Tuesday, March 27, 2007

Advice For Comets

I watched a comet burn up this week. It was a most impressive flame-out, with raised voices, threats of legal action, hints of physical violence and tears.

The inmates, on the other hand, were relatively well-behaved.

I've seen many health care professionals come and go through the years. As the token employee assistance person (unofficial, uncompensated) I've provided supportive counselling (translation: been ranted at) by some of them. I struggle to know what to say, but over the years I've learned a few general principles.

When you're new to the correctional environment you have to go through an adjustment process that's analogous to the Kubler-Ross five stages of dying: denial, anger, bargaining, depression and acceptance.

1. "I'm working out of a bare cell? No way!"

2. "I'm not going to be treated like this!"

3. "If you want me to do X, you need to give me Y."

4. "Why do I stay here? I should just leave."

5. "It's pretty cool when my patient gets better."

Not all people go through all stages or in the same order, or sometimes it happens all at once pretty fast.

The main thing to know is that you're working in a bureacracy, and bureacracies are notoriously slow beasts to turn. You can't be a fighter pilot in a jumbo jet. Some professionals hit the bureaucracy with guns blazing, making a virtual declaration of war, and burn to cinders in the atmosphere within the first few months. If recent American politics can teach us anything, it's the importance of building a coalition prior to taking action. Your coalition is your team of co-workers. Now, your co-workers may (in your opinion) be inebriated incompetent dim-witted dickheads (I wish I were as eloquent as Shiny Happy Person. She would say this so much better than I could---I believe she'd use the terms 'fuck-wit' or 'git' which just don't get captured by American colloquialisms) but they are your battle-buddies and they're all that you've got. If you antagonize them they will let you go down in a hail of bullets. Or worse, turn weapons on you themselves. Your credibility depends upon tact and restraint. Translation: don't even try to start "writing people up" until you've been there a year or more.

At some point you're going to come to believe (or to witness) that this bureacracy rewards mediocracy and punishes malcontents. Once you hit this stage, you have three choices: you can throw up your hands and walk away, you can bury your head in the sand or you can change tactics. More importantly, you can take time off. You can cool down. You can go home and hug your kids (or your dogs or your cats). But the thing you should never, ever forget is:

We need you. You're smart. You care. And you've saved a few lives while you were here.

I hope that's enough to bring you back.

Overheard: "Are you a psychiatrist? You walk like a psychiatrist."


sophizo said...

Do you mean a meteor rather than a comet? Sorry, it was bugging me because you don't watch a comet burn up like I think you are referring to. I come from 4 generations of astronomers, so these things get to me.

Back to your regularly scheduled program.....

ClinkShrink said...

Yes but it just doesn't have the same ring.

Rach said...

how exactly do psychiatrists walk?

Dinah said...

kind of like ducks

DrivingMissMolly said...

Where's Roy with the Monty Python references? I'm thinking specifically of the "silly" walks.

That, of course, is the way psychiatrists walk.

I love your "fighter pilot in a jumbo jet" reference. Great analogy.

Take care, Clink. You're one good shrink.


Roy said...

No Monty Python, but I thought you might like the lyrics to the song, "Walk Like a Psychiatrist" (to the tune of "Walk Like an Egyptian", with apologies to The Bangles):

All the old inmates in their cells
They do the Haldol dance don't you know
If they move too quick (oh whey oh)
They're gettin' a dose of Inderal

All the bizarre men have a file
They got a gray mouse for a pet
Seroquel smiles (oh whey oh)
They trade their pills for a cigarette

Freudian types with the hookah pipes say
Ay oh whey oh, ay oh whey oh
Walk like a psychiatrist

The big COs like to take their keys
They spin around and they cross the floor
They've got your back (oh whey oh)
You're in the clink so they guard the door

All the prisoners like to see the doc
If they don't then they are pissed
When the buzzer rings (oh whey oh)
They're walking like a psychiatrist

All the guards in the dining room say
Ay oh whey oh, ay oh whey oh
Walk like a psychiatrist

Every day's the same front and back
Noises make you miss the sleep you lack
Life is hard you know (oh whey oh)
So block the lows with your Prozac

If you want to please all the cops
Then stop before work at the donut shop
They sing and dance (oh whey oh)
They're keepin' peace down in the cell block

All the inmates dealin' with their nerves
No overdosin', no cuttin' wrists
And the nurses know (oh whey oh)
They walk the line like psychiatrists

All the cops in the donut shop say
Ay oh whey oh, ay oh whey oh
Walk like a psychiatrist
Walk like a psychiatrist


Midwife with a Knife said...

Um... Roy, that is truly a work of art. I'm in awe.

