Doctor Psychobabble

“Roll away your stone, I’ll roll away mine
Together we can see what we will find
Don’t leave me alone at this time
For I am afraid of what I will discover inside

‘Cause you told me that I would find a hole
Within the fragile substance of my soul
And I have filled this void with things unreal
And all the while my character it steals

Darkness is a harsh term don’t you think?
And yet it dominates the things I see”

- Lyrics to “Roll Away Your Stone” by Mumford & Sons

It’s almost 9:00 a.m. on a Saturday. I just got home from a 24-hour work day. Sleep is a stranger. Food is even stranger.

(Disclaimer: brain fried and not functioning optimally.)

I saw patients this morning in the outpatient psychiatric clinic. Then I was on call over night on the psychiatry consultation liaison service.

Two moments today made me pause. The first one was when the psychologist on the inpatient psychiatric unit contacted me to tell me that my patient who I had hospitalized was wondering if I was okay. It turns out that I had not been able to visit her for several days, as I had been doing for the past several weeks. It didn’t immediately occur to me that this would have any impact on my patient. That was silly. Not only had she noticed, but she had started to decompensate because she was worried about me. I visited her and saw the change in her immediately. Small things. Big things.

The other moment was when I told my psychotherapy patient that I would be out of the office for two weeks and unfortunately would not be able to see her. It mattered to her. More than I anticipated. She told me I was “her rock.” Sometimes I wonder how I can consistently be a rock, when my stone rolls away sometimes as well.

I potentially could have slept and eaten on my overnight shift last night. But I ended up not being able to because of worrying about my parter who was out and about.

Doctors are imperfect. I have a multitude of flaws. Yet sometimes I have to be “the rock” when I feel more like a stone tumbling down a hill. Perhaps tumbling together sometimes is not a bad thing.

It turns out that what is true for my patients is true for me: Don’t leave me alone at this time, for I am afraid of what I will discover inside.

Photos: All taken around my hospital in the past 2 days.

Part of My “Yo Brooklyn, Fuhgeddaboudit” Photo Series

“Insanity laughs under pressure we’re cracking
Can’t we give ourselves one more chance?
Why can’t we give love that one more chance?
Why can’t we give love, give love, give love, give love, give love, give love, give love, give love?..

‘Cause love’s such an old-fashioned word
And love dares you to care for
The people on the edge of the night
And love dares you to change our way of
Caring about ourselves
This is our last dance
This is our last dance
This is ourselves
Under pressure
Under pressure
Pressure”

- Lyrics to “Under Pressure,” by Queen

Today was a long day for me. I worked at the PTSD (Post Traumatic Stress Disorder) clinic at the VA (Veterans Affairs) Hospital in the morning. I was reminded, yet again, of what the true spoils of war actually are. Yes, many fewer soldiers have died in the Iraqi war than in wars in the past. However, those who actually live are (arguably, not necessarily) less fortunate in some ways. Many of them suffer lifelong mental distress from their experience during the war. Many of them suffer from TBIs (traumatic brain injuries) and other consequences. These are the ones who show up in my office. And they are not the minority.

I also spent a portion of my day doing what I call “BP” work. BP is a term that I coined years ago, which stands for “Business Professional.” BP means all that work in the universe that few people enjoy, but simply has to be done. Examples include doing laundry, filling out forms so that one continue to have a job come July, and taking online quizzes that have absolutely zero benefit to me or society. It was quite painful, as BP stuff frequently is. Yet I did it. Because I have to.

I then went to a meeting of a society that I’m a part of. It started out as a BP item on my list, but eventually culminated in the fruition of some actions, so the end was somewhat worth the means.

On a completely unrelated yet related note, a quite random stranger in the UK has been shipping me boxes of books, magazines, dolls. She is one of those one in a million type folks with a heart so big she doesn’t know what to do with it. I’ve been filling up my office with these paraphernalia, and many more still exist in the mailroom of my hospital and possibly on a plane somewhere between the UK and New York. She sent me these things for my patients, and for not my patients, and for anyone who may benefit. Soon they will be on their way to changing other people’s lives.

I’m not entirely sure where my thought process is going in this post. But it has something to do with being under pressure. And with releasing pressure. And about the love that dares you to care for the people on the edge of the night.

Photos: 1) Taken on my walk to the hospital for the meeting tonight. 2) The “K Dara Library,” which is growing exponentially at my hospital.

Slap the turkey neck and it’s hangin from a pigeon wing
You can’t write if you can’t relate
Trade the cash for the beef for the body for the hate
And my time is a piece of wax, fallin’ on a termite
That’s chokin on the splinters

Soy un perdedor
I’m a loser baby, so why don’t you kill me?
(Get crazy with the Cheeze Whiz)

- Lyrics to “Loser,” by Beck

It’s almost 11:00 p.m. I am home and post-call from a 14 hour day of seeing clinic patients and being on call on the consultation liaison service. I’m quite pooped and food-deprived. I never stopped today. Barely ate. Move, move, groove, groove.

