“You need to assess this patient RIGHT NOW! I put in the consult an hour ago! He’s making a racket in MY ER!”
I sigh inwardly and look up at the emergency room staff who is yelling at me, oblivious to the fact that he is making a bigger racket than the patient he’s referring, then I peer over his shoulder at the tall angry middle-aged man with dark sunglasses pacing at the entrance of the psychiatry emergency room.
I say: “I’m reading his chart right now, and will see him as soon as I’m done”
“That’s not good enough! I want to know EXACTLY when you’ll see him!”
Wow..sorry I missed the memo about me being your slave.. (of course I don’t say this out loud, but I think it) I look up at the clock on the wall, it’s 9:50 pm. “I’ll see him in 10 minutes” .
“OK” he puffs, looking a little deflated and disappointed he had no excuse to keep yelling. He marches off to his next poor victim-uh I mean- patient.
After he leaves, I roll my eyes behind his back (I know-shame on me!) and smile at my team of two. He’s not ruining our shift. The nurse, Jack shakes his head and laughs. He has more experience than I do in this ER. Jack is funny and usually relaxed, and a good advocate for our patients- I’m always relieved to find him on duty when I’m on call. Bonus, he is tall and well built, and when in the ER, it never hurts to have team members with more muscle than you do-just in case physical strength is needed.
Peter, the med student, was the other member of our team tonight. It was the first time I’d worked with him, but I could tell, he was one of those students who actually shouldered some of your load. I could delegate to him, and I could trust him.
To him I take a”teaching moment” to say: “never just give in to pressure to see a patient quickly without going in armed with all the information you can get. Rushing may give you the feeling that you are getting things done quickly, but trust me, reading the chart is a good investment of your time, especially when you’re dealing with a potentially dangerous patient. Your interview with a patient like this is mostly a mental status exam. Honestly, what information will you get from a screaming patient anyway? You need to enter the interview room with a preliminary idea and plan”
You learn these things from experience, from the lucky “near-misses”. In my first month in psychiatry, I spent over an hour alone in a room with a patient, totally clueless that he had a history of violence and antisocial personality disorder. The last time he had graced our ER with a visit, he had thrown and broken furniture in the very room I sat with him! When the staff -who knew him- realized I was interviewing him, he was kind of horrified, and took me off the case. “I’ll deal with him, don’t go back into that room!” he had barked.
I had to hit my forehead with the heel of my hand-again-for my naiveté. I had been totally taken in by the patient’s heartbreaking story, and had not picked up on the antisocial part at all! What can I say? It’s my fatal fault, my achilles heel. I trust. I believe. One day after getting back a positive tox screen for a patient, I said to the staff: “but how can this be? she said she didn’t use any cocaine this weekend!!” The psychiatrist teaching me chuckled, looked up at the heavens and said: “Wid, have I not taught you anything during your time in addictions and personality disorders? PEOPLE LIE Wid. people lie”
So, back to the current situation. Let’s call our patient Mr.Maxwell. He is pacing the hallway like a caged animal. We are so busy with other consults that I decide I can’t afford to take the student or nurse with me to see him. Better divide and concur, I thought. In hindsight, this was my first mistake.
I invite him into the interview room, and that was my second mistake-why for the sake of protocol, even for the sake of privacy, cage in someone already wild with anxiety or anger? I think I at least kept the door behind me slightly open.
“Hello Mr.Maxwell, sorry to have kept you waiting. I’m the doctor on call tonight. What’s going on? You obviously don’t want to be here, so how’d you end up here tonight?”
He starts talking. It’s often a good idea to let people talk for a few minutes at the beginning of an interview, and listen with all your senses. In seconds I’m thinking: this guy is not just anxious or angry, he’s manic. No I mean MANIC manic. And psychotic. Not good.
There he is, leaning back in his chair, all smug, 3 days of stubble on his face. He emanated grandiosity. He thought he was God’s gift to mankind..or womankind. He spoke so fast, it was hard-and pointless- to try to follow everything he said.
