Archive for November, 2009

Soul Points

November 26, 2009

It has been a while since my last post, but it’s my lunch break here at the psych clinic, my med-student colleague has left early, and my next patient isn’t supposed to show until 1pm.

Psychiatry is a funny clerkship (and a funny profession). Most other specialties in medicine focus on physical, quantifiable parameters of the body; your weight, your blood pressure, x-rays, sodium level, and so on. Psych on the other hand is much more interested in how you feel, think, and behave; qualitative things that require a certain rhetorical flair to portray fully. Psychiatrists need to think about how their patients make them feel. If the patient makes you feel sad, then it lends credence to the thought they are depressed. If they make you feel annoyed, then perhaps they are borderline. If you are entertained, perhaps they are slightly manic.

Psychiatrists have this uncanny ability to cut through a person’s outer layers (onions vs cakes anyone?) and seem like they are looking into your soul. Much like the Jedi, they can’t so much read minds as they can read emotions. This is unsettling enough watching your superiors use this power with patients, but it is truly disquieting when they turn that piercing gaze on you (think Frodo and the eye of Mordor). What this all means is that their critiques of your performance during the clerkship tend to be very incisive, and not a little bit painful. They seem to be able to find your insecurities and bring them to light, in an attempt to “fix” them. This is a painful thing for a student, knowing you are flawed, feeling shitty about it and trying to hide it, only to have your boss drag it out into the light and examine it under a microscope. People say that good critique is painful, and if it is one thing that these guys do, they seem to give good critique.

And so I get to what all this has to do with the title of my little entry (in a round about, or as we would say “circumferential,” manner). I’m not going to lie, I have had a couple of really crappy weeks during my first month of psychiatry. I think I was finally reaching that part of third year when, for want of a better phrase, I was running out of soul points.

What are soul points? Well, it’s kind of an extension of wins and losses. The way you get them is by doing good, self-affirming (or just fun) things. A patient tells you that you’re going to make a good doctor. Someone notices your hard work. You get in a good game of ultimate frisbee. You lose soul points when bad things happen; you watch the unsuccessful code of a 10 year old girl, or participate in another unsuccessful code of a 17 year old girl who shot herself in the head. When you worked for 2 months setting yourself the challenge to honor a clerkship, and don’t. When you have to help keep another human being in the hospital against their will . . . for their own good. When your supervising psychiatrist tells you that you that he thinks you have made one too many inappropriate comments during rounds. When the world singles out a vivacious person doing good work to get sick and die for no particular reason.

Talking about some of this with a fellow third year, I swear to god I nearly cried. Tears in my eyes and everything. That’s probably the closest I’ve come to crying in front of somebody in five or six years.

People generally say that third year and internship are the two hardest years of medical training. Those two years are long, and they nibble away at your soul-points without offering much time or many chances to replenish them. I think one starts to “burn out” when you run out of soul points to absorb the random shit flying at you. Once you run out, then it’s all body blows; you can’t muster the enthusiasm, optimism, idealism or any of that life-zest anymore because everything gets to you, and it beats you down.

I know soul-points is kinda a funny name for the concept, and truth be told it’s more or less just a sardonic nod to the elephant in the room. Rather than not give it a name, or give it a less melodramatic (and thus more credible) one, I feel like like this way there is some degree of acknowledgment both of the problem’s existence, as well as some degree of defiance; that is hasn’t gotten so bad as to sap all humor.

I’m feeling much more myself now than I was a week or two ago. But the point stands all the same; they weren’t kidding when they said third year was going to be hard.