As a psychiatrist, I do not encounter many situations in which I feel like I “saved the day.” Treating mental illness is a long game, and time with patients can be regretfully short. In training, we may start to see the pink hues of the horizon as the darkness lifts, but we often graduate before the sun comes up. I seek to make days more tolerable—saving them entirely is not even on my radar. Impostor syndrome lurks in my shadow, regularly causing me to question if I said something comprehendible, let alone meaningful. As a physician, I never feel that I am enough. As I held my newborn, I considered how similar this feeling of inadequacy is in motherhood. And then, I thought of Kevin. I was to inherit Kevin from a previous resident in my psychopharmacology clinic. But he contacted me in July of PGY3 year urgently begging to start therapy. Complicating matters, Kevin added one detail: He had just been diagnosed with cancer.
The rest of the story does not unfold with heroic details or life-saving techniques. Kevin’s cancer had already metastasized to vital organs. He was only in his 50s; he had a wife and young daughter. He spent our sessions pleading for more time — he wanted to watch his daughter grow up, reach milestones, be OK. While I prescribed an antidepressant and conducted weekly therapy sessions, I could not take away Kevin’s physical or emotional pain. And unlike what the movies show about oncology patients, Kevin’s diagnosis did not lead to beautiful epiphanies of self-actualization. Kevin had thought he was going to be someone special. And, no matter how I tried to convince him otherwise, he lamented that he was merely “ordinary.” For him, this was not enough.
The work was hard. I sought weekly supervision to figure out ways to help this man. I could give you countless reasons as to why Kevin was special. But he was not interested in my reassurance, and he spun deeper into despair. As though he were playing a recording, he begged for more time and repeated the same mantra week after week: He needed to be exceptional; he needed his life to be enough. But in those sessions he also spoke of his daughter — her recent report cards, sports accomplishments, their shared passion for music. His love for her allowed him to endure the pain of chemo and radiation. His love defined extraordinary. I often found myself holding back tears as he spoke about leaving her without a father. But Kevin remained stoic in these sessions, seemingly unable to acknowledge his own feelings of grief or agony. And I worried that showing my own emotions would chaotically unravel Kevin’s. So, we continued, both afraid to reveal our own feelings. Both wondering how to be enough.
I worked with Kevin for the last two years of residency. As he defied the odds of his six-month prognosis, I became pregnant. The pandemic hit. In-person sessions were converted to Zoom, and Kevin could not see my changing body. I feared it would be selfish to disclose to Kevin that I was harboring life within me while Kevin grappled with losing his. Thus, I concealed my news. My body grew larger while Kevin’s withered, secrecy cloaking our visits, emotions kept at bay.
Finally, at eight months pregnant, I prepared for our last session together. I had not solved any of Kevin’s problems. He had grown increasingly alone with his anguish. And his conviction that his life was unremarkable remained steadfast. Ultimately, I felt like a failure. But as I began to say goodbye, an urge came over me. In the most ineloquent of ways, I blurted out that I soon would become a parent. Like him, I would have a daughter. Suddenly the words came spilling out, and embarrassingly, tears followed. Caught up in my own emotions and not fully thinking through my next statement I said, “Kevin, you have exemplified what it means to be a good parent. And I hope I can love my own daughter even half as well as you have loved yours. Just that would be enough.” Kevin, stunned, said very little in reply. I immediately questioned whether I had revealed too much. Then, as he choked back his own tears, he smiled and thanked me. He revealed a glimpse of his feelings of fear and grief that he had been masking, said how much he would miss me, and thanked me again. And that was enough.
Kevin went on to live a few more years. I learned of his death while pregnant with my second baby. Around that time, I also received some concerning medical information about myself. The universe is nothing if not simultaneously cruel and serendipitous in its timing. Although not dealing with anything as harrowing as a cancer diagnosis, I still thought of Kevin. I felt less alone knowing that someone else had struggled with the same concepts of time, legacy, and the gut-wrenching fear of leaving our children. I let myself cry thinking of his daughter prematurely losing her father. And I thought about my final statements to Kevin. I do not think my words saved him. How could they? But I felt reassured that when I let my guard down and followed my instincts, I showed Kevin just how special he was to me. Hopefully, I too made him feel less alone. I’ll never know how much of a difference this made, but I have since come to use honesty and vulnerability with patients to uncover their feelings and my own. This allows us to walk with their pain, together. This tactic may not save all the days for my patients, but I hope it at least saves some days. As for learning to acknowledge and accept my vulnerabilities as a mother? That remains a work in progress. But maybe, just maybe, that work will be enough.
Dr. Kinasz is in her final year of Child and Adolescent Psychiatry Fellowship at Stanford. She completed her General Psychiatry residency at the University of California San Francisco where she served as a Chief Resident at the Zuckerberg San Francisco General Hospital. Dr. Kinasz enjoys spending her free time with her husband, taking her two young children to the park, walking her golden retriever, and traveling to Chicago to see family. All names and identifying information have been modified to protect patient privacy.
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