HOW I FOUND MY RHYTHM WHEN THE MUSIC STOPPED

At a time in everyone’s life, we come to find ourselves in a situation where the music stops, and we must go on.  The unfortunate truth about life is that the unexpected will happen. Some of us learn from it, some of us change because of it and some of us find our life’s calling because of it. The latter was the case for me.  After our dad picked us up from middle school, we spent that afternoon like we had every afternoon that month. We went to the oncology unit at the hospital, where my brother was admitted.

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THE MAN IN A BLUE SARONG

I remember him. I remember the man in the dark blue sarong the same way I remember the lines on back of my own hand. He was hunched over next to a column on a dirty platform at a railway station in Calcutta, India in the middle of the harsh summer sun. His hands were withered, his fingers and toes looked like tiny nubs, and he was completely malnourished and alone. He had opaque blue eyes, as if fog had taken place of his irises and pupils.

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PATIENT “OWNERSHIP”

I studied insects in college; my favorite insects were the bees (I found them diligent and so helpful to humankind).  One of my favorite classes was about medical diseases caused by insects. My professors noticed my interest in the medical side of things and connected me with a professor who did clinical research. Our work focused on a clinical trial for children with intractable epilepsy and exposed me early on to patient care and patients.

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with the new kid that was admitted last night… the 19-year-old overdose?” She was referring to Christopher. “Yes?” I responded. “Well, he’s got a pretty significant lump on his left testicle. It needs further work-up.” “Oh, OK.” I acknowledged.


I approached Dr. Tron, who’s the unit director about Christopher. “Well, you handle it Rebecca. I haven’t thought about those tests since medical school back in Vietnam.” I set up an ultrasound and went to talk to Christopher. He was sitting up in his bed still in the black pea coat. It seemed like he was wearing it like armor to help protect him from the world surrounding him that had felt too much to bear. I re-introduced myself and did a cursory check on how he was doing. Did he have any current thoughts of hurting himself? Others? Hearing voices? etc. I then proceeded to tell him that when he was being examined earlier the PA found a lump on one of his testicles and that he would need some tests so we can figure out what it is. He politely listened and didn’t ask any questions.


Right before I left the unit for the day, I checked to see if Christopher’s ultrasound results had returned. I read a few of the words over and over in disbelief: CONCERNING FOR CANCER. My heart actually hurt. I distinctly remember walking to my car and literally shaking my fist at the sky.


How could it be that this young man who had his innocence stolen from him by a mother who never received proper psychiatric care, who felt so alone and hopeless that he tried to take his life, now has to deal with having testicular cancer too?


Once I reached my car, I actually cried. It just didn’t seem fair. And what could I do? At that moment I felt so helpless and powerless. I had lost my perspective.


The next day my morning on the unit started as usual: on pre-rounds, I briefly chatted with Dracula, Sally had another poem. I took a deep breath before I entered Christopher’s room. There he was like yesterday sitting up in bed still with the pea coat on. “How did you sleep last night, Christopher? “OK,” he responded. “Christopher, do you like to read? Would you like me to get you some books? “Yes, please,” he replied. Come to find out, the unit had about 6 books and none looked rather appealing. I settled on the one that was some sort of US historical fiction. Be careful what you offer! is what I quickly learned. Note to self: get some donations to build up this “library.”


In order to confirm his diagnosis of cancer, some blood work had to be obtained. It felt like a century waiting for the results to return. I hadn’t yet used the “C” word with Christopher. There was no point in scaring him until we knew for sure. He seemed to be having a better day than yesterday. I got a big smile when I brought him the book. That was a first.


In between, the ordering of labs and taking care of my other patients, I noticed something. I was not sad. I was feeling empowered. I was taking action. I wasn’t sitting in the corner crying, hurting because of the bad hand my patients had been dealt. I was equipped with training and knowledge to help turn that hand around. My perspective had shifted.