A thought from today: all of my patients are extraordinarily different, yet sometimes fascinating themes arise.

Today’s theme was “losers.” None of my patients are losers, yet sometimes their problems stem from the fact that they might feel like one for some reason.

I saw three patients on the consult service.

One was a woman who was depressed and had a delusion that she smelled disgusting. She thought everyone else noticed her smell, and moved away from her on subways and were abhorred by her. Not true at all, but incredibly true for her. She cried. I listened. I told her she smelled just fine. I admitted her.

The second patient was a young girl whose boyfriend had humiliated her and broken up with her. She was devastated. Literally wanted to die. Felt like a loser. But wasn’t. I told her so.

The third patient was a 10 year old boy who was being intensely bullied at school and taunted. I had to perform a “psychiatric evaluation for clearance to return to school.” Unfortunately, this is an incredibly common consult. I see young boys and girls who are the recipients of being bullied. They come in for evaluation because they end up saying they want to kill themselves or run away or something else as a cry for help. Why is it that I never receive requests for psychiatric evaluations on kids who are doing the bullying? Makes you think. He thought he was a loser. He wasn’t. I told him so.

I was told by my attending tonight that I spent too much time talking to my patient’s family. Yes, maybe I did. But they needed it. They needed to talk to me. They needed to vent their frustrations. I listened. I comforted them. I shook their hands. They thanked me. Sometimes I comfort families as much as their patients. Maybe it’s not billable. But I think it’s important.

Time to eat!!

Photos: 1) Me and my “loser associate” protecting ourselves from rain on our walk home from the hospital. 2) Loser me.

“My life is moving on, and its moving fast. But, for the first time, I’m moving with it.”

- Author Unknown

I’m home, post-call from a very long 14-hour day at the clinic and hospital. Am hungry and brain is blurry.

The theme today was “Moving Fast.”

I talked to another “psycho” today about why it is that I move so quickly. I do everything at high-speed. I think fast. I act fast. It’s always been a challenge for me to slow down.

Some random happenings from today:

1) Visiting a patient of mine on the inpatient unit. He is unbelievably sick. Floridly manic and psychotic. Yet for some reason, even in his blur of reality and delusions, he remembers me and identifies me as his doctor. Yet he became quite agitated and required an injection. I took it as a personal failure, although perhaps I should not have.

2) I saw a patient experience an acute dystonic reaction (his body was twisted and stiff). I treated him. I pretended like I wasn’t scared in the least, yet I was.

3) I moved at light speed in between consults and emergencies.

4) I told an adorably sweet and psychotic patient that, no, I could not give him my phone number to “call me sometime.”

5) I managed to go from “f you, you are working with the devils” to “thank you for listening, I’m okay now” with a patient.

Light speed continues. Blurry. Slowing down. Food now.

Photo: My doggies Scope and Molly in the “drunk tank.” I was dogsitting my “ex” doggy, Molly.

“On the first page of our story
The future seemed so bright
Then the saint turned out so evil
I don’t know why i’m still surprised
Even angels have their wicked schemes
And you take that to new extremes
But you’ll always be my hero
Even though you’ve lost your mind

Just gonna stand there and watch me burn
Well that’s alright because I like the way it hurts
Just gonna stand there and hear me cry
Well that’s alright because I love the way you lie
I love the way you lie
I love the way you lie”

- Lyrics to “Love the Way You Lie” by Skylar Grey

I’m home, post-call from a 12 hour shift on the psychiatry consultation liaison service. Had a fabulous day. Saw some very interesting consults. Some highlights:

1. A quite psychotic man who kept repeating, “you were sent by the devil to kill me…I don’t have to answer your questions.”

2. A teenage girl who was obsessed with the size of her leg (it was actually normal in size).

3. A morbidly obese depressed patient who told me all about what eating does for him emotionally.

4. A “malingerer” (feigning symptoms) who told me, “I’m hearing voices telling me kill myself…they sound like Richard Simmons.”

I sensed today that more than one patient was lying to me. I knew they were lying, but for various reasons in each case, I did not confront them on their lies. Sometimes my job means pretending to believe. I’m okay with that.

I love the way you lie to me!

Photo: Taken on my walk home from the hospital.

Part of My “Yo Brooklyn, Fuhgeddaboudit” Photo Series

Home. Post-run. Quite pooped. In need of sustenance. My stats below. Not too shabby.

“Oh, ma children are cryin’
Oh, children, weep no more!
Oh, ma sycamore tree, saw the freedom tree.
All you … have spoke:
Oh, children, weep no more;
Weep no more: children, weep no more!

Jah would never give the power to a baldhead
Run come crucify the Dread.

Time alone – oh, time will tell:
Think you’re in heaven, but ya living in hell”

- Lyrics to “Time Will Tell” by Bob Marley

Today was a very busy day. I saw 10 patients in the outpatient clinic. Three of my patients cried. I had to borrow a fellow “psycho’s” tissues continually.

