Tag:

doctor

Shock and Denial

I review the 5 Stages of Grief with my patients all the time. Yet, no matter how many times I review them, nor how many patients or people I lose in my life, experiencing these stages never gets easier nor avoidable.

Stages of Grief:

Shock/Denial
Depression/Sadness
Anger
Bargaining
Acceptance

The following was written last week:

Today, I shall focus on shock/denial. Why focus on the shock/denial stage? I received a call from the medical examiner (aka coroner) today. I hold my breath each time I answer my office phone in fear that the medical examiner’s office is on the other line. The worst sentence to hear upon answering the phone is “Hi doctor, this is (insert name here) from the medical examiner’s office.”

My biggest fear became a reality today, yet again.

Currently, I am in the shock/denial phase and I’m coping by intellectualizing (a defense mechanism that many of my colleagues employ to deal with difficult news; mostly because I’m more comfortable processing the loss clinically rather than emotionally at this point, hence, the reason I am focusing on writing a blog post that teaches the stages of grief), carrying on with work, and going about my day, with the occasional few tears and blank stares when I have downtime. These moments of sadness are periods that I try to avoid, especially after glancing at my fully-booked patient schedule. According to the medical examiner, “cause of death is not known, the toxicology results are still pending.”

Each and every one of us go through this phase when we experience loss. I blogged about the subject of grief recently when I lost a patient to suicide two months ago. I am aware that my demeanor is currently “off” because I’m quite tense and impatient right now as well. I might be going through the motions of a regular day, but in no way am I taking this loss lightly. I know the anger stage will approach soon. For me, the worst stage is sadness/depression because I generally want to isolate and hide.

The following was written today:

One week has passed since hearing the tragic news about my patient. I enter the clinic, greet my usual “good morning” as I observe everyone going about their busy day as normal. I enter my office and suddenly have a desire to punch my computer as it takes forever to reboot. I settle for slamming my palm against the keyboard instead. Note that this is my usual morning routine, minus the angry/”I wanna punch something” part. The anger stage is here.

I see my first few patients and notice a decline in my usual empathetic statements, my mind drifts more frequently, however, I remain fully aware of my thoughts and am able to re-focus. The 20 minutes that I have with each of them is their designated time and I must not let my grief impact any medical decision. I take my lunch break and run into one of the therapists, who was also involved in my deceased patient’s care. I decide to open up about the struggle I’m having today, in hopes that we can provide comfort and support each other during this difficult time. Instead, I get a remark that pisses me the hell off, or at least that’s how I interpreted her curt comment. I essentially wanted to tell her she was an insensitive idiot and to f*** off, but I held my composure. I normally wouldn’t be bothered by such a comment, but I’m clearly more irritable than usual. I let it go and tried to have compassion for her especially since she might be grieving as well, or thought that perhaps she’s a cold witch and doesn’t care, then thought that perhaps I misinterpreted her comment. Perhaps I feel that nobody understands, and maybe no words can make me feel better at this moment anyway.

February 5, 2015 23 comments

Personal therapy

Sticking To It

written by freudandfashion

{midweek hike in Malibu Creek State Park}

My “Monday Motivation” consists of posting my continued efforts to maintain my New Year’s goals for 2015. I truly appreciate all of you because you’re part of my support system — you’re helping me hold myself accountable to stick with these goals! I can’t emphasize enough how important self-care is to maintain a sense of well-being, which is the reason my last few posts have been dedicated to the topic. Most of my patients struggle with the same issue, which leads to burnout, increased stress, uncontrolled anxiety, worsened health, and much more. The photos in my post are proof of my activities from last week, and serve as my motivation to continue this week. If you’d like to join me in my efforts to prioritize self-care, would love for you to share how you’ve been doing so thus far!

{Took a REAL lunch break & caught up with celeb gossip and world news}/ {went to two amazing yoga classes, even though I was initially too lazy to go and wanted to back out (pic taken before class)}

{Took a stroll on the beach of Playa Del Rey after my weekend therapy session}

January 27, 2015 11 comments

therapy

Restful Week

written by freudandfashion

Have you ever felt guilty about having an unproductive week? That’s how I initially felt regarding this week, but in retrospect, I believe it was necessary to take it easy.

To be easier on myself (which is difficult for a self-critical person like me), I had to keep in mind two of my goals for 2015 (which I discussed in my previous post):

be mindful
be aware of my need for self-care

I felt ill this week and wanted to sleep most of the days, and therefore, couldn’t complete most of my tasks. However, I needed to listen to my body and its need for rest and recovery, whereas in the past, I’d push myself to go to the gym and stay up late until I completed everything on my to-do list. I also had insightful, yet emotionally-draining group and individual psychotherapy sessions, which resulted in me not wanting to write a blog post due to how much thought and psychological overtones I put into my posts. Yet, this is a pattern that has occurred in the past since I first started blogging in 2010, which resulted in large gaps between posts. I am trying to avoid those large gaps this time around and want to let you all know of the reason I’m late with this weekly posting.

