I forgot to call her back. I wasn’t really her doctor anymore, as she had been discharged from the inpatient psychiatric unit several weeks ago. She should be following up with the outpatient psychiatrist to whom she had been referred. But she had left a message on my office voicemail, telling me she wanted to stop her medication. I did intend to call her back. Since the phone number she had left was not discernible, I had taken the time to call the inpatient social worker and obtain her phone number, which was sitting on my desk.
When she had presented to the hospital several weeks earlier, she had been in an acutely psychotic state. She refused medication, preferring to follow the guidance of Jesus. Not sleeping, she would walk the halls of the ward, screaming “prayers” for herself and the other patients. She was taken to mental health court and, in a hearing, her mother testified about her not eating and about her wandering, partially clothed, through the streets at all hours of the day. Involuntarily committed, she was medicated against her will.
After that, she improved. What seemed to be years of accumulated psychosis slowly cleared. She began sleeping through the night. She was able to have a coherent conversation. I became fond of her. The treatment team held a family meeting with the patient and her mother. We learned that her loving and devoted mother had been struggling for many years with the patient’s illness, to get her some help. The patient had lost custody of two children because of her untreated psychosis. She had gotten married, moved to Nevada, divorced, and returned to Philadelphia. Her mother had watched, frightened, as she lived her life in a desperate, disorganized manner.
As she became more coherent in the hospital, she became quite sad. She cried, almost continuously. She was sad that Jesus no longer had the same power over her; she was worried she was losing her faith. She “missed” her symptoms. The tears emanated from profound loss. She had lost her children and years of her life because of psychosis. We comforted her and propped her up. We got her to feel better, probably better than she had in many years. We also gave her a shot of aripiprazole decanoate and reminded her daily that continuing to get this shot monthly would help her stay out of the hospital and maintain stability.
I was surprised, then, when I heard her voice on my office voicemail. It had been three weeks since she had been discharged. My busy life had moved on. A quiet voice in my head whispered that she was no longer my responsibility. I’ll get back to her when I can, I thought.
Sitting quietly at my desk a few days later, enjoying a journal article after a busy, stressful day, my office phone rang. A pang of anxiety coursed through me. I knew who it was.
“It’s S. The medicine you gave me, the Abilify, it’s causing side effects.”
“What side effects are you having?” I asked.
“I looked it up on Google. It causes a lot of side effects. Can you give me something to flush it out of my system?”
“You received the shot almost a month ago now. It is almost out of your system,” I said.
“It’s causing side effects,” she repeated.
“Can you tell me specifically what the side effects are?” I asked again.
We went back and forth like this for 5 or 10 minutes—she, expressing her worries and concerns to me about the medicine that was in her body, and me, listening to her, trying to be rational and to reassure her that she was okay. I felt like I was failing, that nothing I said was helpful. Sadness emerged within me when I told her that I had to go. It occurred to me that during the time she was hospitalized, when I was her doctor, we had developed an actual relationship, with real feelings for one another. While I had “forgotten” about her, she had impacted me profoundly. As with many patient–doctor relationships, a unique and powerful intimacy is created, something permanent. I imagine that my significance to her also remained strong. I suspect that the positive experience she had in the hospital will carry forward, perhaps buoying her a little as she struggles with the waves and torrents of her illness.
When we said goodbye, she touched me with her gratitude. “Dr. Kersun, thank you very, very, very much.”
A tear welled in my eye. Although just moments ago I had felt as if I was failing her, I now knew that quite the opposite was true. I had succeeded at being her doctor.
Jonathan Kersun, MD
J. Kersun is assistant professor, Department of Clinical Psychiatry and Behavioral Science, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania; e-mail: firstname.lastname@example.org.