| A multi-vehicle trauma! This is what it is all about, I | | | | once learned, cannot be unlearned. Some bad |
| thought, as I followed my senior resident to the stairs. | | | | experiences are unconsciously assimilated and |
| While my age placed my training against a St. | | | | eventually inhibit function, much like adware on a |
| Elsewhere's backdrop, my excitement was more | | | | Windows 98 computer. Memories accumulate like |
| consistent with the modern, high-energy ER | | | | boxes of artifacts in a darkened basement. In my own |
| soundtrack. The emergency room itself inspired | | | | case, half-opened boxes litter the floor, and some emit |
| excitement, and as a third year medical student I had | | | | frightening noises. |
| not yet developed the healthy fear that affected more | | | | As I work toward becoming a psychiatrist, I would like |
| senior, and more answerable, members of our surgical | | | | to develop an understanding of the biases that shape |
| team. As we approached the cubicle I noted that the | | | | my attitudes; biases that have the potential to interfere |
| patient was small, maybe two years old. Red froth | | | | with neutral observation and reflection. It is easy to |
| bubbled from his mouth as the emergency room staff | | | | identify the obvious examples of personal experience |
| frantically removed his cervical collar. I heard the word | | | | that interfere with the neutrality that I desire. For |
| 'tracheotomy', and someone said "hold him down!" as | | | | example, I can easily recognize the barriers that stand |
| his arms reached into the air. I grabbed his hand and | | | | in the way of my feeling compassion for the |
| held tight, grateful that I had found a mission that I could | | | | playground bully. And the death of one of my best |
| handle. | | | | college friends during the attacks of September 11 |
| To my surprise, the hand gripped back. And suddenly... | | | | undoubtedly affects my opinions of America's role in |
| time stopped. Small fingers wrapped around my finger, | | | | the world. But while in psychiatry we learn to identify |
| and at once I was sitting with a small boy, stillness | | | | personal and historical events that have shaped our |
| around us. I looked beyond the red froth, to see his | | | | attitudes, I wonder if work and training experiences are |
| clear, blue eyes gazing forward. No longer aware of | | | | incorporated in potentially prejudicial ways as well, |
| the work to be done, I began to understand a tragic | | | | perhaps beyond question because of their |
| story. Through pieces of conversation I realized that | | | | endorsement by common medical experience. I would |
| the boy's mother and father lay dead on gurneys in | | | | like to identify the ways that my experiences in |
| cubicles behind me, victims of a drunken driver. In a | | | | medicine and psychiatry change my view of the world, |
| flash I could see all of what our experience on earth | | | | in order to have foresight into bias that will develop in |
| offered: life and death, hope and despair, beauty and | | | | the future. Of course, unique character traits result |
| horror. | | | | from experience in all professions; as I sit in the |
| After 15 years, I still feel heaviness in my heart as I | | | | auditorium prior to my daughter's band concert, the |
| remember that night. I have not attempted to describe | | | | principal, oblivious to the ages of the assembled |
| the scene before, but I have sometimes felt the | | | | parents, reminds us to remain quiet and respectful |
| moment's essence, as a secret part of what has | | | | during the concert. But with admitted narcissism, I see |
| since become 'me'. | | | | the experiences faced by physicians as particularly |
| I have many secrets. I remember the 5-year-old girl | | | | memorable. |
| who I met in the oncology clinic, with newly diagnosed | | | | The experiences faced in psychiatry training, while less |
| leukemia. I silently winced in pain at the smile on her | | | | overtly dramatic than the world of CPR and |
| small face, an innocent unaware of the needle-sticks | | | | tracheotomies, force one to incorporate a different |
| ahead of her. She sat with her mother, whose | | | | type of emotional experience. In my short training, I |
| expression betrayed the knowledge that her daughter | | | | have been moved by the isolation of schizophrenia, by |
| would be forced from the world where she belonged; | | | | the emptiness and despair of depression, and by the |
| a child's world of security and happiness. I remember | | | | ravages of families wrought by addictions. It is often |
