My resident said that the other day, right after a patient of ours walked out of rounds.
The patient was a man who acted even younger than he was. I had met him before, and like everyone else on my unit he was wrestling with an addiction.
From where I was sitting, he was making progress. The first time I met him he couldn’t keep his mouth in check to save his neck, and he had a critical word for everything from staff’s interpersonal skills to the clinical management on the unit. While thus acting in loco JCAHO, he found himself too busy to make it to many of the therapeutic groups; though he found tremendous therapeutic benefit in the big-screen in the day area.
He did what young people who act that way tend to do – left the unit with a crappy plan and then relapsed post-haste, to return some time later looking even more beaten up. Such is the nature of the beast.
It could have been worse. First off, he was still alive. He didn’t stay out all that long before he came back, and he left with a (slightly) better plan. After some frank discussions with the nurses about the value of keeping one’s mind on business, he seemed to spend a bit less time talking about others’ failings and more about what he should be doing. He even reduced the F-bombs to every fourth sentence, thus perhaps improving on my performance in that area. Still, this was gradual improvement; nobody would mistake this admission for a life-changing epiphany and there were no shafts of light and celestial choirs to be noted.
So, really, this looked like business as usual to me. Then, on the last day as he was walking out the office, my resident said that.
My first reaction was that was a really odd thing to say, and I had no @#$^ing idea what that meant. My second was to notice that every other person in the room obviously did.
A thing you might want to know is that, as usual, everybody on my team is female. That could just be a consequence of demographics. Both nursing and social work are female-predominant professions and doctoring is going that direction too. It’s happened so many times in my life, though, that I suspect there’s something more to it – like how I kept winding up with the really chronic, refractory patients when I was a resident; while one of my crew who ended up treating eating disordered patients had a waiting room full of thin, depressed young women. Your people tend to find you, or vice versa, and there’s some funny juju to that.
As mentioned, it became instantly clear that something was going on that was utterly obvious to other people and lost on me. I employed the combination of odd facial expressions, quizzical noises, and curse words which my team has come to understand as a request for clarity.
My resident splained it for me. (This may be irrelevant to the point at hand, but she is aces. Sharp, thoughtful but quick, with that intuitive diagnostic sense that marks the true Jedi.) This isn’t verbatim, but I will try to get it close:
“I talk to him and he’s so flirtatious and it just never stops. He does it to all the women. Sometimes I just wish I was a guy and I didn’t have to deal with it.”
Again, every other head in the room seemed to be nodding. One looked downright disturbed, now that it was said out loud.
Doing psychiatry changed me in a lot of ways. I look at things with a slightly different set of eyes. It also has knocked a lot of humility into me. It is tremendously easy to make judgments about others until you have heard their story, and wondered, if I started out that way, would I have ended up any differently? Appreciating the complication of human life is hard unless you’ve had an inside view of so many of them. Yet, here I sat, with my much-vaunted perspective and skill in observation, in a room full of people who I work with constantly and who bail my a@@ out of trouble on a very regular basis. Every single one of them was going through something right in front of me that I knew absolutely nothing about. Suddenly I had this feeling that we were in some Star Trek episode where we were slightly out of phase with each other, in some overlapping not-quite-the-same realities.
I have never once had any patient encounter in which I could walk out and say, I really wish I was a girl so I didn’t have to deal with this crap. Sure, I have dealt with my share of female patients with warped transferences – from the needy and dependent to the psychopathic and manipulative. Usually, though, the tricks are more along the lines of Oh, you’re so very very smart and handsome Dr. C. Thank you for your brilliant advice. Sometimes consciously manipulative, sometimes just an automatic pattern. Yet very seldom dismissive. If anything, the opposite.
I flashed to a time when I called this guy on his language. More than a little hypocritical, I know, but I do try to clean it up in public. He walked out of the room with his eyes down and the last words he said were, “Yes, sir.” I could joke and engage him, but if push came to shove I could also pull out the, “I have the grey hair and the letters after my name so settle down, kid,” routine and it would probably work, at least while he was in front of me.
As it turns out, that probably had less to do with the grey hair and the letters, and instead was about having a Y chromosome.
I started thinking what it would feel like to be capable, experienced, wise, and loaded with general badassery as all these folks on my team are, and yet to be standing in front of an immature misguided young man who nonetheless treated me like somebody he was trying to pick up at a bar.
It felt really, really icky. I-need-a-shower icky. Then the more I thought about it, the more it made me mad.
This would be the place where a large proportion of the population will be slapping their collective foreheads at my naivete, and I certainly have to cop to that.
I am not sure I have a point in this other than being slightly dumbfounded at my own ignorance. I have the strong sense I’ve been doing something wrong. I don’t quite know what, and it’s not coming clear to me yet.
I think this is going to be on my mind a while.