series of decision-making landed Mrs. B in our psych ward.
Because of the laxity of our clerkship site, my 2 fellow medical students and I often saw our patients by ourselves, in rooms with closed doors. Meeting these people for the first time was always a daunting task – simply put, it was often difficult to assess whether someone’s “crazy” would come out in an aggressive and physical way. The first time I met Mrs. B, I was quite nervous. I knocked on her door and was greeted by a sweet lady, wearing shorts, a t-shirt and what can only be described as a strange head-dress. She closed the door after letting me in the room. I was immediately frightened (I believe this is described clinically as a “feeling of impending doom”). However, all it took was one question before my fear was assuaged and I was able to delve into her rich personal history: “How are you doing today?”
Having met with her daily for a week and a half, I learned a great deal about Mrs. B. She quickly became the favorite part of my day. Growing up during the civil rights era, Mrs. B spent much of her youth living with her grandmother in the South, shielded from the harsh realities of Jim Crow laws and segregation. As a pre-teen she and her sister moved to Boston to live with their mother. At this point, she came face to face with the limitations that came with her skin color. The experience was quite shocking to her and left her feeling quite jilted.
The more I learned about Mrs. B, the more her illness seemed to make sense in the scope of her experiences. Her life was filled by her attempts to obtain a high education, her shock at the culture of the North in the 1950’s, and her extreme sense of faith. All of these contributed to her “delusion” that she was the chosen one, elected by Jesus to lead “her people” to a better life. Her faith in Jesus was so strong that it was almost admirable.
After a week in the ward, Mrs. B’s medications began kicking in and she became more receptive to completing normal tasks of daily living such as paying bills, going grocery shopping and attending appointments. Her strong sense of faith, however, remained. She and the big guy in the sky were still pals, communicating as they always had. Jesus was now telling her that seeing the doctor was a good thing and that she needed to take her medications. She was discharged from the ward a week and a half after I had met her.
For the duration of my psychiatry rotation, I often thought about Mrs. B. While we could all agree that she was a little off, it was impossible to ignore the fact that her rich “delusions” could in fact be true. Talking to Mrs. B made me realize that there was a fine line between prophecy and fantasy. Her faith combined with her conviction made it difficult to confidently dispute her beliefs. Let’s be honest, if many former prophets tried to pass of their beliefs in today’s world, their stories would be strikingly similar to our beloved Mrs. B.
Although my psychiatry rotation was full of interesting patients, it was hard to shake the feeling that maybe they weren’t completely crazy….
Today, I leave you with my friend Vivek who is an incredibly talented singer. Check out his website: www.vivekmusic.com