A Psychiatrist shared a story …

Most small town doctors have experienced something similar to the story related below. It got me thinking about how often we all criticize doctors and I am as guilty as anyone else.  I wonder how many of us realize how much pressure doctors and psychiatrists are under. Many doctors make life and death decisions daily. Psychiatrists have to take decisions without ever having performed a single test that we are familiar with, so their decisions must be even harder to take. Nobody is perfect and we all make mistakes is the lesson to be learned here. To err is human, to forgive, divine.

Here is the story: It was a particularly vile night in that small town. The wind howled, rain lashed down wildly from every direction and in the middle of this storm, the psychiatrist received a heartrending call from a family he was treating, who claimed that they were unable to cope with an extremely sick daughter who was threatening to jump from the small balcony leading off her bedroom. Their garden had turned into a lake and her parents were very concerned for her safety. Her father implored the doctor to make a house call right away. The year was 1993. In the manner of doctors then, the psychiatrist bundled up warmly and drove slowly and carefully during the forty-minute-drive to the given address. The patient’s father was waiting for him at his front door, holding up a lantern to light the way. He greeted the doctor with; ‘I am so grateful to you for coming, doctor, sir. It is such a vile night that I doubt whether I would even let my dog out in this kind of weather!”

 

The Price of a Miracle

When I heard the story I am about to relate here, I felt sure that my readers would understand why I posted it even though it has nothing to do with my usual blogging subjects. Please bear with me as we can all do with a miracle from time to time.

A little girl went to her bedroom, pulled out a money box from its hiding place in her closet and poured the coins out onto the floor. Then she counted them painstakingly – not once, not twice, but three times. She returned the coins to their hiding place, twisted the cap tightly, then slipped out of the back door and made her way to Rexall’s Drug Store which was six blocks away. She knew that she had to watch out for the large red Indian Chief sign above the door of the store.

She entered and waited patiently for the pharmacist to attend to her but he was far too busy. She moved her feet about on the rough wooden floor, making a noise to get his attention. Then she cleared her throat; … to no avail. The pharmacist continued talking on the telephone. Eventually she banged on the glass counter and that did the trick.

      ‘What do you want?’ the pharmacist asked in an irritated manner. ‘I’m talking to my brother in Chicago, you know. And I haven’t done that for a long time,’ he said, without waiting for her reply.

      ‘I need to talk to you about my brother,’ she replied in the same tone. ‘He’s really very ill … and, I want … I need to buy a miracle.’ 

      ‘What did you say?’ the pharmacist asked. ‘My brother has something bad growing inside his head and my Daddy says only a miracle can save him now. So, please tell me how much a miracle will cost, sir.’

      ‘We don’t sell miracles here, little girl. I’m sorry but I can’t help you,’ he said, his tone softening a little.

      ‘But I have the money to pay for it … and if that isn’t enough, I can get more. Just tell me how much I need to give you.’

 There was another man in the store who chose that moment to stoop down to ask the little girl a question. ‘What kind of miracle does your brother need?’

      ‘I don’t know,’ she replied, tears welling up in her eyes. I just know that he’s really sick and my Mum says he needs an operation. But, my Daddy can’t pay for it so I want to use my money.’

      ‘How much do you have?’ asked the man.

      ‘One dollar and eleven cents,’ she whispered. ‘And it’s all the money that I have. But, I can get some more if I need to.’

      ‘Well, that’s a coincidence,’ smiled the man. ‘A dollar and eleven cents is the exact price you need for a miracle for a little brother.’ He took the money in one hand and with the other, grasped her little hand saying; ‘Take me to your house. I want to see your brother and meet your parents. Then we will decide whether I have the miracle that you need.’

 That man was Dr. Carlton Armstrong, a surgeon who specialized in neuro-surgery. He operated on her brother free of charge and it wasn’t long before his patient was home again and doing well.

