||[Aug. 23rd, 2012|01:53 am]
Sometimes I feel like I'll be a failure unless I'm good at everything. Then I remember that no one's good at everything, and all you can do is the best you can, and I feel better. Then I meet someone who really is good at everything, and it's super annoying.
The psychiatrist mentoring me, Dr. H, is good at everything. When psychotics who believe they are God quote the Bible at him, he quotes the Bible back, and he knows it better than they do ("I made a point to study all world religions because they're so important in these people's lives"). When drug addicts talk about making their own crystal meth, he points out flaws in their manufacturing techniques ("I've treated so many meth-heads by now that by this point I know more about it than they do"). When a nurse was trying to puzzle out a patient who kept lying about his sleep habits, Dr. H told her five ways to test if someone's really sleeping ("I used to work nights in a sleep laboratory.") Whatever his patients' trade - plumber, welder, mechanic - he quizzes them on domain-relevant knowledge, then afterwards declares whether or not they're good at their jobs, which is of course relevant to their psychological health. ("My brother's a master plumber, I repair vintage Buicks as a hobby, and I just thought I'd learn welding because you never know when something might need to be welded.")
He gets results, too. Someone will come in, screaming and flailing about, shouting that all psychiatrists are quacks and we can't make him stay here and he'll sic his lawyers on us. Five minutes with Dr. H and he's calmed down. Ten minutes and he's agreed to treatment. A week and he's crying thanking him for changing his life and saying that agreeing to come to the hospital was the best decision he ever made.
I asked him about the effectiveness of his drug rehab program. He said that 99% of the addicts he treats are drug free after one year. I expressed some doubt, and found some studies of a bunch of programs, none of which had above a greater than 35% success rate. "None of those programs," he said dismissively. "Here, we do it right."
Doing it right involves knowing everything. He assigned one of the doctors under him a "homework" project of going into the local liquor store and learning the differences - price, alcohol content, et cetera - between every brand on the shelf ("Your alcoholic patients will trust you if you know that information.") He himself can discuss everything from the history of the 19th-century Opium Wars to amusing facts about narcotics. Did you know that heroin was originally invented (and marketed!) as a cure for morphine addiction? That part of the stigma against methadone comes from people incorrectly believing that its trade name (Dolophin) was a reference to Adolf Hitler?
After a particularly difficult patient confessed during morning rounds that Dr. H was the only psychiatrist who had ever understood him, one of the residents just sort of stared at him and asked "How do you do it all the time?" Dr. H just shrugged and said "I'm the best there is. It's that simple." And he meant it, not in a boasting way but as a simple statement of fact.
When people complain that doctors are basically just technicians with good memories, and not really professionals who require any particular skill or creativity or intelligence, I think instead of people like Dr. H. He is a type. There are doctors like him at every hospital and in every specialty. It's not always obvious who they are from a patient perspective, but if you know them well you can pick them out pretty quickly (my father is another from the same mold). It is a personality type I have never seen outside medicine - there are genius scientists, and genius politicians, and geniuses in a lot of places, but it's a different kind of genius. The doctor who knows everything, knows she knows everything, and manages to combine reassuring arrogance with a reassuring humanity is a sort of person I just don't find anywhere else.
I was hoping I would learn how to be that way in medical school, but last time I checked I was still fallible (though I might be wrong about that). I'm starting to think my best bet is one of those occult rituals where you eat someone's heart to gain their powers. Working thirty-five years in the same hospital like Dr. H did might also work, but eating someone's heart sounds much simpler.