What made me feel better was reading statements such as “it’s okay to not be okay,” which is definitely true, however, society makes you feel as if you have to be running on all cylinders ALL OF THE TIME. Which is fine, as long as you take necessary breaks and don’t wear yourself out. However, we are all human, and I often try to help my patients overcome barriers towards being less judgmental on themselves.

As you can see, I’m trying to take my own advice 🙂

January 18, 2015 7 comments

Personal

Fresh Start

written by freudandfashion

{Napa, California}

I’m excited about the new year, but must admit that I’m in a strange transition phase where my professional identity and personal identity are at odds with one another. Most of my life has been devoted to my education and in many ways I believe those years halted my personal development. When most of my childhood friends were getting married and starting their own families, I spent most of my days studying, memorizing, listening to lectures, getting grilled by senior physicians, studying so that I don’t look like an idiot in front of senior physicians, eating, sleeping (then repeat). My free time was spent either catching up on sleep or celebrating to make up for the fact that I spent several straight weeks studying (I think I’ve used the word “studying” way too many times in this post already).

“I wanted to become a doctor so I could serve others. And because of that I’ve lost everything. But I’ve also gained everything.” ~ ‘Patch Adams’

Being in my mid-30’s, I certainly miss the vibrancy that came effortlessly as an energetic 20-something year old. I recall working a 12 hour overnight shift in the Labor & Delivery unit, then heading straight to the airport (with only 1 hour of sleep) and boarding the plane in my scrubs in order to attend my sister’s graduation that day in San Francisco, then flying back the next morning (in my scrubs) to make it in time for another 12 hour shift. Time flew by way too fast. Before you know it, I’m at it again struggling to get a few days off in order to attend my sister’s wedding. I barely had any time to think…and little time to fully enjoy life outside of school. But that’s the path I chose and I am grateful with no regrets. Now that I have a bit more free time, I am mindful that the more I allow myself to savor the present moments and especially invest in my own self-care, the better a person and physician I become. After all, how can I care for others if I can’t take care of myself? In the past, my new year’s resolutions consisted of external measures such as losing weight, getting high grades/scores on exams, etc. But this year my goals are more internal and self-fulfilling…

My goals for 2015:

be present
be mindful
be open to self-discovery
be aware of my need for self-care.

Thought of the Day: What personal goals would you like to achieve in 2015?

Photos by Marlon Santos

January 8, 2015 11 comments

Psychiatry

Holiday Mental Break

written by freudandfashion

{With our new family dog, Levi}

Whenever I visit my parents’ home, I regress to a childlike state and become the complete opposite of how I am in my normal, adult life (i.e. instead of my usual high stress, on edge, active, rigid self, I wake up late, lounge around in sweats, and enjoy writing “nothing” on my to-do list). Hence, I’ve taken a brief mental break to reset/recharge and in my relaxed state, I realize this is the first time in eight years that I’ve had time off during the holiday (consider 2 years of hospital rotations during medical school, 4 years of residency training, and 2 years being the newbie doctor at my first job). I initially felt guilty about being away from the clinic for so long, but am aware that my ability to provide quality care declines the more burned out and overwhelmed I feel. I know how hard it can be to prioritize yourself, especially if you’re the caregiving type who’s used to putting others’ well-being before your own. I hope you are able to find time to care for yourself during the remainder of the year, and if not this year, then consider as a possible New Year’s resolution to put self-care amongst the top of your list.

December 28, 2014 11 comments

Psychiatry

Loss Hurts

written by freudandfashion

{Serra Cross Park, Ventura, CA}

Every bit of me is fighting not to lay on the couch and immerse myself in reality tv to distract from experiencing the emotional distress of a recent loss. Doctors grieve the loss of patients. I have grieved. Unfortunately, the grief process is all too familiar in my line of work. In fact, tears stream down my face as I type this because I know I have to acknowledge my grief rather than having shock, anger, sadness, and a whole mixture of emotions take control of me. After receiving a call from the coroner’s office earlier that day, I drove home dazed and missed the entrance to my voter polling place…three times. And I almost got in an accident.

The worst part is knowing that suicide happens too often. The second worst part is a combination of feeling horrified, sorrow for my patient’s family, and disbelief (what did i miss? what did i do wrong?), wondering if there’s anything I could have done to prevent it. But worst of all is to think of the depths of severe, emotional pain that my patient must have experienced to reach that point — no words can describe, and nobody can empathize with my patient’s despair unless they’ve been to a similar dark place before, or know someone who has.

