A surgeon’s instrument is a scalpel. A psychiatrist’s instrument is a pen.
Towards the final months of medical school, I felt more doctor than poet. Actually, I felt more doctor than anything else, maybe even human. I was perfectly curated to view the world through a critical medical lens, biweekly exam after biweekly exam, OSCE (Objective structured clinical exam) after OSCE. Poetry felt like a distant echo through the howling winds that swept through U of T’s St. George Campus.
This was until my very last rotation in my clerkship year, right before I was set to apply to residency.
To be continued…
The mid-July sun crept through the curtained windows of a downtown Toronto hospital, bathing the psychiatric unit in sheens of gold and casting long shadows down the corridor. Faintly in the background, you could hear the chatter of nurses by the nursing station, the thwack of heavy doors announcing the entrance and exit of doctors and patients, and the dings! of the elevator bringing families and friends up to the highest floors. What I noticed, early in my psychiatry rotation in clerkship, was that patients on our wards rarely received the “Get Well Soon” cards, flowers, or balloons that you would frequently notice on the post-operative or medical units. Their suffering was no less, I can assure you, but the stigmatization of mental illness can often (and unfortunately) keep public sympathy at bay. It was one of the many observations I would make during this final rotation of my clerkship year.
For the past ten and a half months, I plunged into different specialties, whetting my appetite just enough to determine if I hungered for what the particular field offered. I learned that I loved the precision of surgery, but struggled to be on my feet for endless hours, or in the operating room as my lower back screamed out for mercy in the final hours of a surgery. I loved the pace of the ER, but found a string of nightshifts to be quite destabilizing. My passion for OBGYN and internal medicine still burned brightly, though I did discover certain elements in either specialty that made me feel uncertain. I loved working with young adults, but general internal medicine skews towards the elderly. I adored working with pregnant women, but struggled to find that same adoration in parts of gynecological surgery (which would make up the bulk of the training).
Still, at the top of my psychiatry rotation, and just months away from doing electives across Canada and submitting my residency applications, I remained steadfast in the direction of internal medicine or OBGYN.
That all changed two weeks into my psychiatry rotation.
“Never a dull moment,” I heard my attending say, as we started our rounds on the units, seeing patients on our list and running through any updates. We managed cases that spanned severe obsessive-compulsive disorder, vascular dementia causing behavioural and psychological symptoms of dementia (BPSD), treatment-resistant depression, forensics, primary psychotic disorders, postpartum psychosis, and mania, to name a few. We would interview the patients every day, inquiring into their mood, medication side effects, suicidal or homicidal ideation, presence or absence of psychotic symptoms, and carry out legal and capacity assessments if necessary. Psychiatry, often seen as the underdog of medicine, sits at an interesting intersection of medicine, the law, and society. In my opinion, it requires the most holistic analysis of patients, from their biological and socioeconomic status to the things that constitute their personhood. In psychiatry, we call this “formulation,” or simply put, trying to fully understand what has led to this patient’s current presentation, from all areas of their lives and position in the world.
I would sit with families, gathering collateral information, as they would tell me about who their loved ones were beyond the hospital: the cookies they baked, the career they’d dedicated their lives to, their favourite pick-me-up after a long day. With my patients, I would do my very best to understand their internal world: the level of insight they possessed, their comprehension of why they were hospitalized, recent major life events or losses that had affected them. I would always ask what brought them joy, and whether they’d had access to that joy lately. The answers, at times, would render me speechless.
When a patient had lost their child, and felt haunted by their absence in nightmares, they told me that their only access to joy was gone, and could never be retrieved. Only years later, now as a mother, do I deeply appreciate the truth in this patient’s sentiments.
We were challenged to understand our patients beyond the illness, so that we could widen our aperture to all the factors that invariably influence how someone really becomes mentally ill. Our ultimate job, thereafter, was to take the puzzle pieces that we collected from the patient, their families, and anyone who could lend insight into our patient’s world, and fit the jigsaw together.
A surgeon’s instrument is a scalpel. A psychiatrist’s instrument is a pen that brings together a narrative of who, what, where, when, and most importantly in this grander medical picture: why.
Rotating through psychiatry, I felt the most like a poet. I was called to make an unflinching examination of the human experience, not turning away when things got dark and heartbreaking. I was required to lead with my humanity first, and give words to things that seemed ineffable. Like metaphor weaves the wonders of the world together, psychiatry weaves medicine into art and narrative.
What I noticed, more than anything, was that being a better poet made me a better doctor. I drew from a deeper well of compassion and understanding. I transferred the art of quiet observation of the world, which I learned most carefully through my poetry practice, into an invaluable asset in the practice of psychiatry. Often, also, psychiatric cases are complex and can bring in neurological overlap, internal medical intersection, and leave many experts stumped as to what is truly evolving. Being a poet has helped me here as well. Poetry necessitates a critical application of language and literary devices, and oftentimes a stanza will leave me stumped until I finally “crack the code.” It has taught me to sit patiently with the puzzle until it opens.
For the first time, throughout my medical journey, I felt that I no longer had to choose between the art that beckoned me home and the science that propelled me forward. I felt like a doctor and poet in equal measure, finally at peace in a medical specialty that I never originally considered, but now can’t imagine my life without.