Closeness

We held the interview in a small conference room in the administrative wing of the hospital’s locked psych ward. I remember a sunny day, and a warm roomer that would soon feel much warmer. My mentor, a psychiatrist in his late 40s, wore an ill-fitting brown sports jacket. He sat to one side, as invisible as he could manage to be, and never once interrupted me or my subject.

She was fifteen or sixteen, a kid who had bought herself a psych eval by attempting suicide. (It disturbs me how we punish failed suicides, but that’s another story.) I had a certain amount of ground to cover and I had fifty minutes to do it. Psych histories are precise things, as precise as anything can be in psychiatry, so by the end of my fifty minute hour my success or failure would be obvious to me and my mentor.

Any medical history is a Rashomon-like experience, psychiatric histories most of all. There is no truth, only the patient’s understanding of the truth. (One of my wife’s neurologists once told his students, “You should never forget that when you are talking to your patient, you are speaking to a sick brain.”) Bottom line, even though I was only a first year medical student, I grasped this idea — I inhabited this idea.

For me, a merely adequate history would have meant failure. I wanted this girl’s version of the truth.

I established rapport gradually, effortlessly. Before ten minutes had passed, we were no longer med student and patient; we were patient and fellow patient. We were in this together.

After watching The 40-Year-Old Virgin, Karen said to me, “You know what your problem is? You know how to talk to women, but you don’t know how to seduce them.”

Damn it. Like usual, she was right. I’ve never seduced anyone, not even accidentally. Karen, I overwhelmed with my cooking ability and my stories, badgered her with the wonder of me so that she never had a chance. This was not seduction, but an effective propaganda campaign.

J in the dorms — the one who fell for Tall Blond Blue-Eyed Jesus — bought me little gifts, left me notes, and laughed at my jokes, but when it came to physical contact, I was Quasimodo.

D stayed up late with me working on Physics 5 homework, and the way she bitched me out reminded me of GFv1.0. Surely, she would be interested? No, she only had eyes for some guy from the soccer team, who only liked her as a fellow soccer player, and not that way.

Carmela — and I know I’ve told this story before, but that’s how much I love it — Carmela told me on our first date that her father the longshoreman would kill her if she married a non-Catholic, or got pregnant, or, I imagine, came home smelling like lox and cream cheese. I couldn’t even steal a kiss from Carmela, that’s how frightened she was.

By the end of college, I had become used to the idea that women don’t see me that way, and it wouldn’t have surprised me one bit if they’d refused to associate with me altogether. But I have had a different fate. Women like me. They pour out their hearts; they volunteer their sexual histories whether I want them to or not.

At first, this was a cool power, like Superman’s X-ray vision. I learned in my twenties how to minimize myself, appear receptive, and ask the right kind of questions. I say “learned,” but all of this seemed to happen without any effort on my part. Eventually, it started annoying the hell out of me when women I didn’t like coughed up their deepest-darkests.

I learned how to turn it off in residency. By then, I had become too tired, too busy, and too emotionally drained to hear this stuff. Heaven only knows how many great stories I forfeited. Oh, I hadn’t lost it; I remember a phone conversation in which I teased out sexual kinks from J (you know who you are, you beer-swiggin’ vixen) she didn’t even know she had. Most of the time, though, I kept my li’l empathy feelers safely tucked away.

Back in my first year of med school, however, I was still flushed with The Power. I figured I was a natural born psychiatrist.

I did it to my mother once.

No, no, no, not the sexual history stuff. Eeew. Here’s how it played out: one evening, my mother, my father, and I drove down I-5 from the Bay Area to Los Angeles. My father slept in the back while I drove. Later, I found out from him that he’d only pretended to be asleep. I think I got bits of history out of my mom that even he didn’t know.

It was a creepy experience, equal parts exhilarating and disturbing. I wouldn’t recommend it.

My subject realized before I did that our fifty-minute hour was coming to a close. She had been animated, pleasant, generous with information. Now, as they say in the biz, she’d clammed up. By the end of our time together, she answered my questions with “yes” and “no,” nothing more. She wouldn’t shake my hand at the end, wouldn’t even look at me as she left the room.

“What was that all about?” I asked my mentor. “We were getting along great!”

“Don’t you understand what happened?”

“No.”

“She just said, ‘Fuck you.'”

“Huh?”

“You got too close. You’re nothing to her — you’re not family, you’re not a friend. You’re not even her doctor. Here you are, you’re with her for less than an hour. After that, you’ll never see her again. You’re nothing to her, and yet she let you in.” He shrugged. “It pisses her off.”

“You’re good, though,” he said.

If I’d gone into psychiatry, that man might have been Yoda to my Luke Skywalker. He had all kinds of cute, pithy phrases, like, “That’s logical, but it’s not psychological.” He seemed thoroughly comfortable and secure in a profession that attracted the unsettled and the disturbed.

It took me a few years, but eventually I figured out psychiatry wasn’t good for me. It’s a problem with boundaries. Okay, if I’m not careful, I’m going to get all Jane Fonda on you, but here it is. I’m good at crossing over the boundaries between people because my own boundaries are tissue-thin. In a perfect world, I would soothe the troubled soul like ice on a burn. In reality, I knew I would be like that empathy chick on the old Star Trek. She can heal others, but only by absorbing their damage.

Hey, I’m burning out on snot and ear wax. How do you think I’d handle an office full of folks with major depression?

D.

Neurosurgery for dummies

During internship, I had a one month rotation on the neurosurgery service. Neurosurgery had a one night in four call schedule with no general surgery duties, so we all looked forward to this rotation. The ward was abysmal, but the neurosurgery ICU nurses had the best reputation in the county hospital.

These nurses knew more about neurosurgery than I would ever know, and they rarely let me forget it. If you think this engendered a constant struggle for dominance, think again. Only a fool of an intern would go up against one of them, and he wouldn’t survive. The neurosurgery residents had learned to trust them. They certainly didn’t trust us.

Neurosurgery is a different world than the rest of medicine. Your patient was discharged today? Huzzah! And you say he left on his own two feet? I’ll buy you a drink. (more…)