Doctor Psychobabble

“Television has done much for psychiatry by spreading information about it, as well as contributing to the need for it.”
- Alfred Hitchcock

I am doctor completing my psychiatry residency in New York City. I obtained my bachelor’s degree in psychology from George Mason University, and my medical degree from Ross University School of Medicine.

I enjoy taking photos, especially with low-tech cameras like my Holga or Diana, and with slightly higher-tech cameras like my iPhone. Mostly, I take pictures of commonly overlooked objects, animals, and people in the world around me, and particularly in my neighborhood in Brooklyn. I have a special penchant for photographing trash, and anything that falls under the umbrella of “discarded.” I consider myself to be an amateur documentarian, and I also create videos to complement my written and photographical journeys.

I began medical school at the ripe old age of 27 with a multi-colored mohawk. I am a life enthusiast and I live by the mantra: “Dance like no one is watching. Sing like no one is listening. Love like you’ve never been hurt and live like it’s heaven on Earth.”

I hope the following essay helps to further elucidate my path, goals, and aspirations as a physician:

Mrs. Dubois was a 57-year old Dominican lady, who spoke with a very heavy island accent, her words a blend of English and French Patois. Her graying hair was matted together, her clothes were torn and wrinkled, and I could tell that she hadn’t bathed in several weeks. She sat before me in a small, rusty chair, which had likely been donated to the hospital from a local elementary school many years prior. As she spoke to me, I watched drops of sweat trickle down her face, reflecting in the sunlight that percolated down from the cracked tin roof above her head. Mrs. Dubois was a patient in the Accident and Emergency Department at Princess Margaret Hospital, a small, dilapidated facility in the capital city of Roseau, Dominica. As a freshly minted third-year medical student, I had been given the task of taking her history and performing a physical exam. She had come in because of severe headaches and blurred vision for several days.

While taking her history, I discovered that Mrs. Dubois suffered from diabetes, hypertension, obesity and osteoarthritis. She was a regular visitor to the hospital, as she rarely took her prescribed medications, and didn’t adhere to the diet and exercise recommendations of her doctors. I quickly realized that she was what physicians refer to as a “non-compliant” patient.

Later on that day, I went to visit Mrs. Dubois. I had an itching suspicion that there was more to her story than what my 10-minute interview could elicit. After delving deeper, Mrs. Dubois began to open up to me. She told me about the recent death of her husband. I learned that she lived in a small shack, without access to running water or electricity. She bathed and washed her clothes in the river, and did not have access to a refrigerator or stove. Her diet consisted of salted, canned meats sent to her from a relative in another country, “bakes” (Dominican fried bread with meat inside), which were given to her by a local vendor, and very little fresh fruits and vegetables.

Mrs. Dubois eventually admitted to me that she had been feeling sad for many years. She didn’t enjoy swimming in the sea, as she did in the past. Her children had all grown up and moved from Dominica. She had even contemplated suicide a few times since the death of her husband. I soon realized that Mrs. Dubois had been depressed for many years.

To understand Mrs. Dubois’s predicament means understanding her life, including her psychological functioning. I first became interested in understanding the psychological aspects of human behavior at a young age. My fascination turned into an academic pursuit during college when I obtained a Bachelor’s of Science Degree in Psychology. After graduation, I applied the knowledge I gained by working at the Northern Virginia Mental Health Institute (NVMHI), a state psychiatric hospital on the outskirts of Washington, D.C.

My experiences at the hospital ignited within me a passion for psychiatry, and the pursuit of medicine. As a psychiatric technician, my duties involved caring directly for the patients. I was entrusted with the task of monitoring them, ensuring their safety, leading group and individual therapy sessions, monitoring their vital signs, assisting in medication administration, and working with the other members of the treatment team to assess the patients’ response to therapy, as well as developing tailored treatment plans.

Because of the proximity of the hospital to Washington D.C., the patient population was very diverse. I treated patients from a variety of different backgrounds and from many countries around the world. Some patients spoke little or no English, and proper treatment required that I have a high level of cultural sensitivity and knowledge. I distinctly remember a Vietnamese patient who was admitted to the hospital for bizarre and disruptive behavior. He spoke no English, and when I examined him, I noticed erythematous scratch marks all over his back. I suspected abuse and reported my findings to his doctor, who agreed. If it wasn’t for one very astute nurse, we might have all come to the erroneous conclusion that the patient was being abused. However, the nurse explained that the markings were from the practice of “cao gio,” or “coining,” a common Vietnamese practice, which involves scraping the skin in order to allow diseases to escape. This incident taught me a lesson about the importance of understanding the cultural impact on patient care and in understanding mental illnesses.