“….I want to get out of here. How long is this going to take? How old are you anyway? Do you know doctor, I bought a motorcycle recently? and a guitar? I could show it to you, I could sing for you..
Goosebumps. Distant alarm bells started to ring, the hair on the back of my neck was raised, my spine tingled ever so slightly. I ignored it. (ding ding ding.. mistake number 3) I’m a brave resident aren’t I? I can handle this. I’m no coward. Who else is going to do this job if I bail? I’m not bothering the staff at home.
“That’s Ok Mr. Maxwell, no need to sing for m-“
He started singing in a low voice
“..And girl I’m a bad boy so I gotta do what I gotta do
Risk my life
In the late night
Cause girl I’m a bad boy yeah..”
He was wearing those mirror sunglasses, did I mention that? even though we were indoors. I couldn’t see his eyes but I knew he aggressed me. A woman always knows. It’s like a physical punch in the gut. I felt sick, and stood up, backed away to the door saying:
“Oh look at that, my pager just buzzed, I’ll be right back. So sorry to cut our interview short”
He was not happy I had cut him off.
I rushed to the nursing station, “Jack! that guy is gonna explode on us. He is floridly manic and needs to be kept against his will, but he will FREAK. We’re going to need the code white team present before I tell him I’m signing a confinement form”
Jack smirked: “Who, that guy? noooo” he waved his hand dismissing my concern, “I know him, he’s been here before, he’s ok. He scared you? I can handle him”.
In my head: yes he scared me. On the outside, I was a bit embarrassed. maybe I am a scardy -cat -girly-girl-coward after all. But I don’t like the way this is going. Not wanting to appear uncool, I cave in (mistake number..oh who’s counting?)
“Ok, Jack, just be careful if you go talk to him. I still think we should call the whole team first”.
“Nah, I said I’d handle him”
I sat inside the somewhat protected area of the nursing station. It’s sort of like a glassed in cubicle where we write our notes. The whole upper half of the walls is made of glass, and it’s “semi” sound proof.
I was on the phone updating the psychiatrist on call with me, and filling the form needed to keep this man in hospital -unfortunately against his will-and through the glass window I kept an eye on the two men talking.
Suddenly Mr.Maxwell takes a dive at Jack! and they disappear from my view and onto the ground. Between punches Jack is yelling: code white! call a code white!
-which I did with shaking hands and voice, then waited for an agonizing minute for the team to rush over to us. I hate that feeling of utter paralysis when I’m faced with violence.
Eventually the team came, and the patient was restrained and medicated..things calmed down. Neither Jack nor Mr.Maxwell were badly hurt, and I was fine.. but you don’t forget a night like that. . another near-miss. If Jack, who was physically more than a match for this patient , was attacked in an open hallway, I shudder to think what could have happened to a 5 foot 2 inch wisp of a girl like me in a closed interview room just moments before.
The lessons I take from this experience, the ones I teach students I supervise:
trust your gut
don’t let others make you doubt your perception
your safety comes first
don’t have to prove yourself to anybody
don’t rush into labile situations unprepared
don’t succumb to outside pressure
Note: All the names/characters have been changed in this story, though the essence of it is very true. Also, please don’t think that people with mental illness are violent. They are more likely to be the victims of violence than the perpetrators. In this situation, the patient is the one who suffered the most, and it wasn’t his fault. Sometimes the violence is just the result of anxiety, or bad situations like this one.
One boy says to his brother:
Hey Moony Moony look!
I’m gonna do something that will make Mama gasp like this: ahhhhhhhh!
What’s with my boys
And upside down?
I get it’s smiles
And no more frowns
Only thing is
my mother’s heart
Until they’re down
Can’t they just stand
Like normal kids
With both feet firmly
on the ground?!
Must they swing so high
while standing up
And must they land
With such a sound?
Can’t they just slide
From up to down
Instead of climbing
Can’t they have mercy
On this heart
Know that their risks
Will make it pound
I swear I age
at least 10 years
with every trip
To our playing-ground
where is home?
is home where you were born?
is it where you wish to die?
is it where you wish to live in between?
is it where you find yourself?
is it the one you love?
is home something you carry with you in your soul?
is it all of these things?
what if these things are scattered all over the earth..and buried under it?
