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Archive for October, 2010

Sometimes I wonder how my work in psych is affecting my future work as a physician. One might say that I could simply look at psychiatrists that have been practicing for a couple of years to see how they change, but my role in their care is very different from that of a physician.

I’m the one they curse at when dinner is late. I’m the one holding their hand while a new IV is put in. I’m the one that makes them remove their own clothing and put on a hospital gown when they are admitted. I’m the one who sees the faces of their family members as they enter the locked unit. I’m the one who gets hit. I hear their insistence that they’ve learned their lesson. And I hear the same plea on their next admission.

So yes, my perspective has changed.

One of the best things that has changed about it is the realization that I can’t change people. I can facilitate and support that change, create a good environment within the hospital to further help that change, but ultimately the patient is the only one who can make that change. And my powers are even more limited than that–once they leave the controlled climate of an inpatient unit, I can’t promise that their home environment will be conducive to the change.

I am not one of the bright-eyed students who crumbles at the first “failure.”

But I also see the darker side of people. I am not the innocent person who takes anyone’s words at face value. I listen carefully, I read body language, and I fact check to see if the patient is being truthful before I trust what they tell me. I’m not sure if this is a bad thing or just neutral. On one hand I don’t automatically trust patients, but on the other hand I don’t label it as a lie until I’ve checked into it further.

What else?

I shrink away from a raised hand. I get really nervous when a patient stands in a doorway and I have no way out. I don’t take insults and curses personally. I can calmly listen to a manic rant that rips at my character and continue on with life. I have become a decent mediator. I am unfazed at any display of anger or intimidation. I can stand my ground.

I have great sympathy for the families who are torn by their loved one’s illness. I have sympathy for the patients who don’t get better. Sympathy for the ones who can’t seem to cope with life in non-destructive ways.

And I take great joy in watching someone leave as a different person and hoping (for their health) that we don’t meet again.

I think this experience is good. I will have a different perspective than most physicians. I will know that what they tell me in the 10 min I see them on rounds is not the whole story, I will have an appreciation for the people who spend every hour working with them.

I will realize that sometimes I will fail, but I will take even more joy in the success of a patient because of it.

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….with my habits.

I’ll admit it: every time I start with a new therapist, doctor, etc. I test them out. It’s a game. How far will they let me go? How serious are they? Do they follow through with their threats? Do they even remember the instructions they gave me at the previous visit?

I do it in a toned-down fashion with a lot of people in my life. I want to test the limits–not because I am an adventure-seeker, but because I want to know exactly where my boundaries are. So I go all the way to the edge, my toes hanging off the cliff, just so I don’t mistakenly fall off it later on.

So I did this with E (my therapist).

How much weight could I lose before having something more strict put into place?

How many weeks could I go without gaining before those rules tightened?

Could I lie about my food and exercise, not gain weight, but still avoid the threat of partial?

The answers? Yes, Yes, and a resounding NO.

I do have that sense of security by knowing where the boundaries are now, but it is darkened. Darkened by the hurt I saw on her face and heard in her voice as she questioned my honesty. Darkened by my shame that not only was she was questioning my honesty, but she was right to do so. Darkened by the fact that I still want to go further…

Today I went grocery shopping and it honestly terrified me. I haven’t felt this way in the grocery store for a very long time. Since my stint in partial last winter I don’t always enjoy grocery shopping, but I go, I get wound up reading food labels, I look at foods that I would like to eat but won’t let myself buy, and I spend an inordinate amount of time doing it all.

Today I had this sense of dread the whole time. I couldn’t stand to see all those foods, the smell of food made my stomach turn, I could barely think straight enough to get the celery, lettuce, and grapes I had initially stopped for, I knew that I should pick up something for supper but I wasn’t sure I could stomach anything.

On the bright side of things….I did buy something for supper. And I ate it. It was incredibly unpleasant, uncomfortable, and I thought I was going to vomit the whole time, but I made it through.

 

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The past few nights I’ve had very similar dreams.

They each start out with me visiting a doctor…one I have now, or have had in the recent past, or even as far back as my childhood. I’m always going in for a routine physical. Each doctor weighs me, and examines me and then declares that I need to go into eating disorder treatment. I am too thin. I am sick.

The remainder of the dream consists of me attempting to convince the doctor, my parents, and my therapist that I am not that thin, I do not need treatment, I am not sick enough. I try to wheedle my way out of going:“there’s no reason to send me tomorrow…tomorrow’s Friday and then it’ll be the weekend. You should just wait until Monday.” “But I haven’t seen therapist! You can’t send me to treatment without talking to her. She’s out of town until Wednesday.”

Invariably, at some point during each dream I sneak away from everyone to go for a run, I avoid eating at meals, and I hide from whatever person is supposed to take me to the hospital.

Such strange dreams…

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Hard Times

…Hard enough that I’ve been working on this post for a few days now…

Last week my therapist set an ultimatum–gain weight by October 13 or go back into treatment.

I gained weight…2 lbs. And it was hell. I felt like the entire week’s worth of food was sitting in my stomach (which may actually have been true…delayed gastric emptying, constipation, all those most pleasant ED side-effects). I was still just as exhausted. I still couldn’t focus.

All that discomfort for nothing. No improvement mentally, no change physically (except feeling massively large).

And I was congratulated for my honesty–in what I wrote, in my exercise, etc.

But I wasn’t honest. I made up most of those meals. I ran [currently only a 20 min walk is allowed], more days than I am allowed to exercise. On top of that I biked to work/school every day.

And honestly, most of the time I don’t care.

I used to pride myself on being honest. I couldn’t tell a lie without feeling terrible about it for weeks, if not months, afterward. I am still that way in some areas of my life…but when I get totally comfortable with lying about food and exercise, I’m pretty far in.

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