“Good afternoon, Ms. Starflight. My name is Samantha Miller, and I am a student doctor working with Dr. Singh. I know you have answered so many questions in the past few hours, but do you mind if I ask you a few more?”
Haha, ‘Starflight’, what an alias? How can these people be so uninhibited? Sometimes I’m not sure I’m even seeing real pathology. These people are just like me with a little less holding them back. The only difference between them and myself is a short white coat. Well, not even that since we can’t wear them on this rotation. Well, a coat we can’t wear, and a few exams. Wait? What if ‘Starflight’ is her actual name?
Patients say that things whisper to them. What do these whispers sound like? We did that exercise last week in didactics, but those voices didn’t whisper.
I wonder what it is like to take pills. Would I stop having these thoughts? What if I am just hiding an illness so deeply that it is hidden from myself? How many people would walk out of my life if they knew I had these thoughts? How do I avoid mania? Hypomania really doesn’t sound that bad. What if I am dysthymic?
Focus! Focus on what the patient is saying to you! You’re going to have to present this patient tomorrow. What are you going say? That this patient is your kindred spirit? Stop scaring yourself!
“Is there anything more about last night leading up to your admission that you would like to discuss?”
She’s staring. She can sense my lack of concentration. She knows what I am thinking. We learned a word for that. Wait? What did I just say? Where is my DSM-IV? Hmm, I might as well check the DSM-V, even though boards will be on IV, but the residents keep referencing V. The clerkship director says it is not that big of a deal.
Her eyes are so sad. I wonder if my eyes look that sad. What is your problem, Samantha? This is not about you! Mood. Affect. How do you feel? How does she feel? How do I feel? Can a rotation make you think strange things? Samantha, are you really going to blame the rotation? It has only been three days. Focus!
“Do you ever have any thoughts of hurting yourself?”
How do these people answer all of these personal questions? Don’t they know I am a fraud, that I’m not a real doctor? I’m a nobody trying to find meaning in life through service. I’m a girl (ahem, adult) struggling with early waking hours and daily professional dress. Focus!
“Tell me about your support system.”
That question was so awkwardly executed. I tried so hard to ask an open-ended question. That is what they told us to do. They also told us to show empathy. I’m feeling for this woman — no, I really am. Can she see that? She only sees that I’m a fraud; she knows I can’t help her. The residents say that students are helpful. I don’t feel helpful. I feel like I am constantly in the way. I wish I was smarter. Maybe I would have done better on boards. Maybe the residents would like me better. Maybe I should give up this journey, avoid the embarrassment of not matching anywhere.
Stop that talk! Focus!
“Tell me about your diagnosis of schizophrenia and what that means to you.”
She’s my age, earned a degree, and was then diagnosed with schizophrenia. I’m so fortunate. If you keep thinking about yourself, do you really care about her? Of course I care. I didn’t have this problem in my last rotation. I wonder what taking a benzodiazepine would feel like.
“Do you feel like the sertraline has made a difference in your life?”
Ugh! That wasn’t open-ended. Failure. How do I make that open-ended? “What are your thoughts on the effectiveness of the medication?” Too late now. Some people are such naturals at interviewing. They say it is like having a normal conversation, but it isn’t. Maybe it is and I don’t know how to have a normal conversation. Maybe something is wrong with me.
“Do you feel like there are people in your life that you can trust? People that support you?”
I just did it again. Failure. Do I even look professional? Am I striking the right balance between showing empathy and maintaining professional detachment? I find it so hard. All their stories are so sad, I just want to hug them all and tell them it will be okay. I just want to go to church and thank the Lord for giving me the life I have.
“Well, Ms. Starflight, if you do not have any further questions for me, I will leave you to get some rest. I really do appreciate you talking with me. I will be sure to let Dr. Singh know of everything you have told me. He will probably have some additional questions for you as well before deciding how we can best help you. Goodbye for now.”