Someone once said to me: once you’ve crossed the ocean, you feel you’re always on the wrong side..
I’ve published these poems about leaving Montreal, which is a home
and here is a poem about going back home..home-home
They’re contradictory, but true
As I step off the plane
I let out a breath
one I didn’t know I was holding
Though it’s all beige and bland
with some sea and sand
To my sore eyes
it’s a sight to be-holding (close)
I feel safe despite wars
And breakneck speed cars
I feel fair cloaked in my abaya*
Best of all I blend in
And completely fit in
No longer …a pariah
- Abaya: long black cloak worn by women in Saudi, over their clothes
- Finding Your Place
This will be clumsy, stilted, contradictory
It’s a reflection of how I feel
It’s my best
I have not been able to write for a few days..or enjoy eating, or sleep well
How dare I, when people are being massacred in Aleppo?
I know that my sleepless nights, my fasting, my paralysis does nothing to help them
but how dare I live as if nothing is happening?
how dare I write about anything else?
but how dare I write about it?
what do I know about it? about their suffering?
I feel Iike I’d deserve it if they spat in my face.
I’m not writing about Aleppo
It’s too huge, anything I say is inadequate, disrespectful
I’m writing about my paralysis
But how dare I?
How selfish to think about myself and write about my own misery?
Maybe it will mobilize me to do something useful..but what? Maybe it will touch other paralyzed souls.
I’m sorry for this disjointed incoherent message
It’s my internal dialogue, spilling over onto the screen
It’s the vicious cycle that has been my home this week..no its been my home for a long time, but like a chronic disease, like a volcano.. it flares up and goes dormant. It is the same disease, though it has many faces: Syria, Palestine, Egypt, Iraq, Afghanistan, Bosnia.. It has other faces, of other countries I’m guilty of not knowing enough about.…it may be my own country one day. It feels like all these countries are my own..but how dare I say that..from the comfort of my heated home, from beneath the warm covers of my cosy bed. This waxing and waning disease that paralyzes me has been my home since the Gulf war at least. I was in second grade then. I know that I know nothing of real war. I only got a whiff of its smoke, inhaled -moreover -through the privilidged filter of a gas-mask, something the less fortunate did not have. We heard of war, but we only heard the sirens -not the bombs.. well, not that I can remember.
My paralysis..It flares up when reality seeps through the barriers I build
I know, how dare I build barriers to protect myself when others suffer? -Guilty
My paralyzed state goes into remission when- in exhaustion, I retreat, and bury my head in the sand-Guilty again
My inaction is not born out of no action
It is the result of actions so strong-so strongly pulling me in opposite directions
It tears me apart
give to charity- but whats the point?
they should- we should
speak- but what is there to say?!
spread the word, the images, the videos- but doesn’t that feed into the collective sense of despair and hopelessness..and more paralysis
How can I be hopeless?
but how dare I say: everything is going to be ok
what do I know?
even if I believe the most terrible things happen for a reason
Can I say that to those over there? who may have lost all faith
Would I lose faith if I lost everything?
I don’t know..
All I know is that an image of child in the rubble..is an image of my child dead
And a video of a girl hugging her doll, or asking where her father is..is a video of my child too
But it’s not
so how dare I say that?
I tiptoe into the house
sneak past my children playing in the living room
dash to my room and lock the door
I’m so so tired, you see. Today, I just can’t make the instant switch from doctor to mother. Babies died today at work. I soaked up a lot of tears. I’m so tired.
In my room, I kneel on the floor, then I lift my prayer rug, peeling it away from the ground..to reveal the trap door underneath (don’t tell. It’s a secret..what? you want to come and see? OK, just this once, then..come along)
I go down the steps that wind down down down in the twisted spiral of time. By the time it turns into a slide, I’m 19 again, and poof! I always love this part..I land onto a bed of feathers.. and bubbles rise to the sky when I arrive..for no reason other than that I wish it.
