Wednesday, May 07, 2008

How To Say Goodbye

In a few weeks I will be less of a ClinkShrink than I currently am. I'll still be a ClinkShrink, I'll just be doing it in fewer prisons. It feels odd to schedule my patients for followup knowing that I will no longer be there for their followup appointment. I am faced with the question of how to say goodbye to my patients, some of whom I've treated over multiple incarcerations in the last fifteen years.

Patients come in and out of my life fairly quickly. With a caseload of at least 150 patients or so, there's no way I can specifically remember each one. Often they disappear without warning, released to parole or transferred to other facilities. Sometimes I read about them in the newspapers later, either arrested or killed. That bothers me. I used to think that inmates didn't get attached to prison doctors because they move quickly through the system and see someone new at each pretrial facility. Generally though once they get into the sentenced side of the system, the prison side, this settles down and you have a chance to develop some longterm relationships. And the longer you work in the system the more inmates you get to know. Dinah thinks that when you're 'only' doing med checks the therapeutic relationship isn't important, but I can tell you it is. I'm going to miss (not all, but many) of these guys. If it matters to me, I'd be willing to bet it's going to matter to (not all, but many) of my patients.

The patients it will matter to are the ones who ask for me by name when they get arrested, the ones who insist on getting on the phone to say 'hi' when the nurse pages me for medication orders, the ones who honk and wave when they drive by me on the street, or run up to me in the recreation yard to tell me how they're doing. These are the patients who prove to me that kindness and a good rapport counts, even when you're 'only' doing med checks.

So I've been saying goodbye this week, not without a fair amount of guilt. Eventually I will be replaced but not right away, not for the full amount of time, and likely by someone with little or no correctional experience. I have sympathetic anxiety pains for the new clinician who has no clue what he's walking into, as well as for the inmate who sees the new face and has to start all over again.

But starting over is what the correctional experience is all about, for patients and sometimes also for physicians.


Dinah said...

OMG!!!!! And you complain when I put words in your mouth.

Listen up my fellow shrink rappers: I am an OUTPATIENT Shrink... I have always worked as a COMMUNITY psychiatrist where I do "only med checks" and I have never felt like the interactions are meaningless to the patients. They are briefer, less frequent, I carry a higher per-working-hour caseload than I do in private practice (in some clinics, a FT psychiatrist has a caseload of 500 or more patients) and because of this, I don't get to know the patients as well--as you put it, I don't remember everyone and every detail.

Sometimes you can change someone's life in a sentence and to the patient, their psychiatrist is their psychiatrist-- they are often a meaningful person. Sometimes, the brevity of the situation, combined with certain personality combos-- leads people to feel unheard or dismissed by their Med Checking shrinks-- I know this because when they come hunting for a psychiatrist who "Does Therapy" they tell me.

It doesn't mean I don't think the relationship has meaning to the patient. Oy.

I'm going to bed now. I've had it with you people.

ClinkShrink said...

That's exactly why I gave you a quote. Now you know how I feel when you do that.

I'm glad you think the relationship is important. I had a feeling you did, but it didn't come through in our conversations.

Anonymous said...

Is Clink shrinking Dinah? Will Dinah let her? Tune in next time.

Anonymous said...

This post speaks volumes to the effects of psychotropic medications.

Sarebear said...

CLINK! Oh my. I have always admired your dedication and spirit. What you give to your patients, at least from what is related, anyway.

I hope you do well in your changed situation, your different arrangement or I'm not sure how to describe it.

I thought of you a bit, Clink, when I was looking at the pics of the inside of my knee, and it reminded me of a time when you had posted something about the brain, with a link to something that you warned had rather graphic (medically) brain stuff/pictures or something . . . . and I had thought gross at the time, but when I was looking at the pics of inside my knee, surprisingly I didn't find it gross at all. Upset by the extent of the osteoarthritis, yes, but it wasn't gross. It was cool to see inside there. In color, for some reason all I could picture was the B&W of x-rays.

Anyway, me not being grossed out by it made me think of you. And that gave me a little smile at a time when any such thing was most needed and very welcome.

ClinkShrink said...

SareBear: Thank you for your kindess. I hope ShrinkRap helps as you and your knee recover.

Midwife with a Knife said...

dinah, clink, are we going to have to separate you two? ;)

And what am I supposed to do with a word verification with an umlatt in it? (that double dot thing over a "u")