He looked straight at me. I remember thinking, “Where were you when the voles were gorging on our lawn?
I’ve never seen an owl up that close, especially roosting on a street sign at a crossroads. Of course it got me to musing on the crossroads in which we often find ourselves at different times in our careers and at pivotal moments in our lives.
There are big and little stages, the minor and major crossroads we navigate every day and at other transitions: childhood, adolescence, college, medical school, residency, graduation, marriage, divorce, and the birth of children, the death of parents, retirement, and our own approaching death.
Recently I got a funny and thought-provoking essay about this from a former resident who is now an attending herself staffing a psychiatry consultation service at a big university hospital in Cleveland. The title of Dr. Jeanne Lackamp’s perspective article is “The Stages of Consultation-Liaison Psychiatry.” In it she describes the stages, the crossroads if you will, of the psychiatric resident in a large general hospital from the perspective of an experienced teacher .
I was going to say she does it with the wisdom of a wise owl, but then I thought of the owl sitting on the street sign, whose wisdom I doubted. The owl’s eyesight is keen but there was nothing but concrete on the roads leading away from its perch.
There aren’t any voles out there.
Anyway, short excerpts (which I hope are considered fair use) from Dr. Lackamp’s stages are:
Anticipation: “As though hypomanic, you will eagerly accept the CL challenge….”This is it—Your Big Chance.”
Initiation: “Coping with patient death will become real…and will make you feel sad.” “You will wonder how you can possibly do multiple months of this.”
Mastery: “Cockiness may backfire…errors still occur.” “…you feel confident that No One Else could have done better given the circumstances.” “This feeling lasts; until it does not.”
Anger: “Anger will manifest in several ways…” “…it will be tempting to start second-guessing your life choice of going into medicine in general, and Psychiatry in specific.” “Sleep will be rare now too…”
Acceptance: “…you will know what you are doing—but more importantly you will realize that what you know is not everything. “…you will know that you have endured something intense and were changed by it.”
I thought of this as I listened to one of our current senior residents talk about her approaching crossroads. She’ll be a consulting psychiatrist at a private hospital. She’s excited about it and also wanted to know that her old teacher (which is me, the wise old owl) will be available for collaboration if she needs it.
I suddenly have this craving for voles.
- Lackamp, J. M. (2015). “The stages of consultation-liaison psychiatry.” Acad Psychiatry 39(2): 217-219.