By Tom Baumel, Class of 2019

 

The evening before Thanksgiving—families come together and card games are played. Meanwhile, we are surrounded by a motley crew of folks who are intoxicated, severely depressed, psychotic, and have fallen through societal safety nets. Often, they come to the psychiatric emergency department for their basic needs and support from others. In what, to an outside observer, must appear to be a cacophony of cataclysmic catastrophes, you, an unassuming patient, are brought in and assigned to the resident and me.

 

You might scratch five feet tall on your tippy toes. Your eyes are the color of a well-trodden hiking trail, dusty and dignified. They dart around the strange place in which you find yourself. You have never been here before. I think I see fear flash across your face. Wrapped in a blanket, you look up at us, and the resident speaks, “Hola, me llamo ——.  Soy doctor.” I learned Spanish growing up in California—even got through four years of Spanish in high school, but that was 7 years ago. I barely comprehend this basic statement. Turns out you have either post-partum psychosis or post-partum obsessive compulsive disorder. At first, we think you can go home, which you so badly want. You care so much for your niña, only 4 months old, and your two hijos, 10 and 12 years old. You want to wake up Thanksgiving morning to go to church with them and cook them a big Thanksgiving feast. You promise us that you will get better.

 

We call your family. Your husband is so anxious for you. His heart breaks, but by the power of God, he hopes you can get better. We call the pediatric clinic where your children are seen and your psychiatrist. They are so concerned. The kids’ weights dropped, and you missed several psychiatric appointments. The clinical teams tried to visit you at home, but no one answered the door. Child Protective Services was knocking too, trying to help, but you heard only loud, incomprehensible English words and the thud of fists rapping on the hollow door of your apartment. You were terrified. We check box 3 on a psychiatric hold. We need to break the news that you will be hospitalized and will miss your Thanksgiving.

 

The resident goes to speak to you. I follow. You and the resident converse in your native language. I feel like a child trying to understand two physicists discussing quantum mechanics. I understand words here and there but cannot follow. But in that space, I observe something more powerful than words.

 

The resident pulls up his chair, angling it just off center from yours. He leans forward, forearms resting on his knees, fingers interwoven like threads on a loom—a posture of stability and unity. His back is hunched, neck leaned forward as if he is bowing, humbling himself, recognizing and honoring your dignity. His chin is turned up, signaling the hope as we walk with you with grace in the darkness of this lived experience of yours. I mirror his posture.

 

His tone is matter of fact. His rhythm is like a galloping horse or tapping fingers—rat-a-tat, rat-a-tat, rat-a-tat. His flow is like a poem, speeding up to connect ideas, slowing for the gravity of the situation, pausing all together to let the significance hang in the air. His gestures are firm but open. Forearms never leave his knees showing the decisiveness of his plan, palms turned upward as if he were reaching out to you and inviting you in for companionship.

 

Tears stream down your face and coalesce at your chin before dropping to the blanket wrapped around you. You cry for your kids, for your heart. You need care not only for your own health, but for the wellbeing of your kids. You understand this, but that doesn’t assuage the overwhelming surprise and sorrow on this holiday eve. The resident recognizes there is nothing he can do in this moment to take away your tears. He pauses. He sits in this pain with you. You are not alone.

 

You look up. He welcomes your gaze. His voice is now like a hug. It is warm, enveloping, tranquil. It reminds me of blissful childhood days, bare feet walking on dewdrop covered grass. I see comfort set into your eyes. In this most terrible of times, you know you can face this with courage. You trust the resident more than I have seen any patient trust before. He leads you to the main area. We part ways.

 

Watching the resident work with you, I am reminded of the most powerful treatment tool: the physicians themselves. When interviewing patients in English, I am swept up in SIG E CAPS and DIG FAST diagnostic mnemonics, assessments, and if-then contingency plans. These blurs were absent in this sacramental moment. I simply got to be in their presence. Observe the beauty of patient medicine at work.

 

Our bodies and minds have a revitalizing relationship. They have the power to share love, hope, and courage, but also the devastation to share indifference, loneliness, and dread. Through action and expression, my mind is reflected into theirs and theirs into mine. The impact of our interaction lingers beyond its temporal bounds. With each posture, word, or gesture my patient’s neurons fire, neurotransmitters release, synapses form. May my presence be a tincture of dignity and compassion. May it be the essence of what I saw today.