WHAT KEEPS US GOING

"What keeps you grounded in your work with patients?" was the question we were trying to answer. It was few days ago, at a round table discussion with a few colleagues, psychotherapists. It was a sunny Friday morning, an early fall day in Southern California, filled with the scents of autumn but warm and pleasant, without a trace of cold.

Someone said "placing myself in their shoes." Another colleague said "the knowledge that their visit to my office is just a brief stop in their life's journey. I decided long ago that no matter what my patients do, good or bad, I will not take neither the credit nor the blame. It's their journey."

While they were talking, I was thinking of what keeps me going, seeing patient after patient, listening to their problems, trying to come up with solutions that make sense, pouring everything I knew, read, heard or felt, into their care. Memories of my residency training came to my mind out of nowhere. I remembered my rotations in the psychiatric emergency room at the County General Hospital in Los Angeles, one of the busiest hospitals in the country. Most patients where brought in by police, found in the streets of downtown, delirious, extremely manic, psychotic paranoid or overdosed on drugs. Once at the hospital, they were constantly bossed around by the staff, telling them roughly where to go and what they are expected to do.

They were scared and rebellious. The more authority it was used to make them quiet, the angrier they would become. I was never able to display that kind of raw authority with them, no matter how sick they were. Early on in my training, I started thinking that I have, in fact, no right to judge these people. I have no right to be rough with them or use unnecessarily harsh words. I always preferred talking to them calmly and respectfully, answering their spoken and unspoken questions, trying to calm them down with patience and understanding. Even when they didn't speak English, and that was nearely half the time, I kept talking to them, often telling them the same thing over and over, hoping that at least the sound of my voice, if not the words, would help them quiet their fears.

And it worked almost every time. The patients assigned to me were the calmest and the most compliant patients in the ER. They needed, on average, less physical restrains and less emergency medications. They helped me understand that treating people with respect, no matter at what low point of their lives we would meet, is something that transcends language and cultural barriers. It even transcended psychosis and mania and drug intoxication.

Taking care of these patients, the sickest patients in the county, I understood clearly that my job was to help if I can, to offer choices if I can figure them out, but to never substitute my judgement for theirs, never to assume they are powerless and can't understand the choices ahead of them. I promised myself that I will always respect my patients' right to live their lives and make the decisions they want to make. But I would also help them make these decisions in full knowledge of the pros and cons of their actions, providing them with reliable, practical, common sense and medically sound information, guiding them, but never imposing my values on them.

Now that I work with different type of patients--high functioning, more motivated to get well and not even remotely as ill--these principles are becoming more valuable than ever.

When it was my turn to talk, all I said was: "What keeps me going is the trust I have in my patients that, if I provide them with good information and guidance, they will find a way to use it well, heal and confidently pursue their highest dreams of happiness."

I wonder what keeps you going, at work or as a parent or doing some of the most important work of your life?