She was a few years younger than me, with auburn hair and eyes, sitting calmly in an interview chair across from me. She was dressed in leggings, stylish fur-lined boots, and a comfortable zip hoodie. I probably owned half a dozen similar outfits that I wore outside of the hospital.
“What brought you in?” I asked, pretending I didn’t know.
“My parents brought me here.”
“Do you have any idea why?”
Aware of the bizarre nature of her thought content, she continued, “Well, I know this sounds crazy, but…”
As she continued to speak, her paranoia unraveled like ribbons around her. She was rationalizing why her delusions couldn’t be true, but wrestling to dismiss the terrifying reality that had been constructed in her mind.
She was a young, working professional who had just finished graduate school. She had just started her first real job in the big city. She was on the first rung of the ladder that was going to build her future career. I was an intern, doing my version of the same.
I tried not to give her special treatment, but I did anyway. Other patients had to make do with the hospital-provided breakfast options, but I put in orders for her to have contraband caffeinated coffee in the morning. Sometimes I’d even greet her with a styrofoam cup in hand, with coffee poured directly from the case manager’s lounge. It was hard not to break the rules. She wasn’t some unfortunate teenager who was snatched by the hands of psychosis while tripping on a high. Nor was she a gray-haired, chronically mentally ill patient sleeping in an army blanket on the street.
She was me.
As her hospitalization continued, though, her mental health deteriorated proportionally. She bristled at the word “anti-psychotic,” and eventually, she had to be monitored for “cheeking” when getting medications. What initially appeared to be brief mental confusion that splattered across the life of an otherwise normal young adult started to solidify into the diagnosis that it was likely to become.
In medical school, I had a series of courses on empathy. I was taught how to say phrases like, “I understand” or “Wow, that seems hard,” even when it didn’t seem hard at all. “That seems hard” felt painfully inadequate, though.
My attending had already told her the diagnosis. I was there when the words “schizophrenia,” “cognitive decline,” and “no cure” had ricocheted off the interview room walls like bullets.
The thing that medical school professors couldn’t teach, though, was the feeling that comes with delivering the diagnosis. The feeling of telling someone that their life is never going to be the same. Or, watching yourself, through the experience of someone else, reverberating from the impact of your words. Sometimes we witness the aftershocks. Most of the time, we don’t.
That evening, before leaving for the day, I went to her room to deliver news about some trivial conciliation that I had secured. She could have her pillow from home or a real pen to write with in her journal or her morning coffee. It was something silly, but important.
It was something that I would want.
As I approached her door from the hallway, I could hear crying. The door was open about three inches, and she was sitting on her bed in the dark. As I got closer, I realized that she wasn’t just crying. She was sitting on her neatly made bed, doubled over, weeping into a pillow. Although muffled by the thin padding, her primal, gut-wrenching wail was still audible.
I knocked softly on the door and pushed it open. She momentarily stopped crying, looked up, and tried to brush away her tears. It wasn’t the time to say, “I understand.”
It was the time to sit down and tell her that she was strong enough to do this. Or, to instill hope that medicine is always advancing and that there are always new drugs on the horizon. Or, to simply hold her hand in the darkness and say nothing, letting the power of a human touch convey what words cannot.
She was alone on a locked psychiatric unit, though. There was no family, friend, or spouse to do this. It was just me, in my work length dress and white coat, flustered by my inexperience as an intern and paralyzed by my uncertainty about what to do.
Instead of addressing her emotional state, I delivered the news about the pillow or the pen or the coffee. She acknowledged me with a nod.
She had already lost her job, her apartment, and her independence. She was living with her parents again, but only in the way that an injured baby bird might return to the nest to heal, fully expecting to spread its wings again and fly.
This was different, though. Her entire world had changed, and she knew it. Walking away, the sound of her weeping pounded in my head. She was me. I was her. Her life would never be the same. My life would never be the same.
She has no actual or relevant conflicts of interest to disclose.