Ophelia

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PORTRAIT OF A PSYCHIATRIST

–Series Editor, H. Steven Moffic, MD

Dr Panfil is an Adult Psychiatry Specialist at the County Emergency Clinical Hospital in Timisoara, Timis, Romania, and a PhD student at the University of Medicine and Pharmacy, Tirgu Mures, Romania.

She just decided to do it.

And I know that doing it on the front porch was another one of her “jokes” that were in fact a cry for help. What did she expect? A random stranger to walk by and stop her? To save her? Nobody did.

I was furious.

How was it that nobody passed by? Are we savages? It was a busy boulevard, on a front porch, in the middle of the afternoon.

That is how she did it.

I bet she laughed thinking of the conversation she might have with that random stranger that would save her; and, at the same time, I bet she also hoped nobody passed by at all. I know she hated herself, but life was stronger until that moment.

She used to flourish telling her story; she seduced people with her trauma. And that random stranger that would have offered to help would have had the time of his life listening to the horrors.

Do you know how seductive trauma stories are?

**

One thing that keeps bugging me is her call. I did not see her for two months, but she called to make an appointment that exact day.

Maybe she wanted me to save her? But, you see, we talked about this. Anyway, she believed women could not save her. Or did she hope I was different? I asked her to come in immediately when she called, but she got scared. What if I really was different? What if I was the mother that she wished for all those years?

“No,” she said, “tomorrow!”

She must have decided I was not different. The possibility-having hope-was too hurtful to bear.

So, I made a note in my agenda and made the appointment for the next day.

I stupidly asked if she was ok. She said she was not. She lost everything, again.

**

I felt at ease when I heard her express anger. For me, it meant hope. I thought that anger and hope would drive her through the night until I could see her the next day. She should have come to her previous two appointments, I told myself; and for this, I would not worry about her. I was both powerless and hopeful.

Thinking about it, was the anger mine? I do not know. Some of it was mine.

For example, I wish the secretary answered the phone more often. It always seems that I must do it myself.

That anger, mine or hers, might have given her the necessary energy.

She was just 21 years old.

**

When her boyfriend decided he wanted her out of his apartment, after she spent the night in the park, she called to cancel our appointment. I asked her what she would do about her medication. She was going to go to her mother’s place, and her family doctor would help.

**

She called again about a month later to say her mother gave her some money and asked her to leave, so she had to find an apartment.

“What about your medication?”

“I have enough! No, I can’t make an appointment! I am busy, and anyway I lost my insurance again and I don’t have the money to pay for my meds. I will solve it!”

**

The last time I saw her, she was with her boyfriend. My impression was that he was never actually interested in her; instead, he saw an opportunity to feel like a hero and he took it. Four to five months into the relationship, it lost its charm. He was bored.

She became submissive. He hated that. She despaired and made scenes. He hated that.

He liked her when she was in a manic state and when she abused him emotionally. He replayed his own demons with her. But depression was boring.

The first time I met her was in December. She came with this man she just met that wanted to help her after hearing her story.

I was on call. I saw them in the consultation room and thought they were strange together. She was laughing, and he was trying to mimic taking care of her. She was cursing him, and he laughed.

They had just smoked marijuana before coming to see me.

Her medical history was abundant.

She was a psychology student.

When I had enough of their show, I started talking. After they managed to take me seriously, I asked her to give me the phone number of someone in her family I could contact. She flourished.

“Yes!” she said happily, “you can call my father.”

I called him right there and then, in front of her. He was not surprised, not worried. He said he would come to the hospital in the morning, as he was not local. He calmly explained her medical history to me, which was the exact version she shared. We hung up.

She was ecstatic. I left to fill some paperwork, and her new boyfriend followed desperately.

“You can’t do this! That man abused her until she was 15, when she managed to leave.”

I had just called her abuser at 1 AM and told him how she was doing. He seemed to get a lot of phone calls like this. She was haunting him; it was the punishment she desired for him.

I bet she felt like that-she was haunted by all the memories, 15 of her 21 years of life. Did she ever learn to feel safe? I bet not.

How was I so naïve in thinking she was safe with me? I bet safe was scary and unknown.

**

After it happened, I held a lecture on depression. I mentioned her at the end as a tribute. I saw that sort of thing in the movies, and it seemed like a good idea at the time. I convinced myself she would like it, and I longed for a closure. People were curious and unsure how to act; they did not know if they should offer sympathy or ask questions, since I was the “all knowing” psychiatrist and teacher.

I was unsure how to act, so I just left. I will never follow a movie script like that. No one knows how to react to death.

**

I wanted to go to the funeral, but I did not. It did not seem appropriate.

I also was angry and too attached. I never shared these feelings outside of supervision, or at least I tried not to do so. All in all, I felt I was of no help, offered no consolation. I was scared. The guilt felt so overwhelming.

I kept wondering: Did I contribute to this? Was I too unexperienced for this sort of case? Was I fit to practice this profession? Was I any good?

I talked to my supervisor, my boss, and one of my peers-a psychiatrist and friend.

I reviewed the history and my actions, step by step, with my boss. She found no flaws, and she said I did well. Well?

My colleague tried to be empathic. My supervisor as well. Was no one able to punish me? If only I said the exact right things. . .

This is the nagging “fault” of a psychiatrist.