Dear Dr. Big Gun

Had other plans for this post. Was originally going to leave an update stating I’ll probably be MIA for the next two weeks, as I have A LOT of studying to do (so much that I’m deeply afraid). But something happened and I think it deserves to be put out in the internet, even if it’s just in my little blog.

Previously, I mentioned how I have a lot of trouble making calls, how it gives me severe anxiety and I avoid them like the plague mostly (unless I’m incredibly relaxed, which almost never happens, or I’m under direct supervision of someone or a patient’s care depends on it and have no choice but to do it then and there). I mentioned, in passing, how I had to call a patient’s mother to set up an interview for a case presentation and how I avoided calling her for almost a month because it gave me such horrible anxiety. I had no problem having an impromptu session with the patient’s father and meeting with him and the patient twice. I was very anxious and it resulted in a “bad day” but was able to manage. Still, calling the patient’s mother was something I couldn’t get myself to do on time.

So, with the pediatrics rotation coming soon to a close, time is running out for the case presentation, which hopefully I’ll have ready for tomorrow. Now, I have to present this case to an attending who’s a big gun at my school’s pediatrics department. She’s a very strict person, but I honestly believe she has the student’s and resident’s best interests at heart. She told me, back in January, that she was probably going to want to meet up with me more than once for the presentation, so I had to give her time to fit me in her schedule.

This all was a huge roadblock anxiety-wise. The simple fact that she’s a big gun really freaks me out, and on top of it she’s really strict and serious. So, that got me off on the wrong foot. Add to that my inability to call the patient’s mother on time because I spent almost a fucking month working myself up to finally be able to do it, and things turned sour pretty fast.

I previously saw this attending in one of the hospital’s hallways and I pulled her aside so I could apologize for taking so long in preparing the case presentation. She seemed to accept my apology and told me to make sure I had the case ready before the end of the rotation. Fast-forward to yesterday and I have the case almost ready, so I emailed her to set up a date for the presentation and discussion we’ll have. In the email I again apologized for my tardiness. I am really embarrassed I had to do that, as it’s honestly never happened to me before. I’ve never before had a problem with deadlines in spite of having anxiety issues.

She responded this morning, letting me know that her agenda was pretty full, and that we would probably be meeting by the end of next week. Her next paragraph is what got to me:

“Remember it’s really important that you separate the dates for your case presentations a few weeks in advance during your rotations. That way, you can guarantee that both you, and your attending, can fulfill your obligations and dedicate the required time so that the case discussion can be a fulfilling experience. The ability to make plans with time in advance is extremely important in our medical profession due to the multiple responsibilities we have; it’s because of this that you should develop it during your medical training and make it a habit.”

Ouch. That really really hurt. Being responsible is something I pride myself in.

I’m still in shock, but I was expecting a response like that, to be honest. I know she’s going to make medical student soup out of me and gobble me up within 5 seconds of beginning that case presentation, whenever it may be. I just have to make sure I don’t break down crying, that I get a passing grade, and don’t get referred for a professionalism concern. That last one really scares the shit out of me because professionalism concerns can destroy your career.

What I feel is a mixture of frustration and anger, but not so much towards her, more towards myself. I know she’s right. However, I can’t help but feel this incredible frustration because if I hadn’t been dealing with anxiety this wouldn’t have been an issue. All because of a stupid phone call.

And to think, the course coordinator (who knows about my hospitalization), told me back in December to reach out were I to face a problem during the rotation. Does being so anxious I start thinking about ways to kill myself count as an acceptable problem? Unfortunately, no.

I wasn’t counting on realizing my being abused for 5 years would happen during this past December. I wasn’t counting on that aggravating my already present problems with men, aggravating my anxiety to sky-high levels I’d never experienced. I wasn’t counting on any of that happening, but shit, life has a way of kicking you in the ovaries. And I’m actually patting myself in the back, more than having self-pity, because I’ve made it this far with those issues in mind without breaking down into a mess like I did last year.

I’d love to excuse my behavior. I’d love to tell this attending, in colorful and unnecessary detail, exactly why I took so long. Not to gain some pity on her part, or her sympathy, but to defend the fact that I am NOT a lazy good-for-nothing medical student who doesn’t know how to plan things in advance and fulfill her responsibilities. Funny thing is, she probably wouldn’t give a shit either way, because as soon as you reveal your inability to be fully responsible was due to “personal reasons” and not some devastating illness like cancer, they don’t give a shit and simply assume you’re an irresponsible liar.

TRIGGER WARNING: GRAPHIC DETAILS OF ABUSE AND MENTAL ILLNESS, PROCEED WITH CAUTION

And this, people of the blogosphere, is what I would love to tell her in person….brace yourselves:

Hello Dr. Big Gun:

I wanted to address my seeming lack of responsibility recently. I don’t expect you to understand, I simply want you to listen intently to what I have to say, because I can’t accept your well-intentioned criticism without putting up a fight. Sorry, I’m a very defiant little person.

I’ve been struggling with depression for most of my life, but most recently since 2011. I was hospitalized last year due to having a suicidal plan. In December of last year I went back to med school and had no problems dealing with all of this. However, also in December of last year, I finally admitted to myself that I was a victim of abuse.