I throw myself back and spread my limbs, eyes closed. Can you smell the pine needles and forest? Can you hear the silence that’s not silent? that’s filled with birdsong, and rustling leaves and running water..and a distant music..it’s the flute. that would be my instrument if I had one.
Hello, Pegasus! you always greet me. The horse nuzzles me so I open one eye to peer up at him. What? enough laziness, you say? Do you have any idea what my day has been like? But Ok, lets go for a ride, let’s outrun my past..and push away my future for just a few moments longer..I already hear the banging on my bedroom door..the children are calling me … but I’m not ready to go back just yet.
I close my eyes against the wind, and let Pegasus lead. We fly above this Mystical world of mine.. The fairies race with us, the mermaids wave to us from the ocean below..I won’t have time to switch into a fairy or a mermaid today..but I promise myself I’ll be back soon for an extended visit with my friends. Oh, there’s Peter Pan! I wave back at him (ha! my sister will be jealous I got to see him).
Pegasus, always responsible, circles back-he loves my children you see, though he only knows their laughter, and my stories of them. He lowers his head down to my bed of feathers. Reluctantly I slide off his back.. I open the trap door above me and imagine trudging back up up up my twisted stairwell of time.. it seems a long way back up to 32… but then I hear my children’s squealing laughter..hmm someone is being tickled.. I race up the steps full of new energy again..just in time to catch the game 🙂
It’s such a gift to form a new image, or pretend to have a new memory of a loved one after they die.
30 years ago
My father stood alone
Gazing out at the sea
And someone wrote this about his meeting with Princess Diana:
I would not have understood then, his charm, his diplomacy, his loyalty
what he was saying
I was only 2
25 years ago..
I stood with my father (well, he stood, and my feet dangled over the wall I was sitting on)
Gazing out at that same sea
“Baba, I’m bored, what should I do?”
“Do what you’re doing”
“What am I doing?”
“Looking out at the sea”
“That’s doing something?” I asked puzzled
“Sure it is”
I ignored him and decided to do something “productive” (yes, I’ve had this obsessive streak for quite a while)
I pulled out my book: Basil the Great Mouse Detective, see?
Again, I did not understand what he was trying to teach me, about life, about time, about “being” rather than “doing”
I was only 7
But I’m starting to get it now
Starting to gather all his pearls
Strung along the seashore of our past
Lessons I am understanding
Only in retrospect
As I walk in his footsteps
which have been washed away by the tides
I’m starting to get it now
Who he was:
Just a man
Trying his best
to be a husband and father
Probably making it up
as he went along
Definitely making mistakes
as he went along
Just like me
Just like all of us
My children don’t get it now
But I’m sure they will
…or maybe 30
long-short years from now
I miss him 💔 and would love to gaze out at the sea with him one more time,
doing nothing….doing everything that matters.
Reference:The Diana Chronicles, Tina brown, 2007, page 271
So, the other day I was shopping, and I was drawn to a pink belt with pink rhinestones and pink feathers (I know!). That is so not my style, right?
but it called to me, so I took it to the cash..
Then, as I waited in line, I thought: Wid. you know you’ll never wear this
So I left the long line and put it back
For a long time, I have taken pride in saying that I was not a pink girl,
I only wear heels if socially necessary (a must at Saudi weddings),
and If I must be dragged to the salon for for hair and make up, then please make it quick, and give me something good to read while I endure the painful time-wasting process of beautification.
See, I’m a practical girl, I’d say. I’m a tomboy, I’d say, comfort before beauty, I’d say.
I resented dressing up to conform to social roles. Once, at a big gathering, a woman -in front of everyone- looked at my hands and said:
“Wid, you should really get your nails done…for your husband”.She then added proudly,
I get mine done every week.
I was too amused to be offended. I laughed, and in my head thought, “honey, weekly manicures are aint never gonna make it onto my to do list”.
