It’s about 10:00 at night as I sit down to write this post in recognition of the Gold Humanism Honor Society (GHHS) Solidarity Day for Compassionate Patient Care tomorrow. It’s been a long day. The medical students, the residents, and I saw many patients today and the pace was so fast that we didn’t get to write our consultation notes until the evening. I did part of that work at my office–and did the rest at home via one of the miracles of the computer age…remote access.
So I’m writing this now because I might not have time to write tomorrow.
I’ve begun to notice something about the trainees with whom I work. Nowadays whenever we enter a patient’s room, one of the medical student hurries to search for a chair for me so that I can sit down in front of the patient. This always helps remind me of how important the demeanor of humility and patience is to those I serve.
The medical students don’t sit down. That’s mainly because there is not enough space in the room for all of us to be seated. I joke about it with the person we’re about to listen to…”They’re medical students; they’re strong.” They can lift pretty heavy chairs. When I remember to shut up and let them speak, they ask pretty smart questions. I asked them to try to ask patients the three questions for Solidarity Day:
What are your strengths?
How would your friends describe you?
What has been most meaningful to you?
Can you recite the months of the year backward?
No, wait, that’s 4 questions.
That reminds me of a medical student’s coat I found about a week ago. It was standing by the tall, gray confidential paper waste bin for confidential patient document shredding. That’s right…standing.
It stood up on its own, a testament to the grand, time-honored tradition of not over-laundering them. We must remember to respect traditions. At first I wondered if the medical student had simply vanished in a blinding flash of scut monkeyshines. The only one who might have witnessed the event was Nigella, our psychiatry consult service mascot, there to remind all of us not to take ourselves too seriously and to guard the bin. I mean Nigella guards the bin, not us.
Late at night, at times like these, I wonder if I’m teaching them the right things. The academic medical center where I practice is all about science. But I am not a scientist. I know that because a colleague told me years ago, “You’ll never be a scientist.” I’m a clinician teacher, activist, humanist, and all ‘round geezer blogger.
I don’t ignore science of course. But the medical students learn more about what a psychiatric consultant does to help make patient care safer and more effective in a general hospital. I deal in pattern recognition, not the pathogenesis and biology underlying the clinical challenges I see every day.
And every time I walk into a patient’s room, I look around for a chair. The trainees see that, and hustle around to find one for me. And they know I sit down not because I’m a tired old man. I don’t use the elevator. I take the stairs. The hospital has 8 floors and I’ve been climbing them for 18 years. I sit down in front of a person because I am uncomfortable standing over them.
I respect neuroscience. But Thomas Insel, the Director of the NIMH, knows that psychiatry doesn’t yet have the neuroscience framework to transform the diagnosis of psychiatric disorders from a descriptive menu of symptoms in the DSM-5 to a nomenclature based on an understanding of their biology. The Research Domain Criteria (RDoC) is never mentioned on my service and I can’t even download the Neuroscience-Based Nomenclature for Psychotropic Drugs app (ironically called the DSM-5 of psychopharmacology) to my iPad.
I respect the resilience of patients. The questions for patients on Solidarity Day are really about helping them remember their resilience, their will to resist giving up, even when overwhelmed by terrible disease.
Threat of Weather
We know we can outlast the weather
the two of us, it has stormed before.
We have been through worse times together
and not turned back, ice seals the door
while the wind throws angry floods of snow
in malediction against our walls
and tries to blind a clear window
through which, we hope, the warm light falls,
such as it is, for you to see
if you are out in the dark. We give
what comfort there is in knowing we
are willing to show you where we live.
As if to defy the wind I poke
the burning logs, the rising cry
of a startled fire through the chimney’s throat
drowns out for a moment the wind’s reply.
Let the house shake, our fire and light
still prove to us, as the books contend,
that two in love can accept the night
and not be afraid how it will end.
I learned resistance from a heart
of oak that lay charred in the grate,
it was in the fire from the very start
and still is solid. It’s getting late
but here I’ll say at the risk of turning
a first rate farmer into a dunce,
it kept back enough for another burning
it didn’t let everything go at once.