Wednesday, July 20, 2011

I swear

My senior resident only went to court once last year as an intern.

In just two weeks, I've gone three times.

Three times. Three!

Now, there is a reason why I didn't even consider going into law. There is a reason why I never participated in Mock Trial. There is a reason why I was never a part of student government.

I hate speaking in public.

In fact, I'm deathly afraid of it. I get full on diaphoresis, tachycardia, dyspnea, chest pain, you know -- the works.

And court? It's the real deal. It's just like on TV - with a judge and a bailiff and a secretary recording your every word in some strange shorthand. But for those who are wondering, no, the judge does not wear a powdered wig, George Washington style.

I do have to do the whole state your name for the record, raise your right hand and swear to tell the whole truth, and please be seated. And I give my testimony, answer questions for my attorney, the D-freaking-A (who coincidentally looks just like Alex Cabot for you Law and Order:SVU enthusiasts), and then I get cross examined by my patient's advocate.

So I sat through four other trials before I got called up to the stand. And as I watched the other psychiatry residents go through the process, I started squirming in my seat, sweating galore out of my armpits, kneepits, elbowpits, you-name-it-pits.

PATIENT ADVOCATE
Sir, you diagnosed my client with schizophrenia. And you believe, based on your clinical judgment, that he should be forced to stay at the hospital involuntarily for another fourteen days.

RESIDENT
Yes.

PATIENT ADVOCATE
Hm, well sir - I just looked at your title. And correct me if I'm wrong, but it says you're a D.O.?

RESIDENT
Yes, but --

PATIENT ADVOCATE
So you're not an M.D.

RESIDENT
No, but--

PATIENT ADVOCATE
So, are you allowed to practice medicine in the US?

RESIDENT
[exasperated]
Yes!

That was the first case.

Second case, different resident, different patient, different patient advocate. Same craziness with the cross-examining.

PATIENT ADVOCATE
Doctor, what year are you in residency?

RESIDENT
I'm in my second year.

PATIENT ADVOCATE
Are you fully licensed to practice psychiatry?

RESIDENT
I've taken and passed Step 3 and am currently applying for my license.

PATIENT ADVOCATE
Oh, so you're not licensed. Should you be seeing patients if you're not licensed??

RESIDENT
I am supervised by an attending - who is fully licensed - on all of my cases.

PATIENT ADVOCATE
So you're nothing better than a medical student.

I think this is when I started quaking in my boots. And before I knew it, I was up. Up on the stand, wanting to throw up.

But I kept it together. And somehow, started going through the motions. Stating my name. Naming my medical school. Naming my residency program. How many patients have I seen with psychiatric illnesses? Over 100. How many with schizophrenia? Over 30. Have you been taking care of this patient since she was admitted? No. Why not? The residents just changed rotations.

The whole time, I kept my fingers crossed that they wouldn't ask me how long I'd been a psych resident (four days), how many patients I had been the primary treating doctor for (only six, as opposed to the large numbers I threw up to include patients seen during my medical schooling), how I arrived at the diagnosis (that's what my attending told me), or anything about my licensing (esp since I haven't even looked at a board review book for about a year).

Maybe they were tired. Maybe they knew I was brand new. Maybe he couldn't breathe, sitting next to my patient who hadn't showered in over three months.

Whatever it was, for some odd reason, my patient's attorney went easy on me. And the judge agreed with me and the hospital, denying the writ, and I was able to keep my patient in the hospital for the remainder of her fourteen day hold.

Granted, we then had to petition to give her meds involuntarily. And then when her fourteen day hold expired, I had to go back to court to ask for a 30 day stay. And in about two weeks, I'll have to go back to the same exact courthouse to testify in her conservatorship hearing. But the people are starting to recognize me. The security guards no longer look at my badge. The DA knows my first name. The judge smiles at me. And I'm starting to sweat a little bit less on the stand. So I'm keeping my fingers crossed that I'll start to feel more comfortable up there soon, and less like I'm about to have a heart attack.