Telehealth mental health or in-person mental health? That is the question. There are mixed opinions among my colleagues, just as with other areas of specialization. As a psychologist in private practice, I’m on my own in this decision-making morass.
Back in 1956, after completing my first year in a rotating internship, I had a few months off before reporting for duty in the US Army. I spent six weeks of that time covering a busy, primary care practice.
As the doc headed for the door, he stopped long enough to advise me on two points. First, he said, “One, all you need for record-keeping is a few 6 x 8 cards. Onto those cards you can write the patient’s whole story. Two, NEVER let the patient know that you don’t know something.”
I’ve spent the last eight years as a foreigner in the U.S. My last two years of medical school, I did my rotations in the Washington, DC, area, but had to leave the country every six months to renew my visa. Each trip, I would think, Will they let me back in this time? My stomach would migrate to my throat every time immigration officers directed me to secondary clearance. I felt like a criminal. They scrutinized the letter from my school validating my credentials, looking for a reason to kill my dreams.
I thought things would be different once I was a resident. But no one had told me that if I wanted to travel “freely” I would have to leave the country to renew my visa stamp every year. Who has the time or money for that on a resident’s salary? I traveled back home just once during my three years of residency. Imagine not seeing your family for two years, praying they stay well until you can hug them again. But when an officer yet again inspected my documents with doubt and scrutiny, he could not seem to look past “Immigrant” to see my “MD.” The uncertainty surrounding being
Tim sat across from me in the small exam room. He was a friend, a colleague, and my doctor. He’d seen me for many years. “We’re walking a tightrope,” he said. Tim’s words rang true. We were balancing my many, complex medical problems.
For me, each day had bocame a carefully choreographed dance. Medications, IV antibiotics, a feeding tube, breathing treatments. A series of precisely coordinated steps, all to forestall my death. I learned to duck under the terror, to tamp down my fear.
I’m not sure why I scrawl quotation marks around the word “dead” when it should be bolded or underlined.
During a regular physical two years ago, my internist offhandedly commented that he’d heard lung sarcoidosis can recur. I smiled to myself as I thought how strange he should mention that, exactly fifty years since my own diagnosis with the disease. I remembered its onset as if it were yesterday—bronchitis, Bell’s palsy, the painful bumps of erythema nodosum, general respiratory symptoms, and a positive skin test.
My subconscious is wiser than I am, and I’ve learned to pay attention to what awakens me at 3 a.m. Maybe others have had that experience, too ― no patient, no friend, no one ― has ever complained when I call (after sunrise) and start with, “I woke up this morning thinking about you.”
Part of why the subconscious is wise, I think, is because it gets to work in a brain that has slowed down from the too-busyness of the day. In the stillness of the night, it asks, “What about this?”
Even as a child, I realized that the only constant in life was change. That recognition brought me angst, resulting in many panic attacks. I am a person who likes routine. I am a person who likes to know what tomorrow will bring.
Dear Pulse readers,
I think it’s fair to say that we’re living in uncertain times.
A pandemic, urgent calls for racial justice and an election year all cry for our attention against a backdrop of global warming. The stakes are high. The outcomes are still unknown.
At the same time, in our personal lives, we need to make choices based on the information at hand. It’s not always easy.
Jack’s schizophrenia prevented him from understanding the importance of taking antibiotics for a diabetic leg ulcer. As a student nurse, I was caring for him on the psychiatric unit where I worked. Based on his olive skin, Jack may have been of Greek descent. Average height and weight, he had thinning black hair, beady eyes, and a hooked nose. Jack’s face remained expressionless, and he usually kept his head down, shoulders hunched.
He’d been found wandering the streets, years ago, so we didn’t know much about him. Jack rarely spoke, and I wondered if he’d suffered a trauma earlier in life.
I was a brand new pediatrician, the most junior faculty member in a medical college in India. The typical diagnoses were different from most that I’d seen in my residency, which meant that every case was like a puzzle. But I was enjoying the challenge, as it led to lots of interaction with faculty in other departments.
I’d been an activist and in protests since college. But this felt “low risk” compared to standing up as a medical student to the hierarchy of medical education.
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