Dear Dr. Anonymous:
Are you a Phil, Michelle or Darrell? Two years ago, you booted my seventeen-year-old son out of treatment, signing your denial letter “MD Psychiatrist.”
I understand that you were hired to qualify, or disqualify, patients based on a cost-benefit analysis. Your letter suggested that my son’s condition could be “managed at a lower level of care.”
As a practicing child and adolescent psychiatrist, I’ve been trained to treat depression and evaluate suicidal risk. Yet when it comes to working with an adolescent who expresses a wish not to exist, trying to clarify what’s actually meant feels daunting.
I’m reminded of this one Monday morning as thirteen-year-old Paula sits across from me in the interview room.
“Let me die,” you say.
You’ve listed the reasons, presented the arguments: You’re a burden, a mere speck in a world of billions, one that will not be missed. A life that never asked to be born. Why prolong this pain?
“Please, let me die,” you say again, this time with a sob that allows no more words.
I hear you, I do.
It was my very first day of psychiatry rotation in my family-medicine residency at the Baylor College of Medicine, Houston.
This rotation took place at the old Ben Taub Hospital with its unmistakable odor–a combination of drugs, detergents, illness and death. Even if I were taken there blindfolded, one sniff would tell me that I was at Ben Taub.
At any rate, having survived my first seven months of residency, I was feeling a little more confident in my abilities.
Suzanne Smith was an elderly white woman who experienced a violent assault some odd years ago. Since then, she’d never been quite the same. Plagued by fears and sleepless nights, the concepts of medicine and psychotherapy were alien to her, and from my understanding in speaking to her children prior to her coming in, she wasn’t keen on speaking to medical professionals.
Having told me you’ve had low energy
and decreased interest
in the things you used to enjoy
(reading, Canasta, sex),
I ask you,
because I believe we have enough rapport—
though how can one ever be certain—
Have you had thoughts of killing yourself?
Seventeen years ago, I was a senior psychiatry resident, moonlighting on weekends in the psych unit at a small rural hospital. Usually the unit was quiet. In this remote corner of northern Canada, we were taught to value resources and avoid “unnecessary” psychiatry admissions.
Arriving one rainy Friday, I headed to the ER to let them know I was there. Among the mostly frail, elderly patients, one person stood out: a healthy-looking woman in her early thirties, about my age.
As a third-year medical student, I did a month-long psychiatry rotation in a large urban psychiatric hospital. I’ll never forget my first patients there: Christian Mitchell and Sabrina Smith.
Christian, only in his thirties, looked about sixty. He had the coarse, bushy beard of a mountain recluse, and his hair was similarly overgrown, with bits of unidentifiable debris tangled within.
About three months ago, I had a Definitely Racist Interaction at work. A patient—we’ll call him Allan—said to me: “I’d like a white doctor. Is there a white doctor available?”
Allan’s voice was even, but his attitude was provocative, as if he were testing me. I felt a flash of fury, but kept my face expressionless. Presumably the surgical mask I wore also helped to hide my feelings.
Beatrice Leverett
When I first met Jason, I was a third-year medical student halfway through my psychiatry rotation, and he was a newly admitted patient halfway through a nasty comedown from crystal meth.
He sat slumped in his chair, scowling, his face hidden by a baseball cap and black hooded sweatshirt, growling responses to my interview questions.
“Why do I have to do this? I hate this crap. I’ve answered these bullshit questions a million times. I’ve been in the psych ward a million times, and it’s never done anything for me.”
Reading his records, I realized that “a million times” wasn’t such an exaggeration. At only twenty-five, he’d been admitted to most of the local psychiatric hospitals. For several years,
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