“I don’t want to be alive anymore.”
My friend Margot was despondent. Her lips quivered. Her eyes, normally the shape of almonds, folded themselves into little triangles when she cried. This kind and gentle woman of 62 years – my neighbor – was undeniably at her lowest point. I was sharing a couch with her during my junior year of college as her composure crumpled before me.
I first met Margot when her companion, a dog named Sofie, ran loose, and I helped reunite them. When I saw her – a slight woman with wispy brown hair, empty leash in her hand – she clutched Sofie like her own daughter. “She is all I have, all I have,” she cried. Her apartment was small, dark, and brimming with unopened cardboard boxes. The scent of wine lingered in the air. Our new friend needed some help adjusting to Los Angeles.
Following a nasty divorce, Margot felt lost. I listened to her stories about growing up in France and, as the years passed, she bore witness to the realization that I wanted to go to medical school. I took her to urgent care, veterinary appointments, the visa office downtown. She showed me Jewish music. She met my family. She was a brilliant woman.
But many of her problems – immigration, depression, drinking – were not easy fixes. I was scared of her trauma. Scared of setting off her tears. Scared of probing too deeply about her son, who she desperately messaged on the days she felt saddest, receiving only silence.
Three years later as I prepared for my psychiatry rotation, I remembered being the college student who realized she bit off more than she could chew. I was nervous. Some say the more intimate medical specialties are surgery and psychiatry. Surgery, my third rotation, struck me as concrete and precise in its handling of the body. I retracted bowel, closed skin, felt a woman’s pulsating aorta and spoke to her the next morning. Intimate indeed! By comparison, psychiatry seemed abstract and imprecise, like surgery in the dark. I imagined myself striking exposed nerves without my knowledge: saying the wrong thing, offending someone, hearing my voice echo back at me from caverns I was too afraid to enter.
My first encounter on child psychiatry was a girl who swallowed a handful of pills. I nearly shrunk into the curtains trying not to betray how terrified I was by a psychiatric interview. Yet I saw how confidently and compassionately our psychiatrists handled her story, responded to her emotions, and drew out the pertinent aspects of the history allowing them to identify what she needed most.
These were the conversations I wanted to learn about.
Navajo surgeon Lori Arviso Alvord wrote in The Scalpel and the Silver Bear, “the scalpel is used to bridge worlds.” Dr. Alvord carved pathways between Navajo culture and white culture, between air outside the body and air within the body. She practiced surgery in the concept of hozho, walking in beauty. The surgeon in harmony with her team, her patient, and her world: hozho.
I imagined psychiatrists wielding a scalpel of their own. One of my first patients was a slim, pale girl hospitalized for a serious infection. Her history included autism spectrum disorder, depression, anxiety, and PTSD. She was extremely intelligent, with a quick and dry sense of humor. But she became nearly unresponsive when probed about her family. I wanted to build a bridge.
My favorite professors challenge us to hone our observational skills. Between images of chest X-rays and angry rashes, one professor presented an ordinary photo of our campus and heightened our awareness to a hummingbird nest (with babies) hidden expertly in the beams of a light fixture. Another professor had us analyze paintings exploring pain. The artist in me had always wanted to sharpen this awareness in a medical lens. So in my patient’s room, I let my gaze wander: over a monthlong stay, what had she filled her space with?
Books for learning Japanese, colored pencils, a Pokemon plushie … so she played Pokemon, which I happened to be familiar with. I have one more question for you, I said at the end of our first meeting. Who was your starter Pokemon from the Sinnoh region?
Her eyes lit up.
Although this girl struggled with her own emotions, she excelled at crafting stories for animated characters. So I challenged her: each day, she chose a Pokemon that represented her mood. At first, every Pokemon she chose was “tired.” But after a couple of sessions she picked one that looked “sad,” and we explored that. When she meditated with the help of my classmate, she shared a peaceful memory with her family.
She was also a gentle introduction to the many visits I took in the ED for suicidal ideation. I pictured myself on the couch next to Margot, afraid, and then reminded myself how far I’d come. My fellow coached me, “when you stay calm and confident, your patients will open up seeing that you can handle it.” So I took my deep breaths. I learned how to let the patient drive their story and tried my best to find what they needed next, even if it was a million things they really needed. There was no rush, no race. Our goal was to build bridges and invite people across.
Margot returned to France, looking to turn a new page in her story. There’s still so much sadness in her I don’t know how to handle, but if there’s anything medicine has taught me yet, it’s that we will learn and grow throughout our entire lives. Part of that learning includes setting boundaries.
It’s a rite of passage for students to see every field and challenge themselves into the doctor they want to be. The gravity of difficult questions stays with me as I continue to ask them in different forms, in different settings, to different people.
But what is gravity if not grounding us with our patients, with ourselves?
Allison Ong is a medical student.
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