"Rule out suicidal ideation by knife emoji"

On crisis call the other night at the local psychiatric hospital, we were asked to evaluate a girl brought in by the police, with her mother's urging. She had run away and was rumored to have threatened suicide. Apparently, she got in a fight with her mother over an alleged Facebook post in which she posted a "knife emoji" and said she was going to hurt herself. She denies having ever posted it and her mother never actually saw the post. We did not think she was suicidal, so I can joke about it. Kids these days.

The really tragic underlying story is that her mother has been trying to get her outpatient counseling services for a year, that counseling services were ordered by in-school supports, and that it never happened. In between the girl has been kicked out of school; it took a day waiting in crisis for an evaluation to finally connect her to badly needed services. Imagine the difference for a family of means trying to connect their kid to services. It was telling to me that the mother said proudly of her son, "He's doing well. He's 17 and never been arrested."

For fun, let's compare local 2013 high school graduation rates:

Among the top performers were suburban districts such as Niskayuna, with a 96 percent graduation rate in four years and 2 percent dropout rate; Voorheesville showed a 94 percent graduation rate and a 3 percent dropout rate. 

Less-impressive results were found in cities with higher concentrations of students living in poverty, including ethnic minority youngsters. In the Albany school district, the graduation rate was almost 54 percent, with a 21 percent dropout rate. Schenectady had a 65 percent graduation rate and a 20 percent dropout rate. 

(Times Union, http://www.timesunion.com/local/article/Graduation-rates-up-5574062.php)

Where do I even begin?

How do you pull a blog back from the brink? Let's start by explaining how I got here.

In addition to having a precious few free hours a day as a third year, working with real patients every day is an intensely personal experience. There is so much to process; over the past few months I've found it easier to do that with just the people to whom I am closest. Then there's the fear that I won't convey as well in writing interactions that have meant so much to me on the interviewing or observing end. Finally, how do you end a glimpse into someone's decision-making with a trivial recipe for kale salad?

Over the past few months, I've learned to feel ownership over my patients, to follow them daily in the hospital and try and make myself useful to them regardless of whether a note needs to be written or not. It's the luxury of being a med student that we have time to do this. And in practicing this, I've begun to feel for this handful of patients, worry about them on the days when I'm not there, become very upset when I hear about a miscommunication. Medicine takes you into the most intimate moments in strangers' lives, from a family meeting in which an elderly couple turned down palliative surgery in favor of home-hospice, to planning next steps after a miscarriage, to intrusively asking a patient whether he wants to die.

Last week I met a man who was a survivor of the earlier AIDS epidemic, diagnosed with HIV in the mid-80s and told at 22 that he would have five years to live. He buried all of his friends from that era, grew close to his family, and only a few years ago stopped taking all medication because he had grown tired of it. I felt so strongly for him, felt so privileged to be in the room interviewing him. Over the past few months I've been reading a nonfiction book, My Own Country, by Dr. Abraham Verghese, about the AIDS epidemic in rural Tennessee as experienced by an Indian-trained, African-born infectious disease doctor. I can only see that book as increasing my interest in this patient.

As I've written enough, I think I will link to this recipe from the New York Times, which looks delicious and inspired my lunch for tomorrow: Apples from Thanksgiving Start to Finish. My adaptation was a quick chopped dinosaur kale, sliced apple, Cabot farmhouse cheddar cheese, toasted walnuts, and a mustard/balsamic/olive oil/black pepper dressing.