  ‘What happened was a real miracle,’ the little girl’s mother told her. ‘ I wonder how much it would have cost?’ The child smiled because she knew exactly how much a miracle was worth: one dollar and eleven cents, plus the faith of a little girl, of course.

I threw a chair, did you hear? Did you hear? I threw a chair.

 We were advised to book our son into a clinic and as he was not working, he slept by day and wandered around at night which was not a healthy situation for anybody. This clinic accepted psychiatric patients on a daily basis from 8 am until 2 pm. A few months later, the patient was then released and after being treated, and learned some life skills.

I decided to give this place a try as David’s doctor had recommended it so highly, so, clutching my son’s medical history in my hand, I drove to the clinic and waited  my turn to speak to the admissions clerk, who read the report I handed her then told me that they were fully booked and could only accept my son in a few months. By this time I was getting hot around the collar as David had recently been released from a psychiatric hospital and was in no condition to spend his time lying around our house all day long. The less he did, the worse he became and he had started talking about suicide.

I begged, cajoled, pleaded and then asked to speak to a social worker or psychologist. She asked me to follow someone in a white coat down a long, winding corridor and asked to sit and wait for a doctor, which I did. While waiting for him to arrive, my mind went into overdrive imagining life with David at home all day and I think I lost it. When the doctor walked in, I told him that I felt that they were behaving in an unacceptable manner even after he explained that there was simply no more room. ‘But my son is threatening to take his life,’ I said in a very loud voice quite unlike my own ‘and if something happens to him, I will hold you responsible, do you hear me?’ The doctor looked at me blankly and then, I did something that I have never, ever contemplated doing before and hope I will never do again. I picked up the nearest chair and threw it at the doctor. Yes, I did that. Me, a person who is usually well-behaved, and I would say rather mild-mannered. I lost it completely.  Of course I did not hurt the doctor, but he got the secretary to call my husband to report the incident and asked him to come immediately, which he did. My dear husband  left his office and rushed to the rescue, probably as worried as I was that my behavior might get me locked up in a psychiatric  hospital. He hugged me to calm me down, apologized to the doctor, smiled and somehow managed to change the atmosphere in that office. I have no idea how he managed it but it did not take long before our son, David, was registered and we were told to bring him to the clinic the following day.

The next morning the three of us arrived on time and David met with the doctor who was taking on his case. He seemed to be an empathetic man. His eyes reflected a lifeline and he looked like someone who had earned his wrinkles. If I closed my eyes when he spoke, I could conjure up the voice of the father bear in the story Goldilocks and the Three Bears.

“Why are you here?” he asked David.

“Because I heard that you have a great setup for playing table tennis. The guys also told me that the café opposite serves the tastiest felafels in town.”

“That’s as good a reason as any I’ve ever heard,” the doctor said with a smile.

David was drawn to his man the way he was drawn to his dad. They both had the same sense of humor. My son only spent a few weeks there as he failed to co-operate, so they released him and once again we had no idea of what we could do next.           

The following day I found this poem on my son’s bed.

 For years, few people cared about me.

The voices tried to convince me it was all a dream,

But even Hitchcock couldn’t have contrived nightmares like mine.

And all this because of an illness, a mental illness?

Everyone is against me

Especially my parents.

         

Are we losing the art of human touch?

The way medicine is being practiced today has put us in danger of losing a powerful old-fashioned tool, the human touch. When I had occasion to be hospitalized due to a serious rotator cuff Injury on my right shoulder, I felt as if I were a data base which made me wonder what would have occured if my arm had been amputated during my accident. Would the medical team have added this information to my computerized chart only after tests including a costly MRI had been called for?

Modern medicine is based on a  scientific model that seems to reject therapies that don’t fit into these plans. Because most doctors are trained in crisis care during their internship, they are less knowledgeable in treating the walking wounded amongst us.

