Psychiatry was such an eye opening experience into mental health. I first started my rotation in internal medicine which appealed to me in so many ways because it required so much thought generation. There was never one perfect way to treat a patient, which opened my eyes to medicine being an art form. The art of medicine involves a balance of caring for your patient so that you’re never going overboard with medicine administration and never doing too little in terms of laboratory and test ordering. A differential diagnosis on patients is such a work in progress, much like a “wet” oil painting. The colors looked different each day you arrived to view your canvas (your patient). Each day I would see how those colors that were on the palette interacted and could be manipulated so that you could produce the best finished piece possible- ultimately healing a patient.
I had the privilege of working with Dr. Chanda Dihenia who reminded me of my reasoning behind my career choice. For the first two years of medical school, I slowly slumbered away into a silo of studying to the point that I lost touch with several of my good friends. The constant stress was enough to break me, but I made it through. The breaking point almost came trying to manage my business courses that I was taking concurrently with medical school in order to complete my MBA. Fortunately- I maintained my sanity and finished the MBA and put my first two years of medical school in my back pocket as a token of success.
Back to Dr. Dihenia’s influence…
One of the most important lessons I learned from her was compassion- no matter the circumstance. I also learned the beauty of hospice. We managed several patients whose bodies were failing with the cancer that riddled them. There was moment in particular that I remember. We entered a patient’s room early one morning while rounding and we were immediately granted with a family concerned about their father that was close to dying. We provided the appropriate opioids so that our patient could have “comfort care” during the dying process. Hospice was involved to help the patient’s family understand the emotions and healing process that would take place when their friend and father would pass away. The patient looked like he was at ease for the first time in our weeks of care- as if his burden of pain were miraculously gone. As we left the room Dr. Dihenia asked our team if we could see the angels wings lifting up the patient while we were in his room. Although I didn’t have the same insight that Dr. Dihenia did that day, I did realize that death is a very incredible process. I came away from that moment realizing we enter this world with nothing, celebrating a true birthday. We leave this world with nothing as well. It was very surreal moment in my medical career, but a lesson on comfort care and the process of healing that I’ll never forget.
OB/GYN was a rotation that was interesting as well. I honestly went into OB/GYN thinking it might be a field that appealed to me. I had several mentors and friends growing up that encouraged me to pursue obstetrics. I was told that I calm people down during moments of stress- that I had that “calming” effect. After all, I am the guy who is probably a little too sensitive during movies, the guy that paints, the guy that enjoys music, food, and style- the guy in touch with his emotions. Not a bad thing, but I wonder if I need to go camping for a week or so to retrieve my man card since we don’t have that luxury of sports any longer as medical school students. Delivering a child into this world was definitely a "medical school defining experience." The birth canal isn’t exactly the largest place to transverse. It was scary to pull and tug as the child’s head (if we were lucky and he wasn’t breeched with his feet coming first) showed itself into our world for the very first time. We’d wiggle one shoulder out at a time and suddenly the child was taking his first breath in our world as his lungs pumped oxygen to be exchanged for carbon dioxide- oxygen then raced to mitochondria in various cells throughout that child’s body in order to provide a fuel essential to life- a process we all come to appreciate as physicians, nurses, pharmacists, microbiologist, and biochemists. There is nothing that can quite compare to celebrating a child’s first day of life.
Psychiatry again played into my skill set as well. I enjoyed listening to patients most of the time, but did catch myself wanting to tell a few patients to suck it up. You’d be surprised how much pain disorder, factitious disorder, malingering disorder, and hypochondriosis exist in a our family, friends and neighbors- even that person checking out next to you in line at whatever store you happen to be visiting that day. I also realized how many disorders in my own family influenced my ideas of what I could diagnose myself with. Did I get the genetics that hindered my grandmother and her mood swings and hallucinations that went along with her bipolar disorder… did I inherent the DNA that would produce protein products through gene transcription ultimately making receptors, clefts, neurons, neurotransmitters- all combining for an excess of dopamine and ultimately schizophrenia that plagued my uncle? Fortunately I think I missed out on the genetic inheritance of those genetic predispositions. My parents were amazing to me as well growing up- and fortunately I didn’t experience any of the abuse that often plagues our psychiatric patients lives. Abuse is one of the most powerful influences in our lives- an inevitable fact I also took away from psychiatry.
I left psychiatry realizing the mind is such a powerful organ- one that we simply do not understand- although we’ve done an amazing job with our analysis of neuortransmitters. I realized the consequences of what utlimately happens when we lack those neurotransmitters or have an excess of them. I gained an insight into personality disorders- clusters A, B, and C- as well as ego defenses- mature, immature, and neurotic. This was enough to make you sit on your back porch and map out your own response to life and all the personality disorders and ego defenses you had acquired over time. I enjoyed thinking about the way my mind has adapted and grown – responding to all of life’s events during long runs and painting. I tried to avoid diagnosing myself- although it was difficult at times.