ABC's of PSP

I straightened my notebook and pen yet again, making sure the edge of the notebook lined up cleanly with my desk, the pen parallel to the notebook, uncapped and ready to write. But ready to write what...? I glanced around in dismay at the bare conference room. My first day at my first job after graduate school and I was sitting in a conference room instead of an office. The walls were bare. No phone. No shelves. Just a round wooden table and four chairs. Oh, and me.

I glanced at my watch. Five minutes until I would walk down the hall and get my patient. My first real patient. After twelve years of regular school, four years of high school, four years of college and three years of graduate school, I was ready to begin my first day as a psychiatric physician’s assistant. I slumped a little in my chair, gnawing on the end of a fingernail.|

That morning, I had taken my thirteen-month-old to day care. While she was happy as a clam, racing into the room crowded with toys and games to sit down with “the gang�?and eat breakfast, I was still wracked with doubt. Was putting her in day care so I could finish PA school a good decision? Was starting a new job, even though it was part time, the right thing to do? Even though I loved being a mom and while I had friends who were stay-at-home moms and I respected the incredible amount of work they did, there was a part of me that had always known I wanted to have a career.

But instead of appearing immediately after college, like a pot of gold at the end of the rainbow, my career had been elusive, involving jobs in sales, waitressing and reception before landing me in graduate school. As a young girl who dreamed of great wealth and fame, had a strong desire to make a difference in people’s lives, and had graduated from an Ivy League school, I hadn’t expected to begin my career at this point - - in my early thirties with a husband, a mortgage, a thirteen-month-old and thousands of dollars of debt. But here I was. A trickle of ice had been forming in my stomach over the years, growing with every moment of frustration. Now, it had hardened into a large mass of ice, establishing how important this would be.

Christina, my first real patient, was not what I expected. She was petite and dressed in pressed cotton pants and a light blue sweater. She smiled easily at me as I led her to the conference room. I couldn’t imagine what she could possibly be here for - - she seemed much less nervous than I.

I tried not to cringe as we settled into the conference room chairs. Surely the bare room and lack of a phone, books or diplomas belied my inexperience! If Christina noticed, she didn’t let on, and as she began to talk, a story unfolded which belied her composed appearance. For her entire life, she had struggled with violent mood swings, at some moments feeling full of energy and passion, at other moments, depressed and suicidal. Tears poured down her face as she described her anger, which sometimes grew so severe she would scream at her family or even throw things. She couldn’t handle stress and would retreat to her room and be unable to cope. Her marriage was rocky due to her volatile moods and her kids were starting to avoid her. She had been treated by other doctors for the depression, but that had only increased her anxiety and irritability. Christina was at the point where she had lost yet another job and was considering leaving her family so that at least their lives could return to normal.

As I questioned her further, it became apparent to me that the young woman in front of me likely had a bipolar disorder, or what is commonly known as manic-depressive illness. People with this illness have periods of depression, but they can also have periods of increased energy, talkativeness, anger or irritability and difficulty concentrating. Despite being treated by several doctors over the years, she had never been diagnosed with or treated for a bipolar illness.

At the conclusion of my questioning, I hesitated. How could I have noticed something that doctors had missed? First real patient, remember? Christina was looking at me expectantly. Waiting. I squelched the tight feeling in my chest and tried to smile reassuringly. Cautiously, I brought up the diagnosis of bipolar disorder and what it meant. We went over the treatments. With a slightly shaky hand, I wrote out a prescription for medication and gave her the name of a good therapist.

Two weeks later, Christina returned to my conference room. As before, she looked well put together in fashionable dark blue jeans and a button-down shirt. We sat down and I spent a moment writing the date in the chart and reviewing the medications I had prescribed. Then came the dreaded moment. It was time to ask the question. I tried to appear calm. “How are things going since your first visit?�?I waited for the tears.

Christina looked down for a moment, then her eyes met mine, several tears already welling up at the corners. “You’ve changed my life,�?she said simply. She sniffed and pressed a knuckle to her left eye. “I don’t know what you gave me, but it was magical. I have been less depressed. I’m not angry anymore. I’m not snapping at my kids. We actually went hiking this weekend and even when a snake almost bit my son on the ankle, I was able to remain calm and handle it. My thoughts aren’t racing a mile a minute. I had the first good night’s sleep I can ever remember.�?BR>
I felt a grin forming and tried not to show my amazement. My treatment plan had actually worked! This was not the same woman who had come to me in tears just a few weeks earlier.

“I don’t know how I can ever thank you,�?she sniffed. “You’ve given me my family back. You’ve given me my hope back.�?BR>
As I pressed a tissue into Christina’s hands, I tried to hold back my own tears. There was an incredible shift in my stomach. The block of ice I had grown so accustomed to was starting to melt. I could feel the water trickling into my limbs, the cold in my gut replaced by warmth and comfort. Finally, it all clicked. All those years of struggling through jobs I hated, of wondering what my purpose was, of second-guessing my decisions, of dropping my daughter off at day care so I could finish school and start a job. They had led me here to this bare, ugly conference room. And I had changed a woman’s life. A woman’s entire future - - and that of her family’s. And she was only my first real patient!

Just think of how many more there were to come!

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Reprinted by permission Rachel Byrne (c) 2002. In order to protect the rights of the copyright holder, no portion of this publication may be reproduced without prior written consent. All rights reserved.

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