The .Plan

Last week I mentioned to my supervisor that things were going great on the ward and that I was somewhat optimistic that I was about to make it thorugh the rotation without becoming too jaded about my patients. And then on Monday, I inherited four — count’em, four — patients with borderline traits. In room 712A I had the Dependent Clinger; in 713B, the Manipulative Help-Rejecter; in 714A, the Entitled Demander; and in 717A, the Self-Destructive Denier. Three of them I could maintain a mild sense of humor about, including the Self-Destructive Denier whose initial suicide attempt (or, rather, should I say suicide feint) and threats about future suicide plans were so utterly incompetent that I almost laughed during the interview — he was most certainly not a danger to himself.

When she was discharged yesterday, the Manipulative Help Rejecter gave me my first present: a 60″ x 43″ map of the world printed on 100% cotton rag paper.

And the girlfriend of my Dependent Clinger brought me cookies. The largest, most delicious cookies I have ever had in my life. But by the time I thought to ask her where she purchased them, they had already left. Boo.

The Entitled Demander was a different story altogether and will probably go down in history as the patient I hated the most.

On the medicine and surgical wards, when you come across a patient you hate, there’s no need for things to get complicated — you just hate her, try to get her off your service as quickly as possible, and that is all there is to it. Time to move on to the next patient. On the psychiatry service, we have no such luxury — we are expected to study our countertransference reactions with the hope that doing so will enable us to more appropriately manage our countertransference and provide better care.

Kindle our sense from above,
and make our hearts o’erflow with love;
with patience firm and virtue high
the weakness of our flesh supply.

Far from us drive the foe we dread,
and grant us Thy peace instead;
so shall we not, with Thee for guide,
turn from the path of life aside.

–from “Veni, Creator Spiritus”, Rabanus Maurus c.856