One of my patients was quite sick and at one point during our conversation ended up throwing herself on my office floor crying. I ended up having to walk her to the psychiatric emergency room so that she could be admitted.

I had therapy with more than one depressed patient. After work, I had a few personal obstacles. I texted my partner about it and he replied “life is a gift.” I marveled at the fact that I had spent the greater portion of my day helping my patients to understand this, yet had forgotten it myself in a moment of frustration. And then they inadvertently helped me to remember that it truly is.

Think you’re in hell, but you’re living in heaven.

Time to eat!

Photos: 1) An awesome doctor’s office sign in my hood. 2) A shot taken in the park on a doggy walk yesterday. 3) One of my favorite spots for margaritas with my “psychos.”

Part of My “Yo Brooklyn, Fuhgeddaboudit” Photo Series

“The sea, the sky, both you and I
the sea, the sky, the you and I
I know we’re all blues
all shades, all hues, all blues

some blues are sad
but some are glad
dark, sad, or bright, glad
they’re all blues
all shades, all hues, all blues”

- Lyrics to “All Blues” by Miles Davis

Today was a busy, but fantabulous day. I saw patients in the outpatient psychiatric clinic. I enjoyed reflecting on the diversity, yet similarity of my patients. One of my patients had a “psychiatric emergency” which required me to walk him down to the psychiatric emergency room. Another patient gave me a photo of herself with a thankful message.

One patient I saw today ended up having to wait an inordinate amount of time due to the lab taking forever to process his blood work. I brought him cookies in the waiting room and checked on him as he slept. Then the clinic closed and he had no way of getting home, as his free metrocard could no longer be processed. Perhaps what I did could be considered a “boundary crossing,” but I’m more than okay with that. I gave him cash to get home on the subway, with a little extra to buy some dinner. I have no regrets. Many of my patients survive on smaller amounts of money each month than most people could ever imagine to live off of, him included. He thanked me profusely. I almost felt guilty for accepting his thanks, as I did not view it as any large gift, but rather a simple offer of human decency.

It just so happens that the sun is still shining right now. I’m not taking this for granted, but rather as a huge gift. I’m currently about to cook dinner. I plan on pulling back the curtains in my kitchen so that I can gaze upon the blueness of the sky while preparing something delicious for me and my partner to devour. All shades, all hues.

Photos: 1) “Kind of Blue” – a photo inspired by the blue sky, taken outside of my hospital. 2) One of the offices in which I work.

“The place to improve the world is first in one’s own heart and head and hands, and then work outward from there.”

― Robert M. Pirsig, Zen and the Art of Motorcycle Maintenance: An Inquiry Into Values

I’m almost out of words at the moment, but full of thoughts.

Last night my partner and I rode down on his Harley to visit his parents in Pennsylvania and to get his bike spiffied up and ready for the impending Spring. We had quite a fabulous time and I enjoyed every second.

We then hopped on the bike and rode back to Brooklyn. Somewhere in Manhattan, the “Check Battery” light came on. Some other stuff happened but the gist is that when we finally arrived in Brooklyn and parked, we realized the motorcycle wouldn’t start.

After resting for a few moments, my partner and I went back outside, with tools in tote to see if we could bring the bike back to life. As I sat there in the sun, watching him attempting to fix his bike, I texted with some fellow “psychos” (psychiatry residents). Somehow the conversation devolved into discussing “Zen and the Art of Motorcycle Maintenance” and about the fracturing of souls, pausing time, and watching “whys” fly by.

The bike still wouldn’t start.

And then a random dreadlocked man happened by. The short of it is that he helped us take apart the bike, put it back together, and eventually gave us a jump. He waited patiently throughout the experience. I lent him my phone so he could call his wife to tell her to take the food off the stove because he was running late. We talked about motorcycles and life and karma and music.

And then the bike started.

It’s all in the heart and head and hands.

Lesson learned from today: It’s not life. It’s your life.

Photos: My partner on his bike this morning and then attempting to revive it.

“I wanna soothe my my heart, I wanna ease my mind
I wanna move my shoes and see what I can find
I wanna stand up tall and open up my eyes
I wanna reach out my hand until I touch the skies
I was a poor lost lamb in a deep dark hole ”

- Lyrics to “Saved” by Elvis Presley

It’s 11:05 p.m. I’m post-call from a long day. Please excuse my ramblings.

Yesterday was not the best day. A long story short, I got a less than stellar evaluation on a patient interview and presentation. I took it particularly poorly.

This morning, I received an email from a quite amazing friend whom I’ve never met in England. It turned me quite around.

During my call today, I validly helped some patients. I did very little but somehow it meant a lot to them.

One of my patients said to me, “are you some sort of superstar in your spare time?” “Only in my dreams,” I replied.

I would write some more fabulous stuff right now but the sushi I just devoured is sucking me away.

I wanna ease my mind.

Photo: Taken in the hospital gift shop today.