You Can’t Help Me Unless You Are Like Me

He was 19.  I saw that on his papers before I let him into the office. I knew it meant trouble.

Someone who was only 19 and was in the county mental health system had to be either big trouble or a big manipulator.  Working with adolescents is tough for me because I have to “set limits;” often yell and scream.  That is absolutely not my favorite way to be a psychiatrist, to read people the riot act.  But 19 year olds often need that.

I sometimes have to be more of a surrogate mother than a psychiatrist.

He had been recently hospitalized for a “psychotic break.”  That is when someone who is alleged to be normal suddenly starts hearing voices and seeing things.  It’s not always mental illness — maybe some drugs on board, maybe some kind of stress.  At least I had the records from the hospitalization.

Yeah, drugs on board.  Some speed, some pot.  The “baby-momma” of his first child (God, was he proud) was no “fun” anymore.  She wanted things like child support — clearly not a “fun” request.

Now I have read some recent studies from other countries — this is not the kind of thing they do here — that when there is the risk of hereditary pathology you can feed a kid Omega-3 fish oil and maybe prevent this “psychotic break” —  or at least delay it. And yes — to me someone 18 or 19 years old is still a kid.

He had done exactly the opposite.  He had placed himself in a high pressure situation by becoming a “baby daddy” at 19 and in addition to this, he talked some about gang involvement. And then there was the speed.

Right now he was sleeping somewhere in the park, hoping his baby-momma would not find him.  Some previous doctor – as is too often unfortunately the case in the county system – had prescribed benzodiazepines ,the class of pills that includes Valium, Xanax, and Ativan.

Anyone who has read even a couple of my blog posts knows how I truly hate these drugs and I avoid prescribing them whenever I can.  Why the knee-jerk reaction? Well, perhaps it’s because:

• They are clearly labeled “for short term use only” (as in response to a major anxiety attack).
• Most doctors seem to keep refilling prescriptions ad infinitum and never take the patients off of them.
• They are highly addictive.
• They can easily kill you – take too many, drink booze with them, take them in combination with certain drugs.
• It’s difficult to get addicted people to agree to taper off of them even when the need for them is long gone.
• And I must taper them off slowly, as cutting someone off them suddenly causes horrible withdrawal — potentially deadly.
• And when an addict is arrested, they will be thrown in jail and all the pills suddenly cut off – see the above for potentially fatal results.

As far as I am concerned they are no better (and I think worse) than booze.

His speech could have been slurred because of the pot he admitted taking (“I self-medicate” is the buzzword of the times). Or it could have been because of these prescription drugs that never should have been started.

At the age of 19, by our laws, this is a legally competent man.  He refused to sign a release to his family, to a general physician, anybody.  Considering he had a swollen red left hand from an old knife wound, (courtesy of one of his homeless neighbors in the park). I told him that he had to go to emergency room now, and get some antibiotics, or he would die.

I’m sure you can understand – although he obviously did not — that it was pretty important to me to get him to listen. Of course, he wouldn’t.  He used obscenities quite freely, and not in some of the constructive and colorful ways I had heard them used in the Army, so I had no compunction about telling him he had made some very stupid choices.

He was, of course, in denial.  Thought his hospitalization was a mistake, even though he had been found wandering the highway and had said he was ready to attempt suicide by running out into the traffic.

I raised my voice plenty, told him that he had to taper off his benzodiazepines and to continue to take the Abilify that was prescribed to stop the voices. It was the only drug in his life that made sense, was properly prescribed, and had no side effects – so of course he hated it.

The county offered group therapy that included others of his age and who had gone through the same experiences — the “first psychotic break” group.

He laughed at me.  Laughed. “You sound a little like my mother.  I don’t listen to her either.  I am a man, I solve my own problems.”

I told him to sit tight until I figured out how the county, state, and/or nation, and/or some charitable program would pay for the drugs I thought he needed to have.  I also needed to think of a way to get him to the emergency room.

Meanwhile, something amazing happened — Really amazing.  A senior therapist recognized him, as I propped open the door to the office while I figured out what to do with him. I had been quite sure that understanding English was NOT one of his problems. Yet she yelled at him in their common native language, using some Old World expressions that I’m probably better off not understanding.

By the time I got back to the office, he was signing his releases, his mother was in the office, he knew how to access emergency services for his hand, and he had been signed up for the “first psychotic break” group.

