On this lazy, rainy Sunday, when the day and night meet at a standstill marking the death of summer and the birth of fall, I feel like creating a fire and thinking of sunshine.
I forget who told me about sunshine drawers. I feel that I can finally make one for myself. A sunshine drawer is a place where you keep mementos that remind you of happier times, a place to reach for when the days are dark and the moods are stormy. I will tell you briefly about three things in my sunshine drawer.
A few weeks ago, on my adult inpatient psychiatry rotation, I wandered through the halls to find a patient. Or maybe I was looking for an attending. Either way, my mind was otherwise occupied when the fellow medical student walking with me engaged in a short conversation with a patient. She caught up with me and handed over a rolled up piece of a paper. One might describe it as a tube, this patient called it a scroll.
The scroll had been addressed to me, and written on the scroll were pictograms demonstrating various martial art techniques. “Pull back and snap! Skipping into infinity” and “Stance w/ scream. (Whisperer) Brain realizes importance. Bent Legs.” are some examples of the written subtitles.
The patient felt that I would benefit from this knowledge. I had, however, never actually talked with him before. I heard his case mentioned on rounds, that he has a history of bipolar disorder and is currently receiving treatment for a manic episode.
When I saw him the next morning, I stopped to say hello and thank him for the scroll. After all, it is my first gift from a patient. A monumental moment in a physician-in-training’s life. We played a bit of hacky sack with one of the stress balls in the hallway and I told him about some of my tattoos, because we shared a love of Avatar: The Last Airbender.
His face revealed the shock he felt and then he asked if I was kidding. “Nope, real tattoos.”
I think I said something to the effect of: “You don’t see many doctors with tattoos, do you?”
And he countered with, “You don’t see many doctors with ponytails.”
The next entry in my sunshine drawer comes from the sister of a patient.
I met the patient on my first day of the adult inpatient psych unit, almost seven weeks ago. On that day, she had already spent twenty days on the unit for mania and paranoia. She was a verbal tsunami that first day. I remember on my way out, she told me that I will drive all my patients wild with my good looks. I blushed and thanked her for the compliment.
Over the course of her long admission, lasting exactly sixty days, her mood slowly stabilized and her delusions receded. I remember the first family meeting with the sister, a tense hour-long affair. The delusions were strong at that point and this patient kept a hostile tone despite talking to me about forgiveness prior to the meeting. I confronted her about the tone, and I think we salvaged the meeting.
We found out afterwards that the sister had Stage IV ovarian cancer. At the next family meeting, we learned that the sister will head down to Philadelphia for cancer treatments because the Lehigh Valley had no more options for her. In other words, she will likely die soon.
The treatment team began to understand the sister’s role more and more. She is dying and trying to wrap things up before she leaves: a sister with mental illness, a brother with intellectual disability, and a father succumbing to dementia. We came to the conclusion that this sister is doing everything she can to care for those she loves.
As I rotated off the adult service and onto the adolescent unit downstairs, this patient began moving towards discharge. This past Monday, I heard from the case worker that she is heading out on Wednesday. So on hump day, I made the trip upstairs to visit her and her sister before they left the floor. For good, I hoped and dreaded, respectively.
As I walked into the familiar room, they were talking with someone from one of the treatment teams. I apologized for the interruption and expressed my desire for an earnest goodbye. The sister stood up and gave me a solid hug. I leaned over to give the patient an embrace while in her wheelchair.
Before I left, the sister stopped me and asked that I remember her face.
She asked me to think of her whenever I have doubts about my career in medicine and psychiatry, “because you changed my life.”
In response, I smiled and thanked her.
And finally, I received a heartfelt letter from a patient.
He discharged from the unit a few days ago. Since then, whenever I’ve interviewed other patients, I have thought of him and our conversations. Because of him, I learned to trust my intuition with the adolescent patients. That I should challenge them and give them homework that forces them to face discomfort and grow into themselves.
He is a young trans man, biologically female at this moment, and still trying to understand what it means to be trans at the age of 16. I conducted the intake interview, talking about his suicidality and how his mother does not accept his trans status on a religious basis. As his admission wore on for almost ten days, I enjoyed our rambling conversations together.
During one of those discussions, I noticed he kept pulling down his pant legs, leaving no ankle skin showing. I asked him why he hid his legs: because his family would make fun of his hairy legs. I challenged him to hike up those fuzzy pants to proudly display his masculine nature while on the unit. After all, if he wanted to undergo hormone therapy to affirm his male gender, then showing some leg hair can be a small first step.
About halfway through his admission, I had wrapped up a conversation with him when the nursing staff let us know that his father just arrived for a visit. For the past few days, we had talked about how he had come out to his mother for a less-than-receptive welcome and how he was afraid to tell his father. He felt that his father already knew, but never had the courage to say the words. I asked him if he wanted me to stick around for the meeting.
I was glad to hear him agree. The meeting went well. The case worker and I had to pull the words out of him that he is trans, but eventually he said the words. The father expressed unconditional love and support through these challenges. The patient was incredibly nervous and anxious throughout. They embraced before ending the meeting.
I spoke with him the morning of his discharge. I gave him all sorts of assignments to complete while on the outside. First on the list: watch Queer Eye Season 2 Episode 5, where they revamp the life of a young trans man. I figured this would hit home for this patient as a view of what life could be like, if he stayed alive long enough to see that reality.
We both held our emotions in check until I got up to go: offering a crisp high-five or a firm handshake since physical contact is not permitted on the psych floors. I could see his eyes beginning to well up and the flush of emotion across his face. So I opened up for a hug and a quick goodbye. I wished him well as the floodgates opened, knowing that I wouldn’t see him again.
A few days later, I had just wrapped up another intake interview when one of the techs told me that a patient had written me a letter and it was posted on the wall of the nursing station. I hurried over, picked it off the wall, and folded the letter into my pocket without looking.
I knew who wrote it without checking and I wanted to read it in private. I had assigned him a daily writing challenge: to write something everyday no matter how long or short. He wanted to write a novel one day, but had fallen off of journaling and his writing of fiction. So I asked him to simply keep writing. The work need not be good, but the work needs to be done.
And so he used the writing of the day to pencil a thank-you note to me. I will frame it one day and hang it proudly in my office or study. To me, this letter feels like redemption for failing past patients and enduring previous mistakes.
I might not change the world, but at least I helped this one human.
Long Form Sundays
- On plastic patient populations
- On a good week (or the beginning of Child/Adolescent Psych)
- On quick reflections (or Inpatient Psych: a post-mortem)