July 1 had dawned. I had a long white coat, two letters after my name, and the ability to sign orders. It was like gaining a superpower! I was an intern at Griffin Memorial Hospital, a state inpatient psychiatric facility. Those first few weeks were a blur, trying to get my bearings at a new hospital and meet new coworkers while also learning how to care for patients with chronic diagnoses and the most severe psychopathology I had seen.
I remember the first patient to yell at me. He was an older gentleman, with a long history of treatment nonadherence, who had spent most of his life in and out of psychiatric facilities. He was admitted for substance-induced psychosis. Dissatisfied with his care, he threw a fit at the nurses’ station one day and demanded a doctor talk with him and give him what he wanted. I was the only doctor on the unit, it was only my third day, and I felt exceedingly small and intimidated. I suggested that my attending speak with him instead. The next day, my attending told me something that took months to fully process: "You are a doctor now, you have to stand your ground and believe in your decisions first."
Over the course of intern year, I saw my fair share of irate patients—angry because they were detoxing and miserable, angry about being admitted, angry about being discharged, angry about the medications they were getting, and angry about the medications they weren’t getting. Slowly, painstakingly, I learned to stand my ground and clinically justify my decisions. I saw how these decisions ultimately benefited patients. Whether helping an addict form a path to sobriety, making the voices manageable for a patient with schizophrenia, or seeing hope come back into the eyes of a suicidal patient, these moments became their own reward.
Ten months later I took care of a patient with an extensive psychiatric history admitted after an intentional overdose. He was a difficult patient. Resistant to treatment, he refused medications, antagonized nurses, and verbally threatened staff. He targeted me one morning, calling me names, yelling curses. A nurse offered to stay in the room with me while I examined him, and I found myself saying, "No, I got this." I didn’t give it much thought at the time, but as I walked out of the room, it occurred to me how poignant that moment was—I had stood my ground. I knew that the care provided would ultimately help him, and I stood firmly, in his room and in my decision.
The clinical work this past year was hard, emotionally taxing, and stressful. But that day during my first week of intern year when I cowered from a yelling patient suddenly seems so long ago. In fact, it may be that the days that are the most challenging are the ones that most advance the goal of becoming competent, confident, and compassionate psychiatrists.