Everything I could not convince him to do, she accomplished. She even told his mother to get him to the emergency room, and he agreed.

After all this was finished and the patient on his way to the ER for his knife wound, I thanked this woman profusely.  I had not even thought to call her. I was just lucky she happened by my office at the right time. I told her that although I wasn’t exactly fluent, I had learned enough of his language to communicate most things (although his English was good and we transacted all of our previous negotiations in that tongue).

But even if I knew the language, I was never able to bond with him – or with the other similar “impetuous youth” that passed through these halls.  I have a lot of 19 year olds. I wanted to learn the words, the expressions, she had used.

“You can’t do it, no matter how good you are.  He would never trust you.”

“You know me well enough to know,” I told her, “that when someone tells me I can’t do something I try harder.”

“Not this one,” she told me.  “You are beautiful and Caucasian and you dress well and you would be using, what did you say, your fourth language? Many people come in speaking languages you do not speak at all, and they will only trust the translator – one of their own.”

I had been of little help with the Russian speaking patients, despite a few words of Russian gleaned from a grandmother of blessed memory who escaped from there a long time ago. I know a lot about what I do medically and I know that I am good at it.

I already know working with adolescents is tough, but there is something else here. Like many people of my background, I was taught that it is neither fair nor appropriate to refuse to trust someone because ethnicity.  (SIGH) – I have been called an idealistic dreamer before, and maybe I’m hopeless.

I remember a hair product commercial on TV some years back where the actress looked into the camera and simpered, “Don’t hate me because I’m beautiful.”

I’m not going to try to tell you that I’m America’s Next Top Model or what-have-you.  I’m a woman of mature age, no spring chicken. However, I’ve lost a lot of weight so I’m not huge anymore, and I dress well and my hair is nicely styled.  Also, I have very pale white skin, through my genetics.

In the state of California, I often deal with disadvantaged folks of many races who  have actually accused me of being too aristocratic, too beautiful for this job.  I’ve even been asked – more than once – if I bathe in milk to keep my skin beautiful.  It seems that some folks feel that people whom they view as in a higher class than themselves should not be working for a living like the commoners.

I naively believe that with all my credentials, anyone who was in medical misery would trust me.  But to the 19 year olds, I’m an old fuddy-duddy.  People with different skin pigmentation than mine would rather trust someone of their own origin.

Every institution insists that doctors sign something to the effect that we will take care of patients without discriminating according to their race, creed or color.  I do my best to make that real, and even go an extra step, learning languages so I can help them when the institution is not able to provide translators. Unfortunately, there is nothing to stop patients from discriminating against me.

This is wrong, wrong, wrong and a situation I have no idea what to do about. Tepid and empty bumper stickers like “celebrate diversity” do not even get close to this one.

I remember an image of America as a melting.pot.  When my grandmother came from Russia she wanted desperately to belong, and learned the new ways with respect and love.

Canada, when I lived there at least, saw itself more as a “salad.” There were diverse ethnic communities, but they seemed to get on incredibly well. It is not my fault I was born with “porcelain” skin.

My credentials are duly earned, my experience is from blood sweat and tears.  We now live in a country where things like ethnicity or religious belief are political, and patient after patient is giving me messages that because I have porcelain skin I cannot be trusted and will not be listened to.

As I write this, Muslim-Americans (actual citizens of the USA) are suffering intense backlash because we recently observed the anniversary of the 9/11 attacks on the Twin Towers in New York City and there is a plan for a privately funded Arabic community center a few blocks away from the site of those attacks. The Muslim people are doing a tremendous amount of charitable community service – especially in New York — hoping to counteract this discrimination, to be accepted.

When I worked with the transgendered community in San Diego, they were always doing charitable projects.  They collected “Toys For Tots” to make Christmas brighter for underprivileged children.  They had a blanket drive to collect money and coverings for street people who might otherwise perish from exposure during the winter.  The transgendered people were demonstrating that they were good people and responsible citizens.  Yet – like the Muslims – their efforts are never enough to overcome ignorance, prejudice and fear.

I know that there will always be a fair amount of people for whom this strategy will not work. Me, I think my life is service.

Ethnicity separates people and it should not. Start with one-to-one human associations. I am doing the best I can, and will do whatever I need to do to get my job done. I do not know how to generalize to the rest of the world.