Ding Dong! Psychiatry’s at the Door

Foreword: I don’t write about my work very often, in part because I have a deep respect everyone involved in it and I don’t want to be mistaken as insensitive.  I understand, quite well, the limitations of medication, the mental healthcare system, and we, who work within that system.  I also understand my patients more and more each day.  I know that people reaching for drugs and alcohol on a regular basis are doing the same thing we are all doing much of the time—trying to avoid negative emotions that range from pesky to excruciating.  It doesn’t make them junkies or lazy or crazy—it means they are human.  And because this job (and life) can feel quite heavy at times, let me provide a little insight into how I smile and move through the week without being flattened.  

Good hell, people—what a week!  When I arrived at work on Monday I was met with the questioning faces of fifty social workers wondering if I would be going in the field for clinic—all clinic—during this COVID-19 crisis.  [Translation: field means I drive to the places where my patients live and frequent for their medical appointments.]  

It’s hard to say no to fifty social workers who have probably done more selfless acts yesterday than I’ve done in the last four years (and don’t be mistaken—these kind hearts are doing some pretty badass work).  Plus, I have these stupid beliefs about myself, like, I am a team player.  So, I found myself committing to see all of my patents “in the field.”  And so for the past week, I have been daily touring the less desirable real estate of San Diego.  

I don’t terribly mind the driving or the fresh air or the sunshine.  The main thing I don’t like is the pile of chart notes I have to write when I get finished.  (This is not the norm for me when I see patients in the office.)  But as I was out and about this week, I tried to register some of the more interesting parts of the journey.  Here’s what I found:  

Plants.  We’ve had so much rain lately that most of SD is exploding with flowers and foliage.  It’s quite beautiful even when it’s growing on a park shelter used for meth deals.  

Side note:  When I first moved to SD, I thought it would be nice to live on a canyon.  For those unfamiliar, SD is very hilly and between those hills are crevices, chocked full of foliage—and meth dealers and people with knives and dope heads and coyotes and God knows what else.  I no longer wish to live near a canyon as I can no longer view one without thinking of horror stories I’ve heard from patients who have been on the inside of one. End side note.

Location advice. When advised by my nurse that he sometimes is able to access a patient at his house by walking around to the back yard and banging on the window, I asked, just to be sure, “So this is a house where you can walk around to the back yard, uninvited, and not get shot?”  The team laughed at this but I grew up in Wyoming and spent a lot of years in Idaho where if you’re gonna start banging on back windows, you’ve gotta calculate the possibility of a gun.  I then pointed out to the team that I looked pretty non-threatening in my new lilac Minnetonka moccasins.  They laughed again.  We laugh a lot because if we didn’t we would cry…or quit our jobs for something where we didn’t have to walk into stranger’s back yards…like scooping ice cream or selling shoes or computer programing.  

Side Note: Incidentally, as I was considering jobs, several came to mind where you may have to walk through stranger’s backyards.  Here’s a short list: installing security systems, home improvement like laying tile or painting, window washing, trash removal, door to door sales, reading meters, dog walking.  So maybe we’re not that special. 

Yellow El Camino.  As I was driving through the aptly-name Paradise Hills area of SD, I spotted a banana yellow El Camino that appeared fit for an episode of Pimp My Ride.  It had the large, shiny wheels, with the very narrow tires.  Should have stopped for a photo but time is money!

Most common complaint.  My number one complaint from patients this week was some iteration of, “I want to move.”  Maybe everyone in the country is feeling that way after spending one or two weeks in social-distance mode.  My observation is that people are either suffering from too much alone time or not enough.  For this reason, I withheld my zen wisdom—something along the lines of “Bloom where you are planted,”—mostly because when I look around at the roommates and the cleanliness and the food quality and the level of muttering crecendo-ing to a yell, I think, good grief, yes. And then I remember that my patient is someone who yells loudly every night about things that are only happening in his mind or lets the homeless woman down the street sleep in his room at night (maybe he owes her money for meth???) or is regularly stealing his roommate’s property for money—for meth…And then I wonder what Buddha or I, for that matter, know about living in such places.  And who am I to tell someone to dream small?  So I tell them I will pass their request onto the team of social workers who may have already helped this person move 37 times in the past year.

Misdirected lecture. I lectured one patient about harassing the pharmacist for Seroquel.  He nodded his head penitently.  Then I got in the car and realized that it was the NEXT patient on the list who did that.  Oh well!  It’s a good lesson for all—don’t harass pharmacists!  I couldn’t find the next patient. Maybe he was harassing a pharmacist. But when I do, the lecture is ready to go!

Side note: Seroquel (aka Quell, aka Suzy Q) is in demand from meth users because it brings you down when you are at the cat-with-claws-embedded-in-the-ceiling level of high.  It’s really annoying when the drugs we are trying to do good with are used against us.  It’s probably also really annoying when you overshoot that perfect high and end up with that cat-on-the-ceiling feeling, so there we are.  I’ve never been a street drug user, but I have had Sudafed and a cup of coffee in the same morning and that’s gotta be on the spectrum.

Patient apparition. I park on the street next to what appears to be a trash pile beside the sidewalk.  I holler the name of my patient and he sits up from the middle of the pile of objects that are his.  I spend the next 15 minutes squatting next to him listening to his deluge of speech about the meth-heads and his storage unit and the business nearby.  I get in some advice about social distancing, though it seems this behavior is intuitive for my patient.  I offer him medication.  That’s when he starts yelling at me.  I sweetly offer to visit him again as he yells me all the way to my car, never getting up from underneath the pile.

Rhyming. One patient made sure everything he said rhymed: rick, kick, lick, fick.  Felt like a fruitful interview. Side note: This is a phenomenon called clanging, which means that words are grouped together by sound rather than meaning.  See! You’re well on your way to being equipped to conduct a mental status exam.

Here’s to all of us trying to make work work in all of the strangeness.  Here’s to all of us facing unemployment or disrupted income.  Here’s to all of us coping with the difficult feelings. These are my affirmations for today: 

May I feel lighthearted. 

May I find the fun. 

May I feel connected and present.