Tuesday, December 15, 2009


I made a skinny girl cry today.

So I'm on the eating disorders unit now. I'm covering for Mike this week and Sparrow next week. And then I'm back for a full month in June. It's an interesting thing, to be up there. It's a whole different planet, really. With very underweight, constipated little Martians.

When I decided to go into psychiatry, I'd originally planned on being an eating disorders doc. I haven't abandoned the idea, but I think that it might be more in the context of trauma. Which is an interesting thing at the moment, because our inpatient unit is really a weight stabilization unit. Which means we tend to get the severe anorexics, who tend to be more on the OCD spectrum. What we tend not to get up there are the bulimics, who tend to be more normal weight, and also have a higher correlation with a history of trauma. They're generally more borderline-y, less inflexible, and I tend to understand them a bit better (duh). The anxious, perfectionistic, rigid anorexics make no sense to me. And because they make no sense, I have a harder time figuring out how to work with them in any sort of useful way. Because the program is so structured, too, I have a hard time figuring out exactly where the therapeutic part of my job is and where I fit into the picture.

The staff is pleasant. My attending is awesome. There's an NP on the service now, too, whom I've known for a while and like very much. I actually really like about half my patients, and the others are tolerable.

But we had this family meeting this morning. And for whatever reason, I identify with this girl. Yes, she can be a pain in the ass, but I really do think she's working hard. And I listened to her parents sit there and give her all sorts of mixed messages about what she's worth to them. She regressed a lot. It stressed me out.

But the crying and yelling and throwing of non-injurious items didn't actually bother me. I have a high tolerance for that stuff. She called one of the staff members a bitch. I laughed. The staff member got huffy and walked out. I was like, really? This isn't about you. She's just being a brat because she doesn't have the ability to say what she's actually trying to express. And if that's the worst thing I'd get called by a patient, cool. But no, she wanted a response, she wanted to push the staff member away, she accomplished what she was trying to do. So the staff member walks out, I kept talking about how we believe she can do this, we know it's hard to tolerate, etc. I made a couple of extra interpretations. By the time I walked out of the room, the patient was able to give me a little humor.

So, you see the difference, there? I tolerated the affective storm without reinforcing it, and we connected in some small way. The other technique? Puts up walls. I agree with the idea that you need to set limits about the way people treat you, but come on.

So I'm back up on the unit later, and the staff member comes to me and is just like, oh my God, that girl, blah blah blah. And I was like, oh, dude, she's terrified, etc, etc, but the staffer couldn't see past the obnoxiousness. The staffer was also incensed that the mother (of this adult woman) didn't say anything about the name calling. I couldn't control the eye roll on that one.

And then I made some comment about the eating disorder being a life-long illness, that you can be in recovery but you're never recovered. And the staffer starts arguing with me about that. And finally ends with, "well, it's controversial."

Uh....no, it isn't.

This annoyed me more than anything up to this point. She says later, "I just think people need to have some hope. By this time, the unit nurse and my friend John had joined the conversation, and were both like, nah, we see people up here over and over. We've seen people relapse after 20 years. Which, I have, too. You can be in recovery, you can be really strong in recovery, but you can't ever take it for granted. Because the moment you aren't looking? It will kick your ass, just because it can.

Seriously, lady. Why are you working with this population if you have no desire to figure out what's really going on, here?


Fortunately, John rescued me and made me leave the unit and then bought me a cup of coffee. I'm not sure he consciously recognized the intervention, but let me tell ya, it was so exactly what needed to happen right then.


Anonymous said...

Life has become sooooo complicated. And right now I could use your "expert knowledge"and probably advice.

But I will "pull up my boot straps, lift one foot up at a time and go" and so will the problems of the week!

Aneroxic (sp)---had a 17 yr old cousin ( boy) who died of it via I think a heart attack--not sure been a while----had a college scholarship as well as a future in major league baseball. But somewhere along the line-----his body and brain took over going down a different path of life.

Hope today is much better.
Enjoy Carol

Anonymous said...

When I volunteered at Texas Children's Hospital in 2003, the eating disorder unit was on the same floor as the cystic fibrosis unit. I always thought that was a bad idea. Once, I overheard a nurse telling a girl that she was going to start her on a carbohydrate IV. The girl was whining. A cf patient was nearby, giving her the daggers from hell. i wondered if anyone else ever stopped to think about the feelings of cf kids having to "live with" kids who, in their minds, probably didn't choose to be sick?