Training Day
Authors: Monisha Vasa
Journal: American Journal of Psychiatry (2007)

Training DayTo be honest, I spent a large part of the past several years complaining about residency.Chronic sleep deprivation and stress had led to a distancing from my patients and generated a selfish focus on my own physical, emotional, and spiritual needs.I was a far cry from the physician I once dreamed of becoming, and I wasn't even sure how to find those dreams again.Until the day I became a patient.I had suffered a miserable night racked by rigors alternating with high fevers and profuse sweating.A headache pounded in my skull.My racing pulse jumped to meet my searching fingers.Yet, I couldn't identify any obvious source of infection.No sore throat, no runny nose, no cough, no abdominal pain, no urinary symptoms, no vaginal discharge.A long and scary differential diagnosis scrolled through my mind over and over in the darkness of the night: leukemia, lymphoma, meningitis, malaria. . . .My medical knowledge never felt so intimidating as at that moment.The next day found me sitting in the waiting room in the emergency department, where I often worked as a psychiatry resident, now with an ID band around my wrist.The nurses and security guards were visibly distressed to see me ill.I was soon ushered into an examination room and instructed to change into a gown and lie down.I shrugged off my white coat and hung it on the back of the chair.The hospital gown felt thin and flimsy around me and seemed to bunch up and gape open in strange ways as I tried to gracefully get onto the examination gurney.I drew the covers up to my chin.Now what?I felt anxious, small, and naked.I retrieved some psychiatry articles from my bag and flipped through them as I waited for the doctor.I couldn't concentrate on the text, but the sturdy feel of scholarly reading material in my hands was reassuring.The emergency physician soon arrived, singing out "Dr.Vasa!" as he entered the examination room.We had worked together many times when he had consulted me on patients with acute psychiatric problems.Just a subtle change in the relationship, I told myself, as he asked about my medical history and proceeded to palpate for lymphadenopathy and percuss my lungs.Since medical school, I had perceived the physical examination, the laying of hands on a patient, as a sacred, intimate dance.I conveyed my concern and respect for the patient by how softly I laid the stethoscope on the skin, how gently I palpated a painful abdomen, how thoroughly I draped the sheets.When I joined psychiatry, I sacrificed this physical holding for a psychological holding, conveyed through my words, my body language, my attentiveness.Now with my physical health and a certain anxiety in the hands of another physician, I viscerally understood the power of simple human words and touch-tools that I had utilized for patients but had never before needed from a doctor.My next challenge was the task of providing a urine sample, something I frequently requested of my patients.I was attached via tubing to an IV bag that hung on a hook high above my head.I could not climb out of the gurney, as the guard rails were raised high, and there was no mechanism to lower them from inside the bed.The nurse was nowhere in sight, and there was no discernible way to get her attention.I estimated the length of the tubing and figured that I could slide off the lower end of the bed without disconnecting the IV from my arm.As I shimmied down, the sheets came along for the ride and my gown hiked up, letting in a chilly draft.With a few strategic jumps, I managed to unhook the IV bag from its hanger.Now I only had to traverse 3 yards of hallway