When I was growing up, my doctor didn’t only diagnose my symptoms, he treated the underlying causes. What would I like my doctor to do today? I would like him to see me as an integrated whole rather than a mechanical machine. What has happened is that a person is divided into separate parts, each with its own specialist. Patients with the same disease are all treated the same way, but each person reacts differently. I need to be treated and not only for my disease. Tests and computerized charts have taken over and seem to have more meaning that the patients.

I believe that a doctor or a psychiatrist can tell a great deal by studying a patient as he/she walks into the clinic. And, if doctors were less involved with powerful drug companies, it might be to the benefit of their patients in general.

Doctor, do you really realize what it means to be chronically ill?

Chronic illness is a persistent disease, prolonged in duration, one that can usually be controlled but not cured. But this explanation can be found in every medical text book. Due to the fast growing aging population the doctor needs to know how to manage even more situations. What should he do? How should he behave? I think that he needs a patient-centered approach to make ill people feel properly cared for during every medical interaction. It is essential that the doctor take his patient’s character traits and personality into consideration.

There are patients who are more pain-tolerant, while others have trouble coping with increased disability and pain which affect them physically as well as psychologically. They are also coping with decreased functioning.

A physician needs to be empathetic, genuine and careful not to say anything without due forethought. Maybe the doctor could ask himself:-

• How would I feel if I had a disease that was constantly reducing my ability to do the things I did a few months ago?
• How would I feel if I experienced constant sleeplessness, pain and the inability to leave home on my own?
• How would I feel if I could  no longer drive, walk  my dog, do my supermarket shopping on my own, or lose the ability to feel comfortable attending a party?

To psychiatrists and other therapists

Please don’t let your patients feel that you are judging them. Your job is to make them feel as safe and as comfortable as possible. I am aware of the fact that this is not easy.

If a doctor comes on time to his appointment in a hospital, it will show his patients that they do matter. If you were in a regular hospital and called for emergency surgery, that would be different but you are working in a psychiatric hospital because you chose to do so.

When a patient’s parent calls, they are desperate and go from one crisis to another, so please take their calls or call back.

When a person with a mental illness is psychotic and maybe out of control, what are the parents supposed to do? They need your immediate input, you know. Those parents don’t have an orderly with a ready-filled-syringe to administer a shot the way you do in a hospital. They need help that minute.

A good sense of humor is helpful here too. I have seen it in action and amazed at the change in a patient when someone jokes with him. Maybe because it is such a common, daily, ordinary thing to do and makes them feel more ordinary.

Psychiatric text books tell a psychiatrist to keep his distance but they omit to add – a little distance only. Your patient needs some empathy; needs to know that you are human .

Doctor, can you imagine what it must be like for a person to lose his/her sanity? I can’t begin to imagine this. What I can suggest is that you give your patient something to hang onto – maybe even some hope. I know that nobody can live without any hope. Try this because no sanity and no hope is not the recipe for a return to a more or less healthy existence.

Doctor, do you know what it’s like to have a child that’s different?

Doctor, have you ever stopped to think what it must be like to have a child that is different from other children?

If I had been a blogger while my son were so ill, I might have sent you a link to my website which might even have helped you and your colleagues understand what was going on in our home then. The first time I came across a blog about mental illness in a family, I followed it religiously even though it was written by a mother I had never heard of nor met. There were days when her posts were difficult to read, but they were always helpful and thought provoking. That was when I realized that I was not alone. I understood for the first time how my readers could connect with me,  a total stranger simply because I was sharing a life experience that may or may not have anything to do with theirs.

I found myself changing. That blog became my life support as well as giving me a feeling of understanding, perspective and a whole lot to think about even though this was  difficult to handle. The mother whose blog I followed, knew that there was no cure for mental illness but she taught me to look on the bright side of life, to find new and interesting activities as well as a love of music. She made me aware of the fact that things do not always happen for a reason and that one does not always get what one deserves in life. Outwardly, I led an ordinary life. I tutored English, tried to give my other children the attention they deserved, and at night, discussed our son’s problem with my husband, searching for a way to help him, to help us all, a way out. I attended a creative writing group that has been my savior but a lot of the time I spent poring through information on the internet searching for a cure, a miracle cure, and then, any cure.

