How old were you when you decided to become a doctor?
My grandfather was a doctor and a grumpy man. He gave my younger brother a microscope and clearly, my brother was his chosen successor. My brother became a Rabbi and I became a social worker. When my daughter was about 3 months old I woke up one morning believing that G-d was telling me it was time to go back to school because I was going to be a doctor to help heal people who were suffering. I told G-d he must be crazy and have me mixed up with someone else. I told him “you know I can’t do Math and Science.” Then G-d told me, “You pushed that baby out with no pain medicine. You can do Math and Science. Now I command you to go to medical school! Its time!”
I was 34 years old. I never doubted since then that I was meant to finish medical and residency because there were people out there suffering who needed help and G-d wants me to find them and help them. I am neither a religious person nor an especially good Jew. At times I wonder if my “epiphany” was a simple case of postpartum psychosis. However, as it turns out, I do have a knack for psychiatry and I find that if I can identify a patient’s core spiritual beliefs and mobilize these for recovery, the results can be brilliant. I tell patients, “There are no pills I can give you that are more powerful than your desire to get well”, and I remind them of their meaningful connections to others, even if they are cut off from every family member they have.
One guy who tried to hang himself in jail told me he had no family or friends. But we talked some more and it turns out he has a Pitt Bull named “Ruby”. (Name changed for HIPAA purposes). For Ruby, he is willing to remain alive, even through the pain of his life. I don’t think I knew as a child that I wanted to be a doctor. But I did know I wanted to help. And I did play “Doctor” (psychiatrist actually) with my friends when I was 4 or 5. It took me up to age 34 to discover that I was being told to go to medical school by someone I can only really identify as G-d. And that it took me until then to receive the message and that my grumpy Jewish grandfather was one major reason I had excluded “Doctor” from my list of possible things to be when I grew up. “If that’s being a doctor”, I used to tell myself, “then screw that. I’ll be a farmer or an artist or a lawyer or a psychologist”. I didn’t find “Doctor”, “Doctor” found me.
At age 34 as a postpartum social worker. And psychiatry was the only rotation that “felt” like my home planet. I tried to be something other than a psychiatrist. But every other thing I considered (family medicine, urology, neurology, general surgery) just didn’t make me laugh as much as psychiatry.
Weird people fascinate me. I love the many ways people can be weird. I don’t love patients despite their weirdness, I love them because of it. There is no more oppressed and misunderstood group of human beings anywhere on earth compared to people with severe mental illness. I find that if I can catch my patients in the act of “being good” and tell them how proud I am of their calmness, their willingness to walk away from a fight, or their ability to handle a disappointment without acting out their frustration, once I can give them a little recognition for this and get them to own it, I have won their trust going forward. All people need to be seen and heard and understood. This is what I feel G- d wanted me to do. Give his most vulnerable children the experience of being seen, heard and understood.
I take care of two different categories of patients, the worried well in my humble office in Tucson and the severely mentally ill in my locum job in rural Tennessee. I love both types of people, the highly intelligent and self motivated professionals and the desperately underprivileged and barely making it through each day, my “lost soul” patients in the state mental hospital. I love them for different reasons and for the same reason. We are all just human beings doing our best to “be good” and trying to get by the best that we can with what we know how.