A Bitter Pill to Swallow

Chapter 3: Better Than Nothing

Chapter 3: Better Than NothingDear Shawn,

It’s always been hard for me to picture Dr. Hoffman actually working as a psychiatrist. As an auditor for the IRS, sure. Or as a bill collector, or a drill sergeant, or even as a standup comedienne who specializes in insult humor. When she was my professor, she always had a sneaky way of getting into our heads and making us question the things we thought we knew. A lot of times she would answer our questions with questions of her own. She put me through a lot when she taught me. I thought when I graduated from med school I had seen the last of her, but I was so wrong. Guess who got promoted? Guess who is now in charge of supervising all the future psychiatrists at the university’s inpatient child and adolescent ward? That’s right, little brother: Dr. Hoffman, the one and only.

I can picture her marching through the corridors, a flock of white-coated interns trailing her like little ducklings who know no better than to follow the first leader they see. (That’s called imprinting, by the way.) Now, as if things aren’t bad enough, Dr. Hoffman was the one I had to talk to today. My worst professor is now my only hope.

Her first question: “What was your reason for leaving your residency at Haven House?”

If Dr. Hoffman had seen Haven House, she’d understand. So I tried to paint a picture for her. I told her it’s a miserable place full of cold white walls and miserable kids. It’s clinical and unadorned, like an operating room. No, not unadorned; deliberately stripped of anything resembling character, making it a place that was no place at all. Sure, it has a nice lobby to impress the parents when they come to visit, but the rest of it looks like the kind of mental institution you see in movies. When I worked there, I realized for the first time just how different the standard of care was for kids whose illnesses were mental and not physical. If children with cancer or AIDS had been treated as my patients had, you would hear about it on the news. But to the staff at Haven House, and maybe to the rest of the world, the patients were nothing but problem children.

I even told Dr. Hoffman about the first time I saw the patients getting what the chief resident called “chair therapy.” In a long corridor, kids sat in their chairs, facing the wall. They weren’t allowed to speak to each other or the staff, or even give anyone eye contact. More than anything I wanted to reach out to them, to be there for them, to listen to what they had to say. I thought that was what I was supposed to do. When I worked in the other hospital last year, the one for adults, that was what I had done. But when I tried that at Haven House, I got in trouble. Just as they weren’t allowed to speak to me, I wasn’t allowed to speak to them!

Shawn, when I say these were kids, I don’t mean they were all teenagers like you. One boy looked like he was only ten years old, and he was crying. Anywhere else, any other doctor would go talk to him to make sure he was okay. I think of all the times you were scared going to the dentist or getting a shot at the doctor’s office. They never just left you there crying. But things are different at Haven House. At Haven House, silently facing a wall for hours on end is just part of the “behavior modification program.”

It was frightening to think this was how they did things there, at one of the most expensive mental hospitals for kids in the northern suburbs. I wondered if the parents who sent their children there had any idea. It wasn’t a place where sick kids could get better. It was a place where rich kids were basically held hostage. If that place was supposed to be one of the best, what did that mean for the specialty I had chosen?

Of course somehow, the patients were always miraculously “cured” the day their insurance ran out. It didn’t matter if the kids were better – just that their bills were being paid. The worst was a boy being sent home too soon. He was still depressed – anyone could see that. I was worried about him. His first day out, he deliberately crashed his car into a tree and shattered both his legs. He’ll probably need several operations before he can walk again, if he can ever walk at all. Nobody at Haven House even seemed to care except for me. That was when I knew I had to leave.

After I told Dr. Hoffman all of this, she asked me if Haven House was a for-profit hospital. I told her yes, and that they’re owned by PHEA. Dr. Hoffman wasn’t surprised. PHEA has gotten in a lot of trouble lately, though many of the other companies that ran mental hospitals and were in it for the money got in so much trouble that they had to go to a big hearing in Washington before Congress about a year ago. Most of those companies are going out of business now. I could tell by the look on Dr. Hoffman’s face that she hates PHEA just as much as I do. I felt relieved that we had an enemy in common. I hoped it meant she would understand why I quit my residency so suddenly.

I also explained to her that Haven House hadn’t been my first choice. I told her I’d wanted to work at the hospital she’s in charge of now, but I didn’t get matched. Then she told me she was the one who rejected me from the program!

She said, “Frankly, I found your credentials lacking. You didn’t major in psychology as an undergraduate, you took a leave of absence after your first year of medical school, and you changed specialties shortly after you returned. And you really struggled in my class. There were too many red flags. I had to reject you.”

