When Hope is Hard to Find, Keep Looking
This patient on my mind—let’s call him Sam—is smart. Sharp might actually be a better word. He knows what he should say to get out of here, and he probably even knows how to do it gradually enough so that we believe him. Sam knows our attending thinks he’s afraid of people caring about him, for instance, so he could play that up and pretend to let him in, fabricate a healthy exchange. These are the thoughts I have about Sam on the walk home, typing furiously away at my notes in my phone, with the hope that they’ll stay in the document and out of my head. I think about Sam, what he says, and what he actually means.
Sam has made multiple attempts to kill himself. He’s had a tough life, and I won’t attempt to explain the root of it all. He accepts his pain as constant, and he does so without drama. He fits the criteria of involuntary commitment because he’s at what’s considered an “unacceptably high risk” of hurting himself if he’s discharged, and he’s waiting for placement at a state hospital, where he’ll be for an undetermined amount of time. Sam keeps asking what the point is, saying that he’ll kill himself when he leaves, that he doesn’t envision a future for himself. Still, he repeats all the things he knows will keep him here. Why does he set himself up to be institutionalized, if he really wants to leave and end it? Does he want help, but is so incapable of asking for it, that he’ll say whatever will compel us to keep him here? How can we connect to him, if that’s the case?
At first glance, Sam looked to me like a lot of teenagers do, with this angst sort of hovering over him, sulking around with huge headphones on and refusing to show up to morning rounds. I’d catch him at groups, sitting with his hands glued in his pockets or folded against his chest. When I say Sam is smart, I mean I think Sam is probably a lot smarter than me. He’s cynical, with a sort of wisdom and a dry humor that ages him and makes him easy to relate to. Sam will laugh at you when he knows you’re trying to “doctor” him, an effective way to puncture and deflate your ballooned ego.
He brightened up a little while we played scrabble during group one afternoon, making me think for a moment, I don’t know, maybe there’s a chance for him. It’s frustrating, maddening even, to see a guy as sharp, as funny, as “normal” as he is, describe how painful life can be, and watch him carry that pain so complacently. But I can’t be mad at Sam for being in the kind of pain he’s in, I can’t even blame him for wanting to hurt himself. The fact is, I’ve only been here a few short weeks. Who am I to say he’s being selfish or pessimistic? Through his charm, in a way, Sam throws a wall up around himself, one you feel like you can’t tunnel through no matter how “real” you are with him. How can you really know him? How can you understand what he’s going through, and how can you know what to do to fix it?
I like to check off boxes, to feel like I’ve accomplished something. I like to feel as though I can walk out of a patient’s room having made a genuine attempt to contribute to their care. With Sam, it feels impossible to do that. At the end of the day, I am one of a batch of students with stiff, starchy white coats that cycles in and out of this locked unit for six weeks at a time, eager to “let these patients in,” but it’s likely that nothing will change for Sam and his painful reality in that time.
I pursued medical school with an idea. I even wrote about it in my application. I wrote that I wanted to become a doctor so I could meet people from all over, each with a story of their own, and that I could take a little piece of them with me and that all those pieces would add up to something meaningful. I think this became a part of my mindset growing up. My dad was in the military, and he traveled all over the world flying huge carrier airplanes. My siblings and I lived on a military base with my mom, and with each trip we waited for him to bring back all kinds of souvenirs and stories. I started to dream up all the places he went to, and the people who lived there. I kept a picture of a pyramid he took while he was in Egypt on my bedside table. I imagined people with lives so different from mine, and I convinced myself that as a doctor, I would find the most opportunities to encounter all these people, to get to know them and become a part of their stories while they became a part of mine.
When I met Sam, I began to wonder if all those pieces I’ll take with me would eventually show me how futile this job can feel. It started to feel like so many of the pieces we take are the ones full of pain and hopelessness, frustration and grief, and fear. My short experience with Sam puts a stark but simple realization back into view. I can’t fix his life, or hand him some profound new way of dealing with it. And it’s not about what feeling of accomplishment I can gain from working with him. All I can do is try my hardest to know where’s he coming from. I can educate myself on all the options he might have—medications, therapy, or anything else I can think of. I can help lay them all out for him and try to be prepared to answer any questions he might come up with. I can be honest with him, and I can listen. I can try my best to know what he cares about most, what he fears most.
Maybe that’s unsatisfying, but I think that’s sort of the point. You have to keep trying, whether or not the feeling of self-satisfaction ever comes.
Jacqueline Hodges is a third year medical student at Tufts University School of Medicine. She is from Gainesville, Virginia and graduated from the University of Virginia, where she majored in biochemistry with a minor in global public health. Jacqueline is pursuing a dual degree in medicine and public health at Tufts and plans to do a residency in internal medicine. Outside of medicine, her interests include graphic design, hiking and traveling, and eating Korean and Southern food.