After my three years at NVMHI, I left to pursue a career in academic medicine. I began working for the Association of American Medical Colleges (AAMC) as a Technical Analyst in the Division of Medical School Data Systems and Services. However, after four years of analyzing data on everything from medical school curriculum to financial aid, I knew that it was time to move from behind a desk into a more clinical environment.

Thanks to my years at the AAMC, I was intimately familiar with the U.S. medical education system. However, instead of applying to U.S. medical schools, I made the somewhat controversial decision to apply to Ross University School of Medicine, a Caribbean medical school located in Dominica, a small country in the West Indies.

There were many factors which contributed to my decision, but the most important one was Ross University’s location in Dominica.  I had always wanted to live abroad, especially in a developing country, and I saw this as my opportunity to finally do so. Of course, I realized that attending a Caribbean medical school would come at a price; I would have to deal with the stigma attached to foreign medical grads. But it was a price that I was willing to pay. I saw the opportunity at Ross University to be the best of both worlds. I would spend two years in the beautiful country of Dominica, learning the basic sciences, and then I would return to the States to complete two years of clinical rotations at U.S. hospitals. After graduation, I would have the same opportunities that are available to U.S. medical school grads. So, once I received my acceptance letter, I bought a ticket to Dominica, packed up my most important belongings and prepared to start my life in a foreign country as a medical student.

During my first week of medical school, I was offered a writing position by Medscape/WebMD, a prominent online medical publication. I was required to publish one article for them every week. Studying for all of the exams and practicals during medical school required dedication, and was very time consuming, but I made the time to write an article for them each week. I found that writing forced me to take a step back, pause and reflect on the bigger picture. Because of my articles online, I was also contacted by the editor of Medicina Moderna, a Journal edited by the Romanian College of Physicians, who requested that I write for a new international section of their journal. Writing for Medscape/WebMD and Medicina Moderna placed me in the unique position to communicate with medical students, residents, and physicians all over the world. I was able to document my experiences in medical school, which helped me to understand and appreciate myself. Through my words, I was able to share with, educate, provocate, and inspire others.

While in Dominica, I soon became involved with Ross University’s chapter of Physicians for Human Rights, an international organization, which mobilizes health professionals to advance health, dignity, and justice and promotes the right to health for all. Due to my very active roll as a member during my first semester, I was elected president the next semester. Because Dominica is a developing nation, and many Dominicans have limited access to healthcare and other resources, it proved to be the perfect setting for our chapter to flourish. I was able to orchestrate multiple community service projects, including creating a center for educating and training at-risk youth, a library tutoring project for tutoring local children, a fund to provide surgery for Dominicans in need, free healthcare and health awareness clinics, and meals for the elderly and homeless population of Dominica.

Following my basic science education, I took the opportunity to begin my introduction to clinical medicine at Princess Margaret Hospital in Dominica, and it was there that I met Mrs. Dubois. If I hadn’t had a background in psychology and psychiatry, I might have missed the salient components of Mrs. Dubois’s case. As the details of her life were unveiled to me, I came to understand why Mrs. Dubois had been labeled as a non-compliant patient. She was so poor that she could not afford to buy her medications. Her growing obesity was directly related to her lack of exercise, and inability to even leave her home. Her poor diet and lack of exercise were contributing to the exacerbation of her diabetes and hypertension. Her long-standing depression seemed to be an overarching problem, affecting the cascade of her other health issues.

When viewed as separate issues, Mrs. Dubois’s story is not truly being told. Her depression was contributing to her other health issues, but her health issues were also contributing to her depression. Identifying each of her problems as separate issues misses the larger picture. Mrs. Dubois was in fact a greater person than the sum of her parts.