Which is perhaps one of the reasons why there are barriers to change the perception of mental illness — do we distance ourselves so much from those diagnosed with mental illness that we can not acknowledge, empathize, or even begin to understand that suicidal thoughts are symptoms of a true, neurologic disease? Or will society continue to turn a blind eye by continuing to believe that suicidal thoughts are feigned, a product of a hopeless mind, or a sign of weakness?

I can vividly recall the first time I lost a patient on the medical floor as an intern during my internal medicine rotation. Cause = Septic Shock. “Here’s where things went wrong and could have been prevented,” said an Attending physician when the case was reviewed. I wanted to quit my medical career that very moment. This time around, there is no Attending physician telling me what I did wrong — the voice is my own. The voice is always there, and I want to quit. I want to isolate and lay on my couch the entire day, but I can’t. I want to cry when I’m in clinic each time my coworkers kindly ask “how are you?” but I hold back the tears. I wish I could redo the last session with my patient, but instead, specific moments from our final conversation replay in my mind. It’s not until now, as I type, that I remember my patient’s last words to me as she gave me a hug on the way out. Touching words I will never forget and reinforce why I need to keep going.

November 6, 2014 16 comments

Psychiatry therapy

Are you ready?

written by freudandfashion

The Great Sand Dune, Point Mugu

I may prescribe psychiatric medications, but the one treatment I advocate for the most is psychotherapy.

Psychotherapy = general term for talk therapy, counseling; meeting with a mental health clinician for support, insight, and development of coping skills for life challenges.

Patients often ask me whether or not I think they should see a therapist. My general answer: “I think everyone can benefit from therapy. I think therapy will help you for (insert reason I believe patient will benefit from psychotherapy here based on my formulation of his/her issues).” However, despite my recommendation of therapy, the more important question is: “Are YOU ready for therapy?”

Here’s a few reasons why I believe this question is so important:

– Therapy can be challenging. As humans, we develop defenses to help prevent us from feeling the full extent of deep, emotional pain. Therapy may lower your defenses, which allows you to experience and process painful emotions in a safe environment. The well-known phrase “no pain, no gain” applies to therapy as well. With pain = growth and healing.

– Talking about yourself can be uncomfortable. You might feel like you’re being judged, which is especially difficult. And if you’re one who loves talking about yourself, perhaps talking about yourself (and not acknowledging others) may be the reason for your problems (a good therapist should be able to point this out).

– You can never predict what might come up in therapy, so being open to the process can lead to development of great insights. There might be times when you want to stop therapy or may question if it’s even helping. Being open to processing your resistance may lead to great insights as well (i.e. any material that comes up in therapy may have meaning and be subject to processing during session).

I write this post not only as a clinician, but also as one who has experienced all I mentioned above in my own therapy process. Even as a psychiatry resident physician, I resisted starting therapy because I feared what I might learn about myself. I grieved the loss of my grandfather, struggled to adapt to my move to Oregon for residency, and felt depressed because I wasn’t performing as well academically, and various other reasons. In effort to avoid therapy, I first turned to exercise, shopping therapy (not the best on your credit card), and talked to friends, which helped temporarily but didn’t help me learn to better cope with my issues. I eventually gave in, faced my fears, and as a result I’m much more self-aware, insightful, and comfortable with myself as a person. I’m also a much better psychiatrist to my patients (nothing makes you more empathetic towards your patients than putting yourself in their shoes and sitting in the patient’s chair).

P.S. Not all therapists are the same. If you don’t have a connection with your therapist, don’t give up on finding the right one! (stay tuned for a future post on how to find the right therapist)

September 25, 2014 4 comments

therapy

Thankful Thursdays

written by freudandfashion

IMGP0257

Malibu Beach

People who meet me tend to perceive me as a positive person, but I’ll admit that I wasn’t always that way. I was quite the complainer growing up and blamed others if things didn’t go my way. My negativity improved through maturation over time, but my four years of psychiatric residency training certainly helped me become more self-aware. Learning about different psychotherapy techniques sharpened my skills even further, and one modality that I use involves Positive Psychotherapy.

What is Positive Psychotherapy (PPT)?

In a nutshell, Dr. Martin E.P. Seligman spearheaded the development and research of PPT as an intervention for treatment of depression and the theory consists of some of the following concepts:

– focus on the POSITIVE (factors that contribute to happiness and build upon one’s strengths)

– build POSITIVE EMOTIONS (about the past, present, and future)

– identify and utilize your STRENGTHS

for example, if you’re a creative person, do things that bring out your creativity (such as writing, photography, etc). If you’re competitive, consider joining a recreational group or league

– instead of letting your strengths and talents go to waste, apply them towards something MEANINGFUL (such as in your job, community, family, religious institution, etc)

Naturally, this can take a lot of work/effort especially since our minds may automatically take us down a negative spiral in the face of challenge and negativity. With our often stressful and hectic lives, when something goes wrong, it seems like it requires more time and energy to switch to a positive mindframe. With that in mind, Seligman’s team developed a series of exercises to help shift your mind towards more positive thinking, one of which includes listing “3 good things” that went well during your day.

