I Was My First Patient

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COMMENTARY

The movie was about to start. I had popcorn in one hand and my purse in the other. I immediately dropped both and closed my eyes. It was January 1, 2009, at 6 in the evening. I will never forget that date because it was the first time I was certain I was going to die.

My heart hammered inside my chest. Sweat started dripping slowly down my forehead. My lungs were screaming for help. My brain began to broadcast a display of images-in my mind, my heart stopped beating and everything I had studied about seizures and strokes in medical school was coming to life. Recent news of a 16-year-old who had suddenly died at a party added to the fear. I was paralyzed and numb, and the deafening sound of the movie was no more than a background roar in my buzzing ears.

I managed to grab my aunt’s arm and mumble, “I don’t feel so well.” She screamed, maybe because she saw my ghost-like face, or perhaps because my family handles stress very poorly. We ran out of the movie theater.

An endless parade of consultations followed-the emergency department, a general practitioner, a cardiologist. My heart was fine, even though they loved to remind me I had had a “peak of stress,” a “hypertensive attack” or, my personal favorite, an “almost syncope.” The cardiologist smiled reassuringly as he held the results and pronounced, “You are one of those women who will die of a heart attack at 50 when they get robbed, just for being so dramatic.” I was 19 years old and my heart was fine, but my mind wasn’t.

Heal the healer

After learning about panic attacks in medical school, I consulted with my psychologist. I had started cognitive behavioral therapy the year before because I felt like a shadow was looming in my future and that an iron bar was pressing on my chest. I felt completely helpless every night when worry and intrusive thoughts made a racket in my head. I knew it was pathological anxiety that haunted me, but I never knew it could, and would, forever change my life.

I said to my wonderful psychologist, “I think I had a partial panic attack, because I didn’t faint.”

Her response marked me forever: “What if you had fainted? Would it have been a complete panic attack then? Why are you so quick to put a tag on yourself? It’s not making you feel any better.”

And that was the first time I thought about labels.

My mother thought I wasn’t making enough progress with therapy, since the sensation of impending doom and endless concern kept sparking in me that malicious, vicious circle of anxiety and pain. I was worried, tense, tearful and, most of all, misunderstood. She took me to a renowned psychiatrist. “Dr. S” quickly “evaluated” me and decided I was “somewhere in the bipolar spectrum.” He gave me free samples of sodium valproate and pregabalin and jotted down an appointment for the following day with his psychiatrist wife (whom I never ended up seeing). I was a fifth-year medical student who knew very well I had never in my life had a single episode of depression, let alone of mania. By then, I had accepted that my ailment was psychological-but it was also physical, emotional, and social.

Like many good psychiatrists, I have empathy and concern for my patients. But in my case, I’ve quite literally walked in their shoes.

Down a cardiologist, and now down a psychiatrist, I tried a second psychiatrist at the recommendation of my psychologist. “Dr. A” also believed my anxiety levels were skyrocketing, even though I kept my cheerful mood and never wavered in my performance at school. She looked at me, smiled, and said, “You are young, you are beautiful, and you are smart. But nothing I say will mean anything to you unless you understand it yourself, because you are full of a blinding anxiety. If I ever hear that another colleague diagnoses bipolar in your case, I will sue them.” With that, she hugged me and prescribed an anxiolytic, which I rarely took. The true anxiolytic was finally feeling normal.

In my third year of medicine, I had already decided I wanted to become a psychiatrist, with its constant challenges and mysteries of the body and mind. The balance between science and compassion, biology and psychology-these were a perfect combination, the right fit for me. My experiences as a patient did nothing but reinforce that passion, and I graduated from medical school and the psychiatry specialty at the top of my class.

The value of empathy

I don’t mention my rise to the top lightly. It cost me my mental health for many years. My desire to please, to give, and to help reinforced feelings of emptiness and isolation. I could barely endure the strain, and life is still a battle to undertake every morning. Nowadays, I tell my story to the patients who I feel will benefit from my suffering. I tell it to those who ask, “Doctor, can you help me?” “Doctor, have you tried any of these pills yourself?” “Doctor, am I normal?” I tell them normal is what we want normal to be. Normal is to feel well, whole, complete, safe, and understood.

I know how to titrate lamotrigine. I’m very sharp at diagnosing personality disorders. I can name all the receptors blocked by tricyclics. But that is not what makes me an effective health care professional. Like many good psychiatrists, I have empathy and concern for my patients. But in my case, I’ve quite literally walked in their shoes. I’ve danced in the hallways of the main psychiatric hospital in Buenos Aires with my dual pathology patients. I cried as I held a patient whose dog died tragically. I sang a song with a patient who thought she was a star in the opera. I’m a good psychiatrist because the patient who changed me was me.

Editor’s note: An earlier version of this article was submitted for the Psychiatric Times Writer’s Contest. The entry was not eligible because the author is not a US-based psychiatrist. Nevertheless, we publish a newer version of this article for our readers to enjoy.

Disclosures:

Dr Giacobone is a general adult psychiatrist and a psychotherapist specializing in CBT. She is a lecturer in psychiatry at the University College Dublin, Republic of Ireland. She reports no conflicts of interest regarding the subject matter of this article.