ClinkShrink said...

Roy, I'm taking away your steroid nasal spray. Donuts, however, remain free and ad lib.

I'm also open to any and all advice about how to rescue a burned-out doc.

ClinkShrink said...

And thanks DMM, the ducklings are a comfort. They're getting big.


Can I have some of whatever Roy is taking?

Dr Dork said...

Roy, love the song.

Should cut it as a single...

Sarebear said...

I'm with Seamonkey! It's like that scene in "When Harry Met Sally" in the diner . . . Can I have what she's having?

Hee hee hee hee!

Clink, I have this impression of you being kinda knit-picked at/on lately, so a BIG sareBEARhug for you.

Now I'll have the song in my head all day! Maybe you should use it for music in your next podcast . . . .

Have Carrie sing it for ya'll. Hee hee.

I wish I had advice on the burned-out doc . . . I know I'm nothing like a criminal (well, except that we're all people!) but I know when I feel I have nowhere to go, psychiatrist-wise, when I feel like there's no access or no one who'd treat me or want to, well that's a really horrible, horrible awful place. Even the worst criminals should have some kind of mental health access, albeit the worst might need to be restrained w/spit restraints (whatever those are called), shackled, in a small cell across the room from the shrink, or whatever . . . . how else could they ever hope to change, without access to help?

It's just . . . in my search for a new psychiatrist (my last one closed practice Dec 1, and frankly, it was becoming clear that we just couldn't work together), I have had stone wall after stone wall, frustration after frustration. I'm getting rather discouraged, and I still don't have a shrink, and I have to beg my GP who is reluctant to prescribe the meds because he doesn't feel qualified to maintain, which is probably rightly so since he's not a psychiatrist. In the short term, though, he's the pinch-hitter/last resort because I know how awful the withdrawal from Effexor is, having done it cold turkey before (OUCH).

Anyway. I know I'm not a criminal, and can't pretend to understand what they go through, and heck, wouldn't want to for so many of them (sorry, but my empathy for certain offenses, the person who did them, . . . is not there), but we are all people, and I know what it is like feeling there is no option, no one available or wanting to treat, no HELP at all. It's not a fun place.

Anyway, I had the thought that maybe thinking about THAT might help the burned out doc feel . . . better, in some small way? There may be the patient who IS touched by the care, by THEIR care, but might never show it. You never know.


p.s. let's hope I can find a shrink who isn't part of the county mental health system which apparently wouldn't see me if I was bleeding to death on their front steps (no plans for such, tho).

Gerbil said...

Roy, you are a man after my own heart. I was going to parody just that song, but dammit, you beat me to it. :P

jcat said...

Dunno if you can do it without being had up for harassment, but...
sometimes what really helps is just a big hug. And a chance to literally cry on someone's shoulder. Even big tough guys need that sometimes

ClinkShrink said...

SareBear, that is the one thing that Comet Doc mentioned---that individual inmates have recognized that she cared. I think that's the one thing that kept her around this long. Yes JCat an open shoulder is a good thing to have---better a soggy shoulder than a doc-less facility. So far that's all I've been able to offer I'm afraid. Bringing in treats (if allowed) or taking out to lunch/dinner is also a good idea. No word yet on the outcome & I'm hoping for the best.

Overheard today:
"You walk like a robot."

Actually, directly told rather than overheard. Different facility, different inmate, different day. Go figure. Try putting that to music.

And thanks to whoever wrote the really really nice iTunes reviews. It made my day.

Midwife with a Knife said...

I'm not sure what causes burnout, exactly, or why some people get it and others don't. The times when I've been the most bitter and angry and closest to burnout (um... I have been close in the past, and behaved terribly at work because of it), I've been completely exhausted both emotionally and physically. I don't know if that's the case with CometDoc, but if it is, my suggestion is a vacation/time off with sufficient sleep and food every day. There's also maybe trying to change work circumstances a bit (may or may not be possible). I also don't know much about CometDoc, but maybe a hobby or something to make it easier to not think about work when not at work.

Hm... my other thought is (and I feel ridiculous saying this to a psychiatrist, and I appologize in advance), is CometDoc depressed or demoralized? If so trying to do something about that might go a long way towards helping with the burnout.

ClinkShrink said...

Thanks for the input MWAK; yes she's definitely demoralized but not clinically depressed (yet). She has many options available to her outside of the correctional system & a life outside work from what I understand from others. She's been offered a change in work circumstances & I hope she'll take it, or at least consider it during a few days off.

The other thing I find useful---but I rarely recommend to others because they just laugh or go 'yeah, right'---is regular exercise.

Midwife with a Knife said...
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