Her story reminds me of the tale involving the blind men and the elephant. The story goes that a group of blind men all touch an elephant to learn what it is like. However, each one only touches a specific part of the elephant, such as the tail, or the tusk. After comparing notes on what each person felt, they are all in complete disagreement. The story is used to indicate that reality may be viewed differently depending upon one’s perspective. I believe that this analogy applies well to a physician’s perspective regarding a particular patient. By examining only one portion of their life, their story, or their diagnoses, it’s impossible to come up with an entire portrait of the person as a whole. In order to diagnose and treat a person successfully, one must look at every angle of a person’s life. All too often the mental health aspect of the equation is overlooked. However, this perspective is the glue that holds the person’s life together. By ignoring this vital aspect, we continue to treat a set of symptoms, without ever digging into the real cause of the problems.

After my two years in Dominica, I moved back to the U.S., first to the Baltimore area and eventually to Brooklyn, New York. Learning clinical medicine in a fast-paced, urban environment proved to be as challenging and rewarding as I had hoped. Brooklyn also has a large Hispanic population, and this created the perfect opportunity for me to improve my Spanish, and become enriched by the variety of new cultural experiences.

I distinctly remember a patient, who I encountered during my gastroenterology rotation. Ms. Rodriguez was an HIV positive transgendered female who had come to the clinic because she’d been having bloody diarrhea for many weeks. When I asked why she hadn’t come into the clinic sooner, she told me how much she feared hospitals. She had experienced many insensitive doctors, who had made her feel worthless and “like a freak.” I told her how sorry I was about her experiences, and assured her that I was not one of those doctors. She eventually told me about the disfiguring breast surgery she’d undergone, and about how it had resulted in a large amount of hemorrhaging and the need for a blood transfusion. This is how she contracted HIV. Apparently, no doctor had ever asked her this question, but had rather assumed that she contracted it from unprotected homosexual intercourse.

As a result of my experience with Ms. Rodriguez, and other similar patients, I felt the need to put my frustration to good use, so I joined the American Medical Student Association’s (AMSA) health equity steering committee. In that capacity, I’ve helped to create campaigns to educate and increase awareness on issues of health equity. I am very passionate about improving healthcare access in the States, as well as internationally, and being a member of this committee has provided me with the ability to give a voice to those who would otherwise not have one.

I have always been intrigued by the connection and complex relationship between mental health and medical illnesses. As a psychiatrist, I will be in the unique position of being able to appreciate the entire portrait of my patients. I believe that the mental health aspect of our patients’ lives is all too often overlooked. I know that my appreciation for understanding the impact that psychiatric illnesses have on physical health, and vice versa, will serve to make me a more competent psychiatrist.

Unfortunately, not every patient has access to the best medical care possible. A patient’s socioeconomic status, race/ethnicity, geographic location, age, sexual orientation, and many other factors can have a detrimental effect on their ability to access medical resources. I believe that these factors are just as important to an individual’s health as are their physical exam findings and laboratory reports. Understanding and learning about these “vital signs” can have a significant impact on a physician’s ability to properly diagnose and treat their patients.

I am a non-traditional medical student in many ways, and my experiences before and during medical school have shaped the person I’ve become. Stories like that of Mrs. Dubois and Ms. Rodriguez have contributed to my desire and ability to appreciate the profound effect that my patients have had on me. They have helped me in as many ways, and perhaps more, than I have been able to help them. In addition, because of my written word, I’ve been able to share my thoughts and experiences with the world. I’ve had the extraordinary opportunity to ask important questions, and to inspire others to do the same.

I know that I will make an exceptional psychiatrist. I have the creativity, determination, resilience, and compassion to effect positive changes for my patients, and in my community at large. I am an outspoken and passionately driven person, who always stands up for my patients. During my years in residency, I look forward to adding volumes to my knowledge base. In addition, I am excited about the opportunity to share my knowledge and experiences with medical students and other colleagues. I am confident that I will be an outstanding addition to your team of physicians, and I look forward to having the opportunity to excel in your residency program.

So, there you have it. I created this website as an attempt to chronicle my experiences as I make my way through psychiatry residency. I hope you enjoy my blog, which is an attempt to document all of my encouragements, discouragements, adventures, misadventures, personal anecdotes, confessions, apprehensions, successes, setbacks, contemplations, and meditations.

Thank you for visiting DoctorPsychobabble.com. This site is intended to be a true reflection of myself: constantly evolving, hopefully progressing, and awkwardly mutating. I document my experiences because it helped me to understand and appreciate myself, and I am gratified when my words educate, provocate, or inspire others. I’m always open to new ideas and paths of exploration, so please don’t hesitate to share any of your thoughts or suggestions with me.

I hope you enjoy my site.

~Doctor Psychobabble