Sunday, February 10, 2008

My Assorted Thoughts on Tara Parker-Pope's Wellness Blog Today

I feel this funny kinship with The New York Times Wellness blogger, Tara Parker-Pope. I don't know her, probably never will, and I'm jealous that her blog is so much more widely read than mine. Why hasn't The New York Times hired me?? Maybe it's because she's a blogger, I think she's a mom, and "Tara" is the name of my college roommate who has journeyed around the country collecting advanced degrees and remains a beach-ball of energy (there's something 'round' about my Tara, I don't know why, she's petite, slim and runs miles a day, but she's energetic and hard to grab on to, nonetheless). More simply, though, Tara Parker-Pope often writes about things we like to address on Shrink Rap, and for the second time recently, we've "known" in some sideline way, the same people. Not long ago she wrote about headaches and referenced my neighbor, the Johns Hopkins migraine king-- a man with beautiful gardens, a lovely wife, who run circles around our neighborhood for exercise, but my conversation with him has been limited to mutual nods.

So the Wellness Blog of 2/8 came to my attention this morning because it's on When Doctors Become Patients. That was ClinkShrink's post!! There Tara Parker-Pope goes, stealing from Shrink Rap again. We got to do something about this!

So I click over and there's a photo of Bob. Who's Bob? you say. Well Robert Klitzman certainly wouldn't remember me, but he pops up in the media now and then so I remember him. When I was a third year medical student doing my much-anticipated psychiatry rotation (for Bob's sake, I won't say where), Bob was one of the four PGY-2 residents on the fourth floor unit I was assigned to. Only I wasn't assigned to work with him, I worked with Beth. Beth was great, the thing I remember most about Beth was she told me she didn't like to go to the movies on a first date; she wanted a chance to meet a guy, get to know him a little, so she could dump him right away (she eventually married a musician, don't know what happened to the marriage, but my feeling towards Beth remain fond).

Bob wrote a book about his residency training experience: In a House of Glass and Dreams. I stumbled upon it in a bookstore. I knew the author so I bought it, and while he never named the program, I knew all the details. I remembered the lock that stuck outside the hallway to my supervisors office. He talks about his first day going to therapy, and I remembered being in a conference and a bunch of the residents saying "Where's Bob?" and someone replied "Bob went to therapy!" "Bob went to therapy???" I didn't really know Bob but I assumed that wasn't expected. This was in an institution where the chief resident posted on a black board what times he'd be psychoanalysis, don't beep me then. At some point, many years ago, I chatted with Bob briefly when I accidentally ended up at the wrong reception at APA, and I told him how much I liked his book. I think he was flattered. The book, which I read well after completing my own residency at an institution where one certainly didn't announce that they were going to psychoanalysis, resonated with me and and left me feeling understood-- it was during a time in my life where I was having a hard time feeling like anyone understood. I'd had enough wine to be at the wrong reception, so who really knows what we talked about, maybe 15 years ago.

At some point, and I'm not sure why, I learned that Bob's sister had died in the September 11th attacks. My heart went out to a man I hadn't ever really known, and the Wellness blog is about Bob's experience of being a psychiatrist with depression in the aftermath of his sister's death, and how his own journey has made him a better, more considerate doc. I don't doubt it.

I guess the other thing I wanted to comment on, since this NYTimes post hit on so much for me, is that Bob initially experienced his depression as physical symptoms and didn't recognize them as a mental illness. This is not uncommon. I've had patients lose tremendous amounts of weight (50 pounds anyone?), have severe pain (usually GI) and have extensive cancer workups. One tells me frequently "No one ever told me this could be depression." Another is only now getting to be a little better after his zillion-dollar work up. When I heard of the case, as he was being referred, I said to the internist, "Hmmm, sounds like cancer." He agreed, said they were continuing to look for the elusive tumor. One look at the patient and I rethought, "Looks like depression." Patients, unfortunately hear this as "Your Pain Is All in Your Head." I' rephrase this as "Sometimes depression is expressed as pain. It doesn't mean the pain isn't real." I want it to not be insulting, but the reality is that the prognosis for pain as a symptom of depression is a whole lot better than the prognosis of pain as a symptom of lots of other things that people are wishing will be found.