Eventually the results retuned, and they were, in fact, indicative of cancer. My heart sank a little, but my head was held high. I knew that he was responding well to his psychiatric treatment and would be discharged from the unit soon. But I was going to make sure that he was set up to receive all the necessary appointments and referrals. It felt like an act of Congress getting someone from urology to come and examine him in the unit, but it was done. Regrettably, psychiatry and other medicine are sometimes like oil and water.


I remember having that conversation with Christopher. I was a little worried. I was afraid that he would break down and lose all hope. The progress he had made would vanish. But then this happened. “You know, I actually feel really good. I feel like I have something to fight for. I am going to have to be strong to beat this. I have a reason,” he proclaimed.


I couldn’t believe it. This tortured soul didn’t turn into a pile of despair. He was hopeful. His perspective was that he had been given a reason to fight, to stay alive, to beat this cancer. I still get chills thinking about it.


Though it may seem a cliché, life is about perspective. I am grateful to Christopher for showing me this early in my medical career. Because of him, I chose to do my residency in Pediatrics, Psychiatry and Child Psychiatry. With this decision, I not only have the ability to bring about an acute change in someone’s mental status but also tend to their acute and chronic medical illnesses as well. I have been gifted with the responsibility of being someone’s advocate. When I keep my perspective on the positive side, I can still have the marshmallow inside that gives me the empathy and compassion they require, but I have a tough exterior to be the defender my patients so deserve.


*Names have been changed to protect privacy

Monday mornings on the unit are always a little chaotic. Even though during pre-rounds,  without anyone stating it, there seemed to be a universal understanding that the weekend was over, it was time to try and get back to business.


I didn’t have the chance to meet Christopher before the individual treatment team meetings. Sally * insisted that she share her newest poems with me. I knew I’d eventually see everyone sometime that day so I remained a captive audience. She was working with me and taking her Lithium without a fuss so the least I could do was listen.


We all gathered round the small wooden rectangular table that has 3 sides with a single empty chair all by itself on the 4th side. There were quick pleasantries among the physicians, social workers, and nurses as we waited for our first patient to be brought in to us. At times, it felt like we were the parole board, and the patients were prisoners coming to plead their cases at parole hearings. We made it through most of the patients without incidence. There were a few tears, many curse words, a couple of threats… nothing unexpected.


Then we came to our last patient. This was the one I had failed to see earlier. I did have the chance to quickly skim his file: overdose on Xanax and Zoloft in a failed suicide attempt, history of molestation by his mother, and voluntary admission. Into the room walked a gentle giant and with him an air of complete defeat and overwhelming sadness. Hunched over, he cautiously sat down in the empty chair.

BY REBECCA BA'GAH, MD

The black pea coat, white t-shirt, and blue jeans he wore all hung loosely on his gangly frame. Then Dr. Tron broke the silence.


“Christopher, do you know why you are here?” Scared dark eyes looked up. “Yes, sir. I tried to kill myself, and I promised my father that I would get help.” The interview continued in regular fashion. An abridged version of Christopher’s story was related to the team, a medication regimen was agreed upon, and he was sent on his way to be seen again tomorrow.


Regrettably, depressed teenagers are not the rarity these days with the pressures of social media and reality television, so I wasn’t that shaken by Christopher’s sad tale. Initially, I was always worried about going into psychiatry because as a self-proclaimed marshmallow what good would I be to my patients if I am crying in the corner because a 13 year old cuts herself daily because she’s teased at school? I was nearing the end of my 3rd year of medical school when career decisions are usually made. But something in me transformed this day.


After treatment team, I went to place orders and prepare discharges. The PA who performs the intake physical examinations came over for a chat. “Are you familiar

REBECCA BA'GAH, MD

Dr. Rebecca Ba'Gah is originally from Los Angeles, CA where she attended UCLA's school of Theater, Film and Television and she spent many years in show business. She eventually found true fulfillment in medicine. She recently moved to Lexington for residency at UK in Pediatrics, Psychiatry, and Child and Adolescent Psychiatry. She hopes to one day be a part of Médecins Sans Frontières and  continue to change the public perception of mental illness.