Whether as a promise or warning, our psychiatry clerkship director had informed us that we would be surprised to find how much we have in common with our patients. What he did not say is how much we would have in common with our patients’ parents. My first evening on call, we were told that a nineteen year old*, who had attempted suicide two days prior, would be transferred that night from a local hospital. I called medical records to have his electronic chart unlocked. As I read through the previous history and physical from a psych hospitalization back in August, I tried to picture this kid. Numerous times in the notes, they made reference to his ‘severe acne’. I conjured up pictures of the pocked, scarred faces of the skinny, loner boys in hoodies I pitied during high school. Surely this was he?
I waited for the intern to come to the floor. I did not want to interview this person by myself. What if he admitted he wanted to kill himself again? What if I didn’t show enough empathy and caused him to feel worse, more alone or more misunderstood? What if I showed too much and embarrassed him? What if I simply projected enough of my own anxiety onto him and around the room that it became more about me and not about him, alienating him even more? I sat nervously hiding in the physician workroom.
When we entered the room, my visualization had nothing in common with our patient. He was nearly a man: well developed, almost muscular and his acne had all but resolved. Wearing jeans and a tee shirt advertising a local restaurant, he was mindlessly picking at his arm hair. One leg was swung casually across the bed. His parents sat on opposite ends of the room, both perched on the edges. Dad rested on the ledge of the room’s radiator and Mom was on the hard wooden chair that matched the pine desk. His dad was wearing a suit, looking fragile and exhausted. He, too, was well-built but unlike his son, looked as though he had just gone through an ordeal. His mom had dark hair and vivid cerulean blue eyes. She glanced up as we walked in and I could feel the breath fill her lungs. She looked over at her son and gave a sad, half smile, ‘The doctors are here, Louis* she said softly. She stood up and crossed the room perching next to him on the bed. She turned to us and motioned, "They’re babies, Louis. They’re so young. They’re practically babies." She continued to attempt a smile, and it was difficult for me to tell if she was simply openly skeptical (and rightly so) of my psychiatric acumen or if she was trying to put her son at ease. I was struck with the thought that he looked infinitely more casual about the situation than they did.
I suppose one of the nice things about getting older is that I only feel pleased to be called young. There are days I feel overwhelmed and exhausted: a result of too little sleep paired the intense time required of young children and academic endeavors. Initially, I fought back the urge to reassure her that, I wasn’t young. In fact, I have four children of my own. But I didn’t say it because, unknowingly, Louis’s mom reminded me of exactly what I am: a student, fledgling in my career, allowed to ask obtuse questions and to fumble through interviews. I often feel that because I am a mother, I should be mature and accomplished enough to be good at this.
With that, I registered that I felt much more empathy for the parents than I did for Louis. They looked anxious: a sick, what-do-we-do now expression as their fatigue mingled with wits-end. I was partially curious, floored, and anxious that two caring, highly educated people had produced a Louis, a Louis who by most accounts had a whopping drug problem tangoing with a schizoaffective disorder diagnosis. Parents, who by all appearances and written accounts, loved their son desperately, but I imagine must have also been furious and yet terrified of him. I pulled back realizing that perhaps I was afraid of him and again, vaguely aware that I could be projecting my parental panic for my own toddler son’s self injurious behavior. Panicked that one or all of my children could end up like this despite, or worse, due to my best efforts, it is little wonder I had trouble concentrating on Louis’s answers to my first question.
After the interview, I finished the write up and drove home in a daze. I recognized that somewhere during the interview my attention fixed exclusively on the patient. While agonizing over his parents’ thoughts, I initially fought to keep his story, his feelings and his concerns as the focus of the conversation. I know I am prone to identifying with the parents; yet, being excessively caught up with their anxieties could interfere with my relationship with Louis. I attempted not to illustrate his story with my own transferred feelings and hopefully, this awareness will improve the quality of care I provide him. But that seems to be the trouble with motherhood: it can be hard to separate it out from how I see and interpret the world.
*Patient's identifiers have been changed.
msm is in her third year of medical school and has just had her fourth child. She enjoys running, cooking and being with children. It will come as no surprise that she's planning on going into pediatrics.