Walk with me: A Day in Clinic
9-10am : A young woman wrestling with a traumatic past, fighting her way to a better future but unable to leave her past behind her. In my mind's eye, she is a lone warrior amongst cannibals who happen also to be her family. She pretended to be them for a while, worried they would smell her out and destroy her. Instead, those years of pretending, surviving have left her without knowing who she. Her instincts, honed for a different, much more chaotic and unsafe time, no longer protect her like they used to. These years have left her doubting her own instincts of who to trust. The question reappearing in every relationship she embarks on: is love safe?
10-11am: A devout man who wants to do what is best for his family, but is torn between everything and all things. He wants to be a pious man; he goes to church. He wants to be a disciplined man; he is pursuing a PhD. He wants to be faithful to his wife and a man who will protect his family and children. But despite his efforts, he is none of these things, and he is coming to realize this. He can not help the smile, more a smirk, when he tells the pleasure of subverting the rules, getting away with things. He wants to know, is he a good man?
11-12pm: A middle-aged man is referred to me. Why? I ask. His partner of 10 years jumps in, it is because he may have had childhood trauma that he does not remember, she says. She goes on, it is because of his difficult time in the Military, his gambling, his difficult childhood. I see he has had 3-4 therapists before. They did not help him, he says. He tells me something about me is different. He wants to be honest and open for the first time in his life. My instincts tell me, I have heard these words before, his partner too I bet. His partner says, I have to be here or he will pretend everything is fine. He will lie and manipulate.
I can't help but wonder, who is my patient? Who here is asking for help?
1-1:30pm: A young girl in university is seeing me for depression...I think. I don't know for certain because she starts and stops medications and she does not show up to appointments. I am aware of the deep stigma against mental health in her community and in our sessions, she can not help but constantly compare herself to her much more successful friends. Her depression is unchanged, she tells me. She is on a subtherapeutic dose of medication I have been trying to increase for the past year. I find myself suddenly frustrated. What else can she expect? What does she want from me? I can see how she suffers, but I am at a loss when she does not take my time, our time together seriously. Normally I would not say anything. Normally I would quietly tally up the no-show appointments and when she has reached the critical number, I let the administrator tell her she has been discharged from my care. Not today. Today I confront her and I am giving her one last chance.
1:30-2pm: A mother of a high needs child is seeing me after our last appointment 6 months ago. I normally do not space out my appointments that far apart, but in her case, I have done this because I have connected her with a resident therapist. Someone who can see her weekly and at an affordable rate. I've had a lot of challenges, but, she takes a deep breath, I am also doing great, she says with a smile. She tells me how she is coping and how she can not believe she is capable of this level-headedness and calm. To top things off, she informs me that she has actually stopped her medications and she is still very stable. We had talked about this before and I had given her the green light. She is beaming. She can take all the credit for her success so far, it is not the meds, it is all her!
2-3pm: A young man finds himself ready for discharge from my care. When he started seeing me, he was suicidal everyday because of his anxiety around others and his preoccupation with a part of his body that consumed him. He had suddenly stopped his medications and found himself admitted to hospital as his family was fearful he would end his life. He tells me today how Cognitive Behavioral Therapy (CBT) saved his life. I humbly admit I had nothing to do with this. He sought this out and what's more, he carried it through. I restarted medications and attempted to help him see himself for the valuable, caring person he is and not the person he was worried others saw, someone cowardly and ugly. He tells me he can take it from here. He knows the skills from CBT and he is motivated to practice them. He tells me he is grateful for his family in a way he never was before this relapse and for once, he feels lucky to be alive.
3-4pm: A young woman is wanting to come off her medications for a psychotic disorder. Does she know the high risk of relapse should she do this? She does not. I inform her of the 90% risk of relapse without medications and she tells me she understands and would still like to come off medications entirely. She is capable. This is her decision to make. Though I have seen far too many relapses to count, especially after medications have been stopped, I also totally understand this woman's wishes. Who in their 20s wants to be on medications for a life-time when there is any doubt if she needs them? She hopes she is in the 10%, and so do I. So I switch gears, switch scripts. Rather than try to convince her to stay on meds, we discuss relapse prevention, what to watch for to tell us when she may need medication again. Better this happens when in care, than without.