Heart to Heart

Today my med student was looking really dysphoric on rounds so I asked him what was wrong. He told me he was feeling really hopeless about how hard it is to help the people under our care on the inpatient unit.

I decided to sit him down to talk about it. He brought up time constraints, space constraints, financial constraints, energy constraints. He brought up a lot of the very real constraints, challenges, and cruelties of inpatient psychiatric care and his own feelings of hopelessness and helplessness related to those. He spoke, as an example, about his patient that he just feels would really benefit from hours of daily psychotherapy from a really skilled practitioner.

And my first instinct was to come up with ways in which this patient didn’t need that, and to combat it with the small list of support items we do offer. Because those are the answers that have been given to me for years when I ask the same questions. Because those are the answers that help us sleep better at night and come into work easier in the morning. Because those are the answers that alleviate our feelings of horror and guilt.

But I stopped myself. Because I don’t think those answers are true or acceptable; I’ve been rejecting them for years. There’s never been a time in my life other than right now when I’ve longed to internalize them more. And that’s a big part of the reason this first month of internship and especially these last few days have been so tough. And it was really surprising to me how in that moment – talking to a student, someone I’m meant to be mentoring – it suddenly would have been much easier to say that stuff, and for a split second I almost did. But I can’t.

Because let's face it  medicine has got a lot of issues. Psychiatry has a lot of issues. We've got a lot of work to do before we should feel, as a society, proud of the work we do trying to take care of the sick and vulnerable.

So I said, “I know, right?” and “It really sucks.” and “I’ve struggled with these feelings too, for a long time.” I told him how it’s especially hard now as a resident when I’m in a position of slightly more power and responsibility but with even more red tape to wade through. I told him how hard it is to find a balance between perpetual outrage/frustration and self-care, but he had to try.

And then I told him that even though it sucks, that doesn’t mean it’s hopeless. Every day we can be better for our patients: I talked about two examples of improvements in my own practice with specific patients that I’ve worked on already in this first month. And every day we can keep our eyes on the long-term goal: we can work together, slowly, for real progress in the way we treat patients.

After this conversation I realized in medicine we don't have this conversation nearly often enough, if ever – I certainly missed out as a med student. So even though it’s monumentally frustrating to call this my biggest success of the day when I wish it was something bigger and directly related to patient care, I’m gonna take what I can get. And besides: helping take care of our med students and ourselves really should be considered a big win.