Wednesday, June 14, 2006


The Difference Is That I Can Get You High

I'm going to be a psychiatrist. Not a psychologist, but a psychiatrist. This seems to be a difficult concept for the general public to grasp. Even my dentist asked me whether I was a licensed psychologist yet. I replied by asking him how long he'd been a dental hygenist. I'd like to be able to say that I've wanted to be a psychiatrist forever, or at least since witnessing the primal scene at age 2, but that would be inaccurate (and weird). I've wanted to be a psychiatrist for about 2.5 years, which seems like eons ago, considering that I was also still wearing Birkenstock clogs at that point and hadn't yet discovered product, but which probably isn't all that long ago in the grand scheme of things. My Hospital ID Badge doesn't identify me as a resident in "Psychiatry," though. It identifies me as a resident in "Psychiatric Medicine." This is a very important distinction. It's meant to highlight the continuum between the mind and the body and avoid drawing absolute distinctions between psychiatry and the rest of medicine. It's also meant to bolster the egos of those who feel as though they are now entering a field entirely unrelated to the vast majority of everything they've studied over the past four years and who suffer from a mild inferiority complex when they find themselves surrounded by neurosurgeons at happy hour. I don't consider myself one of those people. When I'm surrounded by neurosurgeons at happy hour, I feel only a deep sympathy for their propensity for butt-cuts as well as an indescribable feeling of uncleanliness, possibly due to the sleaze that I find seems to radiate off of their bodies as they ogle female med students. The concept that I am dedicating my life to a pursuit that is largely denigrated by the general public does not bother me. As I said before, popular opinion isn't always where I place most of my stock. I used to worry about the stigma. It bothered me when a classmate commented, "Psychiatry? But I would think you could do whatever you wanted." It disturbed me when my mom responded to my excitement by telling me to wait for a year and then decide, before retiring to her room, no doubt to sob hysterically into her pillow while leafing through old photo albums and wondering where she went wrong. It turns out, however, that it wasn't simply a passing phase. And as I spent more time talking with psychiatrists and working on psychiatric units, I realized that psychiatry isn't just for foreign med students, or people who fail Step 1, or avoidant personalities whose fear of doing procedures outweighs all other factors that may be influencing their career decision, or even middle-aged men who live alone, take baths, and talk to their mothers on the phone every night, though certainly these groups are likely well-represented. It's also the field of brilliant, compassionate, dynamic individuals who love film and literature and who understand the importance of a balanced life. And if there are any lingering doubts about my narcissism, yes, I'm grouping myself more towards that final category, although I must say, who doesn't like a good bath?

Whenever someone finds out that I've just graduated from medical school, their first question is always "What field are you going into?" (Actually, their first question is usually, "How old are you?" immediately followed by the declaration that I look 14, or younger than their teenage son, or not quite old enough to take their daughter to the Prom, or just like Neil Patrick Harris,etc.) This is a friendly enough inquiry - it conveys the right amount of interest and buys even somebody who has no working medical knowledge at least 30 more seconds of conversation. This has also become my favorite question to be asked. I have friends accompanying me along my journey into psychiatry who do not like this question. They whisper the answer. They laugh before they reply. The smile and nod knowingly. They pretend to choke on their shrimp puff at dinner parties. They pray that their histrionic classmate will create a diversion at this precise moment. I, on the other hand, revel in this query. Male or female, young or old, Republican or Democrat - it doesn't matter to whom I'm speaking. With just the right amount of aplomb, I boldly reply "Psychiatry." This is the best technique I know of to discriminate amongst potential conversations at a cocktail event. I urge you to try it. Each person you meet will be instantly divided into one of three categories. There are the tactless souls who don't even attempt to hide their disdain and reply "Why?" or "Oh, I'm sorry." My favorite example of this first group came from my dry cleaner, who replied "Psychiatry? Jesus Christ. You and Sigmund Freud." I told him that he had astutely captured the exact place I want history to remember me - between the God of the Christians and the God of the Pagans. These are the people I usually string along by telling them that I'm actually lucky to be practicing medicine at all after that horrible accident in the emergency room where I mistook the patient's ventriculo-peritoneal shunt for a tapeworm and tried to excise it by myself. Nothing I say is going to alter their convictions, anyway, so why not have a little fun? The second group of people are those who immediately launch into a full life history starting with their mother's neglect of their pet rabbit and the sense of disattachment it created for them at the age of 5, hoping that you will suddenly offer the therapeutic breakthrough that they've been pursuing via seven different therapists over the course of 37 years. These people are best avoided. I find that a simple fake seizure works well here. For realistic effect, it's a bonus if you come prepared, wearing a medic-alert bracelet (either way, it, too, is an excellent conversation piece.) Once you've cycled through the first two groups a few times, you might be lucky enough to encounter someone who actually shares your enthusiasm. These are the people who require the most delicate handling. Very carefully reach into your back pocket and produce a card with my blogsite on it. Tell them to send me money and hint at a possible lucrative book deal in the future.

Your rant reminds me of peoples responses to my chosen field of pediatrics. The most common response I recieve from people is "oh thats so cute!" which I find nauseating.

Never mind I'm starting residency in 2 weeks and will be caring for 5 pound babies in intensive care who are missing entire ventricles.

Last night at a wedding a guy was explaining his job as a HR person in a pharmaceutical company - where he professed he literally did nothing every day and his job was a joke. He said he pretty much just encouraged people to do better every day, then he looked at me and was like "kinda like being a pediatrician huh." I was slightly stunned and then he asked "so what is the hardest part of your job?"

I narrowed my eyes and wanted to tell him about the two patients I had had on the wards who died of leukemia, and eating dinner with their parents on my night off at 11pm in cafeteria while they withdrew care.

Instead though I looked at him and said "sometimes I get picachu confused with transformers and it really upsets the kids."
um, hi! i know you. but don't worry, i won't throw your name in here and blow your anonymity. i just linked to your blog in mine. i am probably going to be applying to your program in a couple of months . . . good luck and i will be reading to see how it is!
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