So you can see why I was surprised to be drawn to a belt with pink feathers! But they gave me that “feeling”.. ladies, you know what I’m talking about.. that joy and pleasure, in just dressing up, in holding a clutch that feels just right in your hand, in hearing your bracelets clink..and feeling the weight of chunky earrings pulling at your lobe.
Remember when you were really young, and tested your clothes according to universal strict princess-girl criteria:
Does the dress expand when I twirl?
Does it spread out like a cupcake? or like a fan?
Do my heals click on tiles?
Is my headband shiny?
A memory came flooding back to me. It’s a secret, but I think I’m old enough to confess and not get into trouble. When my mother went out, my sister and I would sneak into her bedroom. We would wear her jewelry, slip on her heels, spray her perfume, choose our imaginary princes (we always fought over who would get Peter Pan), and step into the ballroom (her bathroom, the only place in the house with tiles..you know.. so our heels would click, obviously). And there we were, having fun, in heels too big for us, definitely uncomfortable for us, pearls dangling to our knees…and happy.
So, where has this little girl been for the last 20 years? After some reflection, I’m understanding what happened to me..and I suspect some of you girls might find it familiar.
Why did I dress up at the age of 5? I had no audience, no man to impress (or to defy). I dressed up for me, for my pleasure, I just followed my instinct.my..femininity..nothing could have been more natural.
Then I grew up into a society (and this is not middle-east specific) that favoured men, and shadowed women. So without realizing it, I did what my young, inexperienced self felt she had to do to to survive, and to thrive. I learned to hide some parts of me. I thought: Don’t draw too much attention to yourself as a woman if you want a place in this man’s world. Besides, if you dress up, you risk being one of them, the brainless airhead Stepford trophy wives. Don’t be a silly beauty whose goal in life was to secure a man-and the harder part ha..to “keep” him. As if anyone ever really “gets” or “keeps” another human being.
In fact: don’t even need a man, just be a man. So, I put on my trousers, and flat shoes, and went to medical school. I proved I had brains and graduated first amongst my class (and I’m talking first among both the women’s and the men’s college. that’s right sista). I kept going. I came to Canada, I learned to drive, I succeeded in this man’s world. I proved I can do anything a man can do, and more (what? do you known men who carried their own winter tires, and loaded them into the car while 9 months pregnant? I didn’t think so).
Phew..so I’ve done it.. and now? Now that I have nothing more to prove to the world (or to myself), guess who’s waking up and having a nice long stretch? That beautiful feminine pink-feathers part of me. Now I can wear my uncomfortable heels..if it pleases me. And if people take me for a fool because of them, I am so beyond caring. And if someone is threatened by my audacity to be beautiful and smart and professionally competitive, tough luck for them. I’m done hiding.
This is freedom, ladies:
Dress up (or down) for you
Be guided by your morals and beliefs and pleasures
full exposure and full coverage can both objectify women
Find your rule book, your balance
Do what feels right
Choose beauty if you feel like it
Choose comfort if you feel like it
Don’t dress to impress
Don’t dress to defy
Don’t dress to comply
For me, for now, that means:
I will not apologize for my sneakers at work
but I won’t apologize for my jewelled stilettos either
Turquoise is still my favourite colour
but I’ll re-explore pink
I’ll do hair and make-up
but I’ll do it myself in 15 minutes thank you very much
I will go back to the store and buy that belt (ok, only if it goes on sale)
And when I’m at home in my comfy fleece pyjamas,
with no audience at all
I will wear that belt
I will flip it over
and wear it as a crown
If that is what pleases me
In psychiatry, we are in the business of dealing with trauma. As human beings, we all have our share of traumas. Different events, different flavours of pain and suffering..but isn’t this familiar to you at some level?
If I speak of it, will it swell?
If I bring it forth, will it dwell?
To examine it, re-imagine it
is torture, a kind of hell
But to hold it in, makes the void within
an Echoing bottomless well
Should I carry it?
and just bury it?
Should I keep it in?
Or tell? Wid Kattan
Image retrieved from: http://artalaska.org/heart-trauma/