“Okay, we need a new strategy. Who has an idea?”
Four medical students, two residents, and one attending made up the hospital’s psychiatric consult liaison service that month. We were responsible for every psychiatry consult in the entire hospital, and rounds ranged from the elderly man suffering from serotonin syndrome to the adolescent female who had a near-fatal side effect from carbamazepine. It was this service that taught me how to assess for capacity to refuse blood draws, manage acute psychosis and not to make any sudden movements in front of patients who had taken phencyclidine. I sat by the bedsides of patients for hours, discussing their alcohol addictions, suicidal ideations and propensity for panic attacks. It was my interactions with many of these patients that taught me to ask the difficult questions, initiate unique treatment regimens and explore the impact of psychiatry within medicine. However, no one had quite challenged me like she did.
She sat on her bed in a bright magenta shirt covered in glittery animals, with her arms folded tightly across her chest. Her green eyes were trained on the muted television broadcasting Disney cartoons, and her bed was strewn with coloring books and crayons. This scene looked quite different from the other overdoses we had been consulted on. Still, our attending calmly walked up to her bedside, introduced our bustling team and asked the universal question,
“Can you tell us a little bit about why you’re here?”
Silence.
“I know it’s difficult to talk about this, but we’re here to help you. Do you think you can tell us what happened?”
Silence. And more silence. Her eyes didn’t so much as leave the screen. We quietly left the room. The attending paced outside, exasperated by the lack of history and concerned by the inability to connect with her. We had a scattered story — a teenager who had overdosed on fifty pills of Benadryl, experienced tactile hallucinations and had been transferred from an outside hospital. Still, it wasn’t enough.
“Okay, we need a new strategy. Who has an idea?”
Silence.
“I have an idea. Let me try.”
I shrugged off my short white coat, distancing myself from my role as a medical student as much as I physically could. I knocked, walked back into the room and sat into the chair by her bedside. I watched Mickey Mouse dart across the screen, and my mind raced to fill the space.
“What are you watching?”
“Cartoons.”
“Do you usually watch cartoons? What do you do in your free time?”
“No. I don’t know.”
“Do you have any siblings?”
“Yes.”
I squirmed in my seat, wondering exactly what I had had in mind to miraculously acquire a history from this patient. I sighed and made up my mind to ask just one more question before I gave up.
“What do you want to be when you grow up?”
For the first time, she turned to face me.
“A therapist.”
I tried to hide the smile quickly forming on my face and casually let her know that I was just a few days into my time as a third-year medical student. In fact, I was still learning the ropes of simply how to talk to patients.
“So, let’s pretend that I was the one who had taken this much Benadryl. What types of questions would you want to ask me?”
To my amazement, she guided the entire conversation. She supplied me with her entire history, walking me through her decision to ingest two bottles of Benadryl. She has been stressed with schoolwork and fights with her friends. She wishes that she had instead turning to coloring, which was her normal outlet for stress. She plans on talking to her therapist about this during their weekly appointment and, in the meantime, asks me to give him a call.
These nuanced interactions are so common within pediatrics and are one of the reasons that I love the field. The opportunity to speak to the notoriously-difficult individual that is a teenager, coupled with the potential to truly establish a connection, is unmatched. The necessity of creative thinking to bridge these divides tests even the best clinicians. And, the clinicians that emerge victorious — rewarded with this connection — are the ones who recognize how powerful going back to the bedside can be.
Writer-in-Training
Loyola University Chicago Stritch School of Medicine
Sahr Yazdani is a fourth year medical student at Loyola University Chicago Stritch School of Medicine in Maywood, Illinois, and is a member of the Class of 2022. In 2018, she graduated from University of Michigan with a Bachelor of Science in Neuroscience and Evolutionary Anthropology. She enjoys exploring new cities on foot, watching reality TV, and baking ginger cookies in her free time. After graduating medical school, Sahr would like to pursue a career in pediatrics.