Manic

My last patient this evening was hypomanic - talking a million miles an hour, super focused on his own train of thought, impulsive, pressured, not sleeping - AND his wife says he's doing better. Our fifteen minute appointment turned into an hour. Only then could all three of us conclude that we were one the right track. We stopped one medicine, tapered another, persisted with another and raised the dose of another. Whew!

My thoughts were getting all scattered just trying to talk to that guy. When I was with a very anxious lady earlier, my leg started to itch like crazy. It took all I had not to pull up my pants leg and scratch it till it bled. Later I was aware of hives spreading across my forehead. Anxiety. My anxiety was triggered by hers. Another lady started talking about taking care of her dying mother, and I flashed back to my own experience with my mother's death. Another woman started talking about her conflict with her husband. I almost asked her if we were married to the same man. A young woman told me about the abortion she had last week. Since then she found a doctor to put her on diet pills. She is fighting with her boyfriend and is getting depressed. What a mess. I watched people cry as they told about the deaths of husbands, sons, brothers, sisters, parents. One lady is on chemo for breast cancer. My mother died of breast cancer. I am due for a mammogram.

I'm not doing a very good job tonight at separating myself from my work. I am overwhelmed by a party we're giving on Saturday; I'm afraid things won't be perfect, people will be disappointed by my garden, the kids will trash the house and then all scream and cry in unison, my husband will get drunk and space out in a corner, and I will be responsible for everything. Oh well. Been there, done that, survived. It will be ok. But my anxiety gets fueled up by my patients' anxieties, and all the old stuff surfaces.

I don't actually have to listen to my patients' stories at all. I could just ask about symptoms, tweak the prescriptions, and send them out the door. An awful lot of psychiatrists do just that. But the stories give me a context, help me see and care about the person in front of me, make it matter to me whether that person gets better or not. I wonder if the young woman with the abortion, who makes really rotten decisions, might actually be bipolar. One of the therapists informed me that another young woman, who seemed to be willfully destroying her marriage, is suddenly better since I treated her ADHD. Maybe if I listen to these stories carefullyI can figure something out. Waht happens in their stories really does matter.

Well, right now my house is quiet. Another day of patients tomorrow, party the next day. Being manic sounds attractive sometimes. I'd get so much done. But being calm is perhaps the better goal. I can take a breath, realize that my patients' problems are theirs, not mine, and I am earnest in trying to help them. And beyond that, it is summer, my lillies are blooming, and Saturday afternoon I fully expect to be attacked by a dozen kids with water balloons. It doesn't get much better than that.