Somewhere late morning, after rounding on my first day of internship, I received a call from my sister.
“She wants to kill herself. What do I do?”
We had been through this before with our mother, fifteen years ago, the week I moved out of her house. She ended up in the psychiatric unit as we packed our bags to move in with our grandmother. This time, fifteen years later, things were different. I was an adult, and since May, I had been a doctor, in title at least.
“Does she have a plan?”
“What do you mean, does she have a plan?”
“Well,” I answered, “if she has a plan to kill herself or is actively suicidal” — sounding definitively medical at this point — “she could buy herself an admission.”
She went from mother to patient easily, almost reassuringly as I recommended taking her to the emergency department. My heart pounded, then it sank. I kept my voice even, my physician demeanor solidly intact. I apologized I couldn’t help more, being my first day of internship and on the other side of the country. At the end of the day, I walked through the dimly-lit parking lot and reviewed the multitude of messages waiting for me. My heart sank again. This time, not because of the pain my family had experienced during the day, but because I had forgotten about them while I focused on the ten patients I was caring for that day.
Medicine has allowed me to intellectualize my mother’s illness although I cannot say I understand it any better than I did before the medical degree. The murkiness of her diagnosis years ago has been slowly clarified by deciphering and translating various prescription bottles: lithium, quetiapine, olanzapine, alprazolam, fluoxetine. I remember the names from when I was young, not knowing one medicine from the next. I remember when medicines did not have names but were forbidden objects of varying shapes, sizes and colors all in a small, child-proof bottle out of my reach. Like a foreign language, these words were printed in sterile script, inscrutable to me, at least as a child.
Over time, the words began to make sense and their meanings were translated and integrated into my understanding of my mother and her disease. A selective serotonin reuptake inhibitor, a benzodiazepine, an atypical antipsychotic, a mood stabilizer. Depression, anxiety, mania. In medical school, I would lose sleep over the heritability of bipolar disorder. Among the multitude of arcane and unlikely diagnoses one worries about while studying pathology, this one seemed disturbingly possible.
When she flies into a fit of rage, depression, or anger, for better or for worse, I play doctor. “I’m sorry you feel that way” is a good phrase which allows me to remain neutral and supportive. Depending on the context, I may ask her to “tell me more” but more often than not, I let her speak, I listen, I set boundaries. I recognize the pain she experiences and mostly, I feel sad. As a physician, I see her suffering, isolation and disease as a problem afflicting many patients and many families. I understand how good people can be estranged from their loved ones.
Perhaps taking care of so many patients with mental illness on the periphery of society is my atonement for our estrangement. For better or for worse, residency goes on, I leave the hospital and for most hours of most days, I forget, focusing my mind on the census of ten patients I am able to help that day.
Elizabeth Horn is a resident physician.