Seeing as you deal with a lot of young patients who have unfortunately been victims of abuse, I would expect you to empathize and know that recovering from this is very difficult. In my case, the process has resulted in me having some really bad anxiety issues, to the point where I tape my curtains to my windows so neighbors won’t point and laugh at me sitting in my bedroom. I also still get triggered very easily, the most recent example being last Friday when an attending mentioned the words “sexual abuse” and I had to take a bathroom break and cower in a corner because I started having flashbacks.

This has extended to my difficulty with making phone calls. I have always had problems with this, but this recent development in my life has made it practically impossible for me to make phone calls. Thus, my inability to call so-and-so patient’s mother on time so that we could schedule an interview. To put it bluntly, I spent a month mulling over something you do fifty times a day from your office or smartphone with no difficulty whatsoever. Why, you may ask? Because in my case, making phone calls reminds me of all my deeply ingrained insecurities, thanks to past bullies and even my family’s lack of understanding from a young age.

Now, going back to the abuse…I’m sure you, as a human being yourself, have your own set of personal problems to deal with. Mostly, they don’t affect your everyday life, but sometimes they do, right? In my case, this has been a problem as of late, seeing as I was informed of three cases of sexual abuse in the ER while I was rotating there. That’s three cases in two weeks, and those are only the ones who actually file a report. Usually, I don’t have a problem dealing with this, but lately it’s been affecting me too much, seeing as I identify a lot with these patients and I am only beginning to process my own experience of abuse. In the future, I’ll be able to deal with it more efficiently, and responsibly, as you so eloquently put it, but not now. Right now, what I need is a bit of self-compassion in this recovery process.

TRIGGER WARNING: GRAPHIC DETAILS

I don’t expect you to understand my having a really shitty and anxiety-laden day after getting triggered and thinking of my abuser taking my hand and putting it down his pants so I could feel his disgustingly moist and erect penis at the tender age of 16, confusion and fear running through my mind as he tilted his head back in his egotistic pleasure trip. I don’t expect you to understand my being triggered and having flashbacks of little kids, big kids, and even adults, calling me ugly or a slut behind my back or to my face. I don’t expect you to understand how I was berated by my abuser for not being able to swallow his semen and how he made it a point to make me feel pathetic and insignificant for having feelings and emotions. I don’t expect you to understand what it feels like to not want to have sex but keep “going with the flow” because you’re afraid your abuser will hurt you emotionally. I don’t expect you to understand being completely naked inside a parked car in a parking lot while your fully clothed abuser fingers you, feeling incredible shame and wanting to run away. Unless you’ve been through the same things, there’s no way you’ll understand, and that’s ok.

What I do expect you to do, however, is to have a little bit of compassion and empathy for me, because I am going through the first stages of a very difficult process. I will accept your criticism graciously because I know I was wrong in letting this anxiety issue fester and not calling for help. What I will not accept is the not-so-subtle subtext of your email where you practically state that you think I am lazy and irresponsible and that is why I haven’t been able to keep up with the deadline. Sorry about that, I was too busy thinking about the times my abuser shoved his penis inside of me without my consent and I had to push him off.

I’m sure that’s not what you wanted to hear, but it’s the truth. I am a responsible person, and I take deep pride in that. However, I am sorry for having faltered this one time and giving the impression that I was careless.

Trust me, “careless” is not a word that describes me at this very moment. Unlike your other medical students, I actually took the time to meet up with this patient and his parents twice, called his mother to make sure I had every detail about his history down to a T, interviewed his teacher and his nurses, and went through every page of his 4-inch wide record (outdated lab reports included). Unfortunately, much like the patient you assigned me who has a life-threatening “physical” illness, life has dealt me some shitty cards, and I’m trying to make the most out of them. I’m sorry in my case it took a little longer than you wanted.

We are all human, after all, and my current inability to fulfill your strict standards doesn’t give you reason to judge. I will not accept your subtly accusing me of laziness. If I were lazy I wouldn’t even have bothered with apologizing for my tardiness in person and via email. 

I know you have your story too. This is my story.

PS: Like I said in the beginning, please excuse my random posting lately. Things will hopefully be back to normal the 1st of March, long-promised posts included.

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2 comments
  1. J said:

    To be honest, I have mixed feelings about this. Having dealt with lifelong severe (SEVERE) depression and anxiety, including multiple life-threatening suicide attempts, dozens of meds/med combos and several hospitalizations, I kind of feel the way you do about expecting compassion and the like.
    ON THE OTHER HAND. When I was in grad school for a health field, including simultaneous full time work in a different county, full time classes, and publication-grade research, I hit a hard period. And you know what? I had to take time off. I had to level with two big wig supervisors and they were mostly empathic and understanding….however, some things were non-negotiable. They worked with me to the best of their ability, but had I not been able to complete x y and z I would not have passed the year. I stepped back from clinical work and took 3 months off because when it came down to it, I couldn’t meet my professional and clinical obligations. If I had cancer, it would have been the same. There would have been less stigma, but when you reach the point where you can’t meet your clinical obligations, which includes professional behavior….it is time to take a step back, whether the cause is cancer or depression.
    I agree mental illness should not have a stigma attached. I don’t agree mental illness should get special treatment.

    Like

  2. K said:

    Hello Love,

    I apologize in advance that this is going to be a very short comment! I just wanted you to know that I have been keeping up with your blog and I’m sorry I haven’t been commenting but I just haven’t had the energy lately 😦 I am glad that you’re back in med school and I knew you could do it! I will write more about your posts soon. I just wanted you to know that I think about you often and hope you are well 🙂

    xoxo,
    K

    Like

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