So, with a slight twist and in the spirit of PPT, I created a new series on my blog called “Thankful Thursdays” where I will list 3 things I’m thankful for from the week and I encourage all of you to do the same!

Here’s my list from this week:

1. Took advantage of living a few miles away from the beach and spent some time there to escape the triple digit California heat wave (picture above).

2. I’m thankful for my family stopping by my office to visit and instead of my usual routine of going home to check email and watch tv, I enjoyed quality time with them over a delicious meal.

Dinner in West Hollywood

3. Received a “sign” today which steered me in a different direction regarding a work project. I truly believe that when one door closes, another one opens, so I’m staying focused and optimistic!

On a boat in South Lake Tahoe

What 3 things are you thankful for?

References:

Seligman, M. E. P., Rashid, T., & Parks, A.C. (2006). Positive psychotherapy. American Psychologist, 61, 774-778.

Photo Credits: Marlon Santos (Diamond Reel Media), Alex Manipod

Disclaimer: this post describes one therapeutic technique and should not be used to replace treatment with your primary clinicians

September 18, 2014 9 comments

Psychiatry therapy

Stay or Leave?

written by freudandfashion

Office Balcony Sunset

I recently made a difficult decision regarding my job, which triggered feelings of uncertainty, fear, and self-doubt. In the process of contemplating my decision, I recalled one of my patients, a college student who struggled with depression. Despite going to a prestigious university, his overwhelming fear of not getting accepted into law school further exacerbated his depressive symptoms. I responded with seemingly consoling statements such as “you’re still young…you’ll get there…you have a lot going for you…I went through the same situation and it worked out okay.” However, my attempts to reassure really weren’t reassuring at all (it’s well known in psychiatry that reassurance generally doesn’t reassure mostly because the statements fail to validate the patient’s current experience). Reflecting back, I realized that in the moment I didn’t want to relive my own pain, uncertainty, and fears that I experienced in my process of applying to medical school. I recalled the discouragement I felt with each rejection letter I received. And I was still feeling discouraged at my current job. Since I gained insight from connecting his experience with my own, I looked forward to validating his feelings at his next appointment. Unfortunately, he cancelled his appointment and never returned.

I realize that contemplating decisions regarding a career path, relationships, love, and pretty much anything pertaining to life in general, makes us vulnerable and uncomfortable. The idea of change can trigger fear and act as a barrier towards future ventures. After a year long process, I finally decided to resign. My anxiety peaked even more because I felt uncertain of the next step to take. Where do I go from here? Will I feel happier? Will I regret my decision?

Seeking motivation to push forward and take risks, I read quotes by famous writers, all with similar themes to never give up, choose the “road less traveled,” try new things, and learn from your mistakes.

The dangers of life are infinite, and among them are safety. ~ Goethe

Yet, it took being on a plane last night watching The Amazing Spiderman 2 hearing Gwen Stacy (played by Emma Stone) give her valedictorian speech to make me realize how mainstream and pervasive this dilemma is:

“…I say it today of all days to remind us that time is luck. So don’t waste it living someone else’s life, make yours count for something. Fight for what matters to you, no matter what. Because even if you fall short, what better way is there to live?”

As mentioned above, my decision involved resigning from my highly-desired, well-paid job in order to take control of my life, practice, and career. Since my last day, I have mixed emotions of feeling liberated, hopeful, excited, yet completely scared at the same time.

I made the right decision.

“…you can fail at what you don’t want, so you might as well take a chance on doing what you love.”

~Jim Carrey

Putting in work at my new office in West Hollywood

Photos courtesy of Marlon Santos (Diamond Reel Media)

September 10, 2014 24 comments

Psychiatry therapy

Letting Go

written by freudandfashion

When a stable patient suddenly feels depressed and can’t pinpoint a stressor, I sometimes ask if a loved one passed away around that time of year. After pausing for moments to think, oftentimes the answer is “yes.”

I had a rough week that I initially attributed to having a heavy workload, but realized that the theme I struggled with the most was death and grief. I felt sad to hear news that one of my patients died and grew frustrated each time I heard the word “suicidal.” I’m normally diligent and confident in managing my patients, but my emotions overwhelmed me.

Nine years ago, my grandfather passed away. I regularly blame myself for not attending his funeral in the Philippines because right before he died, he asked that I stay home, focus on my studies, and make him proud by becoming a doctor. I live with regret, but recognize that I’ll keep struggling around this time of year until I learn to forgive myself and accept that my grandfather is gone.

February 12, 2011 2 comments

Newer Posts

Older Posts