My blog remains the place where I can be free to write and tell my story to those who want to hear it and share my experiences the way that blogger shared her story with me.

Maybe it’s due to the stigma, but most of the comments on my blog arrive via email instead of on the blog entry, which is a pity. However, that will not stop me from blogging.

The model doctor

Doctor, please:

• Show respect to all your patients, irrespective …
• Try using a sense of humor.
• As your patient walks into your surgery, observe him.
• While keeping a respectable professional distance, showing a tiny bit of T.L.C. (tender loving care) won’t harm, you know.
• It’s not a bad idea to consider your patient and his/her family as a team players.
• Do inform your patient about any expected side-effects of medication.

 

 

 

 

Dear doctor, you might be a patient one day …

 Dear Doctor,

One day you might have the misfortune to be on the other side of the medical system and become a patient. A nurse will hand you a hospital gown that does not close at the back showing your rear end to all and sundry, and suddenly, you will understand how embarrassing that can be. You will lie in a hospital bed and feel just like the rest of us. When you need a nurse’s help, she might ask you to wait because she is busy with the more seriously ill patients. When your doctor friends follow the same recommendations you have given every single one of your patients in the past, you might begin to feel awful. Things like; ‘Don’t worry, you will soon be out of here. Or, you are getting the best treatment, you know.’ But, after a few days, when your condition persists and you don’t feel that you are being treated well or not being treated at all, you will find it hard to believe that you are simply not getting better. You might consult with some of your colleagues on the outside and be amazed to discover how callous their remarks can be, no matter how well-intentioned. Didn’t you say similar things countless times to your own patients? Oh it can’t be that bad, or, it probably started a while ago and you didn’t notice the symptoms. Don’t be upset, it is rather minor, you know. You should barely be aware that you have this complaint at all. ‘But,’ you probably replied. ‘Minor or not, it is driving me crazy.’ “Oh, it can’t be that bad,’ is what they shoot back at you instead of some tea and sympathy. Maybe a colleague will even dare to say, ‘It’s so minor that it does not even fulfill the criteria for treatment in a hospital.’ But you probably replied. Minor or not, I know how I am feeling!’

 My dear doctor – until this happens to you, you’ll probably have prided yourself on your communication skills with your patients yet here you are, being schooled on what it means to be in a hospital and worse still, without any sympathy whatsoever. And when you recover sufficiently to return to work in your clinic, will you remember that no matter how minor a condition is, it’s painful, frightening, depressing and very real to the person concerned? Have you ever wondered why after giving advice to a patient, he will probably ask; ‘Would you recommend this if your wife were suffering from the same condition, doctor?’

 

 

The operating theatre

 I had to have surgery on my shoulders after an acccident. The one side needed ligaments repaired but the other side was diagnosed as a rotator cuff injury which is serious and it’s usually something that athletes manage to do to themselves, not an average mother. I did as I was advised by my doctor which left me with no sense of control or power over the situation. Even though I was in so much pain, there were times when I felt invisible. I wondered whether the surgeon remembered my name, whether he’d studied my case history, seen the results of the innumerable tests I’d undergone, and whether he knew which shoulder he had to operate on – the right or the left. So, I took a pen and wrote a large R on my right arm.  He’d asked so few questions. Did he know how I came by this injury? Getting down to business and moving on seemed to be all he was interested in doing. I needed him to look at me straight in the eye. I needed to see a smile on his face or a sympathetic expression. But no, he was entirely focused on his work. ‘How painful will this operation be?’ I needed to know. ‘That’s hard for me to tell as I’m always on the other side of the operating table you know.’ I was hurting, afraid and very upset and I needed some human kindness. How come he didn’t know that? Shouldn’t he have learned that at medical school?