Faking it

So yesterday, I'm sitting across from my patient, we'll call her Marlena (although I don't know why, because that's not even close to her name). You remember Marlena, she's the one who's uncle raped her for two years straight, threatened to kill her mother if she told anyone, and then shot himself when he got found out. Poor kid. So, I finally sit down with her yesterday. And she opens her mouth, and the floodgates open. She answers everything I ask - what he did, does she remember the first time, how she feels about him killing himself, how she felt about the way her family responded, etc, etc, etc.

I was telling Mike about this later in the evening, and he gets all excited. He's all, "I knew you could do it! I knew you could get her talking. I knew she'd do just so much better with a woman, and I knew you'd be good for her."

I just kept talking over him. Not because I didn't appreciate the compliment, but because I couldn't stop and talk about it. I was 15 minutes from going on call. I couldn't tell him that what she needed was, indeed, me, that what she needed was someone who knew what a flashback felt like and how pervasively this takes over your life. I couldn't tell him that I was sitting across the table from this sweet little girl, thinking, ohhh, God. How do I keep you from turning into me?

I'm so afraid for her. I'm so afraid of the life she has ahead of her. She's going to do fine, she's tough, she'll be a survivor. But it's going to be such a tough road.

Today, before we met with her family, she tells me that she was all sad and anxious in morning meeting because she'd just had a flashback. She won't tell me what the flashback was. And that's fine, I didn't push, I just encouraged her to think about who she could safely talk to about these things when she was ready.

Which was something I directly plagiarized from my therapist, when I sat on her couch Monday night talking about a particularly vicious memory that percolated through on Sunday. I hate that, when they're all sharp and jagged and newly recovered, how it takes over your whole body, your whole self, how the day even tastes different, how you feel caught in a rip in the fabric of time and you can't quite dislodge yourself from being back in that place. Everything seems out of phase. And I was telling this to my shrink, but I was totally holding back on the details. Because that's what I do. I'm always so afraid of traumatizing whomever I'm talking to that I temper the facts. Not that I want Marlena to do this - in fact, I could totally handle what she had to say. Not that I want any of my patients to do this with me (remember, I want to make a career out of Marlenas. A great number of years from now). Not that I really feel like my therapist will be too disgusted to listen or suddenly take on my nightmares. But it all feels too graphic, too abnormal, too hideous. Too shocking. I know I've got to pull out the gory details and show them to someone safe if I ever really hope to process them for real. My psychiatrist? She's very safe. She's quite wonderful, actually. And I sat in her office Monday getting the very same speech from her that I gave to my patient today.

I felt like such a fraud.

We had such a good session today. She totally knows. I don't have a poker face, and I keep saying things like, "You can't know what a flashback feels like unless you've had them," and then proceed to describe the feeling in detail. I'm completely transparent in this arena. We had a family meeting this afternoon. I'm certain her parents probably know I'm a trauma survivor. I've never said it outright, but, given all of my "you have to try and understand that you don't understand her experience", I clearly do understand. And I pulled out a page long list of resources - websites, books for victims, partners, and parents - that I'd read and could recommend personally. I've been there. I get it. And I left today feeling such conflicting awfulness...I knew it was helpful. I knew I made a difference.

And I also felt like I should sitting in jeans and a sweatshirt working at one of those Rape Crisis centers, not that I should be a psychiatrist. In fact, I felt very much at that moment that I should not be a psychiatrist.

No, I don't know what that means. I think it means that somehow possessing this knowledge firsthand makes me less worthy of being a doctor.

Yes, I recognize that it makes no rational sense whatsoever. I get that. Can anybody explain this? I have truly no idea what that feeling is about. And I don't particularly like it, frankly.

I'm so in Hell right now. It's really not the unit that's so awful, or the patients that are so bad. It's the me that feels inept and horrible. It's totally me that keeps getting assailed by my own childhood. It's all me who feels like I can't deal with kids very well (my attending today told me that she thinks I have a lovely rapport with children) and like I'm a big fat fraud who can't even move through her own trauma. Not that I've made miles of progress over the past few years or anything. Not that it's really helpful to patients when their therapist gets it.

I just don't get it.