I was stunned. All this time I thought I had been randomly matched to Haven House by a computer, not turned down for the program I wanted to work for by an old teacher who didn’t like me. But knowing that, I couldn’t let Dr. Hoffman’s opinions about me keep me from getting a good opportunity.

So I did my best to explain myself. I told her I knew what she meant about red flags because I saw them at Haven House from the first day I worked there, but decided not to pay any attention to them. Even though I knew things weren‘t right, I tried my best to make it work. I ignored my own instincts until I couldn’t ignore them anymore. I told her that even though I didn’t major in psychology in college, I learned a lot about human nature from all the stories and poems I read as an English major. I explained that now, to make up for all the things I didn’t learn in college, I’m reading as many psychology books as I can.

I didn’t go into all the details of my leave of absence. You know why I couldn’t. I just told her that something happened to someone I cared about and it made me see the value of psychiatry. What I’ve learned hasn’t come from taking all the right classes at all the right times. It’s come from having my life turned upside down.

Then I asked her who a troubled kid can relate to more, someone who has always had it easy, or someone who knows how tough life can be and didn’t have to read about it in a textbook? After all, isn’t that what our profession is all about, helping people cope with what life throws at them?

I tried to sound confident even though I was so nervous and so scared that she would tell me no. I think I was trying to convince myself as much as Dr. Hoffman that I really wanted to job. Because honestly—and I know I’ve never told you this—I started having my doubts about psychiatry from my very first day at Haven House. I’ve always been worried I’m not good enough and might end up making a terrible mistake. Sometimes I still wonder if I should have made the switch from radiology. It’s so much easier to look at the pictures we can take with MRI machines or x-rays and understand what’s wrong with people. I like feeling certain. But I told you why I switched. I promised you I would see it through. I want to be a good sister and keep my promise.

I think I got through to Dr. Hoffman. After I stated my case, she said she needs to know she can rely on me and trust me to finish what I’ve started. She’s not hiring any new residents until July, but wants me to prove I’m serious. She has an old friend who helped start a small boarding school for kids with emotional problems. She said she would call him to see if he would hire me as one of his counselors, and that if things go well, she’ll consider me.

The whole thing makes me uneasy. What if there are no openings for counselors? What if Dr. Hoffman’s friend is just as hard to please as she is? What if things don’t work out at the school? What can I do, go back home to California? You know I still can’t. There are too many ghosts there, too many wrongs that can never be righted.

So Dr. Hoffman’s offer is better than nothing. She promised to call as soon as she hears from her old friend. So much depends on that phone call. What if I’ve come to the end of my career before it even begins? After all I went through to apply to medical school and then finish, could all of my time have been wasted? I have worked so hard and wanted so much, and now here I am so close to finishing what I started, yet so close to losing it all. I don’t deal well with such uncertainty.

On my way out of Dr. Hoffman’s office, I saw someone I knew from medical school. I told you about Omar before. He’s seventeen now, and is about to start his internship. I don’t know him very well, but I always make sure I speak to him so he won’t feel out of place. It must be tough being a teenager in medical school. Omar wants to be a brain surgeon, so he really has his work cut out for him. But at least he knows what he wants to do.

“You’ll probably be board-certified before I am,” I joked.

When Omar smiled at me, I suddenly knew that I still want to work with teenagers more than anything else.

For now, I wait. I already had a chance to get things organized around here and be a better roommate to Anjali. I even figured out what to do with some of my old things from med school. Beetlejuice the model skeleton is wearing my white coat.

If wanting to put my medical training to use wasn’t a good enough reason to make me want to go out into the world and do something useful, daytime television certainly is. With Anjali out delivering babies, the TV has been my only companion since I quit my residency. You know I always liked talk shows better than soap operas, but there are only so many times I can watch people on Oprah, Jenny Jones, Ricki Lake, and Sally Jessy Raphael make their private lives public. Then there are the ads for The Psychic Friends Network, vague commercials for a new antidepressant ("Denoxamine - ask your doctor"), and the worst offender: “If you don’t get help for your troubled teen at Haven House, please get help somewhere.” Reruns of ‘Quincy’ are all that have sustained me. Watching him go on a crusade to find the truth behind the medical mysteries he solves reminds me of why I wanted to become a doctor in the first place. Hopefully soon the phone will ring and I will have another chance to prove myself.