Posted by CareBear04 on April 11, 2008, at 19:38:49
what is the extent of a T's duty to the patient? i have a hard time asking my T for help.
i've been seeing my T for over six months now, but most of the time, i still have trouble talking to him. there's a lot of silence at my appointments. mostly i just look to him to manage my meds. he's been good, though, about communicating that he's avilable after hours. in the fall when i was really depressed, he called me every morning and over the weekend to check in. a couple of times, i've experienced lithium toxicity, serious dehydration, and other bad symptoms but never called him and waited until my appointment. at each instance, he asked me why i didn't call, and i felt really bad because it never even occurred to me. he seemed sorry that i didn't ask him for help.
so on monday, i had a morning appointment with him. that afternoon, something happened that completely threw me off left me sort of in shock. i wanted to shake it off and do the things i needed to do, but i felt totally paralyzed. i knew i needed to eat, but i couldn't bring myself to eat anything, and all i could do was sit there. my hopelessness was much intensified, and in the short term, i was worried i would hurt myself, though i wasn't sure i could find the energy to do anything. in any case, i felt like i owed it to my T to tell him how horrible i was feeling. i don't know what i wanted from him; i wasn't even sure what i was feeling. anyway, i followed the directions to have him paged. i sort of told him what happened, but as for how i was feeling, all i could say was that "i feel... really bad." i really suck at communicating my feelings, and the more upset i am, the worse i am. he seemed irritated that i'd called without being able to tell him how i was feeling and what i wanted from him. what i really wanted at that point was something that would just knock me out and make me stop feeling... some zyprexa or haldol or thorazine or something. but i knew that's not the kind of self-help he wants me to be using, and i was ashamed that i wanted to take the easy way out. so i didn't ask him to call in a script. he asked me whether i had suicidal urges, and i paused awhile and said, "not so much." i didn't feel like burdening him, and i guess i was afraid that he might [over]react and do something like call the cops and have them drag me to the hospital.
he stayed on the phone w/ me for well over an hour, but i felt guilty about every minute. after awhile, he started telling me that he was glad i called, that i reached out to him because it showed that i felt we had enough of a relationship to do that. he tried to convince me that this episode would pass and that he wasn't going anywhere; that he would be there with me to help me through. it was all very nice, but i had a hard time believing that he wanted to, and i felt so guilty about imposing on him at home and requiring him to give me that time.
something he said that interested me was something along the lines of his experiencing a strong countertransference reaction. he explained that it wasn't the negative reaction associated with the word but just a strong empathy with how i was feeling. he said that he sensed that i was really distressed. early in the conversation, though, when trying to convince me that my life wasn't so bleak, he mentioned that he was a psych attending in the ER and he'd seen a lot of people with really hopeless situations. i know he meant to make me feel better, but it made me feel worse, really guilty. i know that i have no rational basis for feeling so bad, and being reminded of other people's suffering makes me feel terrible about asking for help when there are people who need it much more.
anyway, i wasn't buying what he was saying about hope, but i didn't want to occupy any more of his time, so i wrapped it up. he asked if i would call the next day to let him know how i was doing, and i hesitated, then agreed "for tomorrow at least." he said that was good enough; we'd take things one day at a time.
i don't know what caused me to call him at night. i guess i felt like i had a duty to give him a chance to help before doing anything to myself. but what can he really do to help? i especially don't want him to feel compelled to expend energy on me. and i have a hard time believing that he would do it except out of obligation. i guess i have a hard time believing that i'm any more than a source of income and that he could have any emotional investment in me.
so what is the standard of care required of a pdoc with regard to an acutely distressed patient? what are other people's experiences with contacting their Ts outside of their appointments? do Ts really care about their patients enough to gratuitously offer their time beyond the appointments? am i the only one to feel guilty?
if anyone has any thoughts, please reply.
thanks!
cb
poster:CareBear04
thread:822769
URL: http://www.dr-bob.org/babble/psycho/20080405/msgs/822769.html