Thursday, July 06, 2006

Out of the Office

[posted by dinah]

This post was inspired by Dr. A's account of his patient Jen in his post Bride of Hyperthyroidism and by Carrie's (NeoNurseChic, whom I always find inspiring) response to it.

"Hey, Doc," she said, "Don't forget to come to my wedding next month. It's going to be a good time." She then proceeded to tell me the entire plan for the day, which made her face light up and bring a smile to her face. "I'm sure it will be," I said, "I wouldn't miss it for anything."

And Carrie commented:
... doctors are a part of my life and hear all the negative things that happen all the time - it's nice to be able to give back and show I'm a normal human, too, and share the positives, too! Hope "Jen" gets her hyperthyroidism controlled and has a beautiful wedding!

This is the thing about being a psychiatrist-- it's this funny little world inside the office where intimacy reigns and boundaries become oh-so important. Psychotherapy mandates a number of important boundaries, sometimes they feel rigid, but mostly they serve as a protective barrier. I could ramble about the obvious-- defined meeting times and pre-determined session lengths, very restricted physical contact (I'm good with a handshake at the initial evaluation, and sometimes patients will hug me at the termination of therapy, a gesture that is beyond me to refuse), payment in exchange for the services (this, in addition to being a boundary issue helps me pay my bills), and perhaps most important, limiting meetings to the therapeutic sessions which take place in my office. In all honesty, I'd rather not see my patients anywhere else; given a choice, I don't even want to ride the elevator with them.

Mostly, I think my patients would rather not be with me outside the office, too. Of course, it's a bit inevitable. I ran into a patient one day when I was out for a walk. I introduced her to Max, my dog, and she said, "I didn't know you had a dog." I do. When I bump into patients and I'm with my kids, invariably they ask, "Who's that?" and I'm left to mutter something I hope won't lead to more questions.

People tell me about the events in their lives; usually they don't invite me, they seem to instinctively know the rule. Sometimes they'll say, "I wish you could be there."

Recently, a patient asked me to come to his art opening. He mentioned it several times, he gave me an invitation, he asked me to invite all my friends. It was important to him that people come, and he made it clear he wanted me to come.

"What would I tell people if they asked who I was?"

This is always an issue for outside the office stuff. "I'm the artist's psychiatrist"-- that just doesn't fly. It's a problem Dr. A doesn't have; he can go to a patient's wedding and just be Dr. A.

"Everyone knows I see you," he said. So I guess I could have said I was the artist's psychiatrist, I just wouldn't.

I went alone. The room was packed, my patient was holding court and doing a wonderful job, though I knew he was extremely anxious. I walked around, loved his artwork, tried to guess who was who from the puzzle of his life that I'd heard so much about inside the office. He was, for that moment, a normal human (actually, a rather talented human) with a normal life. A woman approached me and introduced herself as the artist's mother. I introduced myself by my first name only, shook her hand and simply said her son had invited me. Mostly I stayed lost in the crowd and enjoyed the artwork.

"The opening was great," the artist announced a few days later. "I wish you could have come."

"I did," I said. He looked surprised, then delighted. I told him which were my favorite pieces, told him how well I thought he did. Somehow I was pleased to have both been there and yet been just a little invisible.