Saturday, October 10, 2009

Mental health care: a Bellevue success story

Although I trained in family medicine and have practiced in a variety of settings, I've never had the experience of being a small-town family doctor - the kind with an office adjoining his house and who runs into his patients regularly at the grocery store. In fact, the only time I can recall meeting a patient on the street was nearly a decade ago, in Manhattan, of all places, when I was fourth-year medical student who had recently finished a psychiatry rotation at Bellevue Hospital. The experience inspired me to write a poem that I share below. (There is a health care reform angle to this story as well, but I'll save that for another post.) "Sanders" is a pseudonym.



I hardly recognized him. How changed
He appeared from that combative, demanding
Patient I knew on those 90-degree days in July!
Then he had been overflowing with suggestions
For his treatment – use this painkiller, not that one –
Living up to the secondhand stories of his terrorizing
Orderlies at Beth Israel. “Can’t anybody see a doctor here?”
Loitering at the nurses’ station, demanding his methadone
On the clock. At war with Sanders over the morality of the unit.
We groaned. Later, dominating therapy groups, he puffed up
With pride at his “progress.” I shied away, leaving him
In the spotlight one last time for others to examine.
Antisocial personality disorder, the attending pronounced.
Sense of entitlement. Which made me wince.
The man just needed a stage. Those final days,
I watched him play spades with the pretty volunteer,
A new man. Praising me to the skies, his Good Doctor.
I saw him on the sidewalk this morning, with headphones
And shiny Giants jacket, inhaling the crisp autumn air.
He shook my hand, wished me the best.