| the seven-year-old child who died of sepsis in our | | | | difficult to come to terms with reactions to psychiatric |
| recovery room after hours of attempted resuscitation, | | | | experience because of the lack of formal resolution. |
| and I remember the horror that filled the room as we | | | | Psychiatric diseases for the most part are not cured, |
| accepted the futility of our efforts. And I wonder, how | | | | and yet are not fatal by themselves; so there is no |
| have these secret images affected me? Am I a | | | | exclamation point to treatment successes and failures, |
| better doctor, or parent, or friend, or do I now carry a | | | | and less opportunity to place experience on the |
| seriousness that has driven some of my personality | | | | opposite side of the line that protects our present |
| inside, and beyond reach? Will I be a better | | | | world view from the tragedies of the past. There is |
| psychiatrist? Am I more tuned in to pain, or has my | | | | also a learned frustration that develops as we accept |
| exposure given me a resigned, grim acceptance of | | | | that the will of our patients does not always coincide |
| suffering? | | | | with our desire to help. And again I wonder, what have |
| For much of my life, my approach to learning was that | | | | I begun to 'understand' about mental illness? Can I |
| all learning was good learning. My goal was to face | | | | make a difference? What is the meaning of life in the |
| life's experiences as a sponge, seeing as much as I | | | | face of such suffering? |
| could see, and experiencing as much of life as possible. | | | | At these moments, I try to find gratitude for the |
| My assumption was that humans had the capacity to | | | | opportunity to seek psychodynamic understanding. The |
| keep the wheat and discard the chaff; to assimilate | | | | beautiful, horrible experiences of life weave tapestries, |
| the positive and to disregard the negative aspects of | | | | unique to each of us and to each of our patients, with |
| experience. The end result would be a 'complete' | | | | fibers visible only to those willing to see them. And in |
| personality, free of bias, unfettered by misconception, | | | | the tapestries lie the questions, and the answers to the |
| and nourished by the ultimate sustenance of | | | | questions, and the answers to all of the questions to |
| personality, information. | | | | come. To study the fabric of these tapestries is to |
| At some point my early opinions about learning | | | | study the essence, and the meaning, of life itself. It may |
| became tempered with caution. I began to see that in | | | | be asking too much to weave our own tapestries by |
| regards to learning, experience, and personality, at least | | | | design, but one can be aware of the admonition of |
| in my own case, I am what I eat. As much as I wanted | | | | Aldous Huxley, that experience teaches only the |
| to believe that I was capable of learning only the | | | | teachable. |
| desirable aspects of experience, I saw that my | | | | And once again, we are back to the original question. Is |
| personality was affected in ways that I hadn't | | | | all learning beneficial, and are all experiences enriching? |
| predicted. I remember briefly facing these questions as | | | | Is it true that what does not kill us makes us stronger? |
| a college student, when I wondered, in 1970's fashion, if | | | | Perhaps the answer is moot, since no matter our |
| there was in fact any evidence that people were | | | | preferences, experience finds us. Maybe I can make |
| 'smarter' after formal education. I thought more about | | | | an occasional decision as to what to remember, or |
| the topic during a period of my life when I actively | | | | face life's challenges and disappointments with the |
| meditated, as I became aware of the constant parade | | | | respect required to ease cynicism. Perhaps I can |
| of thoughts that drifted through my consciousness, | | | | embrace the feelings and the meanings of life events, |
| despite my best efforts to limit them. This view of | | | | rather than attempt to diminish their awareness. |
| personality as an unorganized collection of experience | | | | Perhaps all I can ask for is to find experiences with my |
| is more Eastern, more consistent with what I have | | | | eyes open, and to place my boxes in a well-lit room, |
| read of the developing ego, and more consistent with | | | | where I won't trip over them. |
| my experience as a parent of teenagers. Some things, | | | | |