asco-logoWe have all seen patients whose distress is off the charts, or off the Distress Thermometer (NCCN). They sit in our offices, dazed and seemingly so depressed that we ask the mandatory question: “Are you thinking of hurting yourself?” Some patients just shake their head, not making eye contact, and even though they say they aren’t going to hurt ...

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I did some pretty crazy things to get into medical school (don’t worry Mom, nothing illegal). For several years before applying I became a medicine groupie. I read books about being a doctor, watched documentaries about medicine, shadowed physicians for hours on end so I could imagine what it might be like. I watched many a friend go off to med school and graduate … and I waited, I hoped. ...

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Jerry once killed a man, his best friend.  He told me about it, unemotionally, but as if it had just happened. He wandered the street like a refugee in a war-torn country, except he was in mid-America: Louisville, Kentucky, as it were.  He was homeless.  I've known him for five years, anyway.  He's approaching fifty, a rough-looking man, large, with thick gray hair, which is quite long now.  He has lost ...

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"You need to come to the ED ASAP." A new patient was admitted at 2 a.m. and requested for a crisis counselor. Unlike with cases of sexual assault, survivors of domestic violence had to specifically request for the presence of an advocate when I was volunteering in NYC back in 2009. This woman, I’ll call her Sadie, had already taken the first courageous step to seek help. I briskly walked past ...

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Getting mental health right for all Americans is a huge undertaking. For the last 150 years, our “solutions” to mental illness can, at best, be characterized as a series of good intentions that were poorly, if not disastrously, implemented. But while there may be a conversation that needs to happen about how we got here, what’s important right now is how we go about shoring up a system that is ...

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As we grow into adulthood, each of us develops a personal comfort zone located on the continuum between paranoia and gullibility.  A few of us are highly suspicious by nature, a few are unwitting dupes; most of us are in between.  Mental health professionals are no exception, and it shows in our work.  Is a request for tranquilizers or stimulants legitimate, or are we abetting a substance abuser? When told of horrific past abuse, do we believe every word, ...

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On October 9th , while President Obama was attempting to console the victims of the October 1st mass shooting at Umpqua Community College (UCC) in Oregon, two more students were killed, and five people were wounded at colleges in Arizona and Texas. In Flagstaff, Arizona, a gunman opened fire at Northern Arizona University. Hours later, Texas Southern University (TSU) classes were canceled at the Houston school as the campus was locked down ...

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Several friends have pointed out to me their observations of my interactions when in public places: That people strike up random conversations with me, ask for directions, of if I could take a couple’s picture at a touristy hot spot, etc.  These types of interactions are becoming less awkward to me in the last few years, and I initially attributed my approachability to giving off a “psychiatrist” vibe, as if people can sense that ...

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“You work here?!” I nodded, a hint of a smile revealing my bemusement at his incredulity. “Well … probably not after this.” The other patients in the psych waiting area of the ER nodded in agreement. In my newly issued brown scrubs, stripped of my belongings, I was no longer a research coordinator at a top hospital, but rather one of them. And sadly, they believed being one of them meant you couldn’t ...

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It’s not always obvious. Sometimes patients register with a chief complaint like “headache.” They tell the nurse their head has been hurting for months and deny fevers, etc. They get put in a room, and when you take the history, there’s nothing remarkable until you ask just the right question:

“So, what do you think is wrong? Are you worried about anything in particular?” “Well, I think it’s probably the plate they ...

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