I'm Thinking About What I'm Thinking About
By: Julia Parker
As a warning, this piece touches on the following which may be sensitive for certain groups: disordered eating, suicide, substance use
It was the last week of my child and adolescent psychiatry rotation when I met an unforgettable girl, “Abby.” She was barely a teenager, but Abby had already been through more than many of us will go through in a lifetime. Recently, her father’s incarceration had triggered a sequence of events and traumas that amounted to a mental health crisis and psychiatric hospital admission, which is where our paths crossed. During our first conversation, Abby was polite and reserved. She dutifully answered all of our questions, recounting the life-altering events leading up to her stay matter-of-factly, as if reading off of a grocery list.
Given such a long list of stressors, I was puzzled when the only thing that elicited any emotion was the subject of school. I listened as she talked herself into a mental loop that she could not seem to exit:
Any attempt to break her out of her loop of despair was met with resistance. Her eyes would often drift away when she talked, averting your gaze if it was too strong. After we left Abby to get oriented with her peers on the floor, I expressed frustration to my preceptor at not having been able to make much headway initially. He gazed ahead with an expression of understanding, likely the product of years of experience working with hundreds of other patients similar to Abby, and replied, “Low confidence is a difficult thing to repair.”
Our next conversation was with Abby’s mom. She had been trying to pin down a diagnosis of attention-deficit/hyperactivity disorder (ADHD) in Abby for years. She explained, with visible frustration and defeat, the difficulty surrounding the process. To diagnose a child with ADHD, you must prove that symptoms are present in more than one environment, the first being home. The second environment is usually school, and you need teachers to endorse that a child is exhibiting behaviors consistent with ADHD. However, Abby was never disruptive or hyperactive, unlike some children with ADHD, and her teachers did not suspect anything was wrong. Without the diagnosis, she could not get the treatment she needed and her mental spiral about school continued.
To her physician, however, the symptoms were obvious. On day 1 of her hospital stay, she was diagnosed with ADHD, inattentive type. We started her on the lowest dose of methylphenidate, a medication for ADHD, and awaited her response. The change was remarkable.
The next day, Abby was on cloud nine. We saw her in the afternoon so that she could report back on how the morning had gone with her new medication. When we walked into her room, her energy was warm and palpable. Her normally averted eyes were locked with ours. She sat down on her bed with gusto, seemingly having trouble containing her energy and excitement. However, this was not the kind of fidgeting you see in kids with ADHD. Instead, it was an inability to contain her joy. “For the first time, I’m thinking about what I’m thinking about!,” she exclaimed. The attending smiled, laughed, and asked her to clarify what she meant. His smile was extra big that day. Abby continued, “Usually when I’m trying to think about one thing, I’m thinking about something else. But today, I was playing cards and I was actually thinking about playing cards.” She beamed. “Usually, I have six songs stuck in my head. Today – none!” She motioned with her hands, emphasizing the “none” part of that statement. We all stood laughing and smiling, listening to Abby describe the hope that she felt for the first time about her ability to accomplish tasks. Although Abby’s mental health journey had just begun, the veil was lifted just a little bit that day.
At some point in my rotation, a child psychiatry fellow cautioned me that listening to the trauma and turmoil that kids go through day in and day out, often at the hands of others, can wear on even the toughest of physicians. However, there is also a lot of hope in the field. Kids are still learning what coping mechanisms and medications they can use to help navigate life’s ups and downs, and with a good support system behind them, there is nothing they cannot do. As she progressed in her stay, Abby welcomed each new patient to the floor as if they were her friend, offered peers and staff compliments as well as kindness, and continued to work on her own growth and healing. Her resilience is forever ingrained in my mind, and I will always be grateful to be “thinking about what I’m thinking about.”
Julia Parker is a third-year medical student at OHSU. She grew up in Eugene, OR, and made her way out east to Tufts University for her undergraduate education. Julia worked as a clinical research coordinator in infectious diseases and hematologic malignancies for three years before starting at OHSU School of Medicine. True to her Oregon roots, she loves being outside. She spends her free time hiking, running, and skiing in the winter.
