Edited and slightly expanded, these are the extemporaneous remarks I made about my mother at the 2019 University of Iowa Department of Psychiatry retirement party last month.
My mother was working on her dissertation for a PhD in English when I was born but was already casting about for something else to do. At her postpartum exam, she decided to become a doctor. How she came to that decision is her story to tell, but after she had me she finished her dissertation, got her PhD, and then she went back and took all the pre-med requirements sheâ€™d missed as an English major. She started medical school when she was 32 and I was three-and-a-half. She became a single mother halfway through med school when my dad died by suicide when I was five-and-a-half, but she finished, did her residency, and went on to the career youâ€™ve heard about.
There were not a lot of female medical students in the early 1980s, when my mother was in medical school. I believe her class was only about 30% female. As you know, med school classes are now routinely over 50% female. There were even fewer mothers, if any, and I would warrant she was the only single mother in her medical school class. As a child I knew many people whose parents were doctors, but I knew only one other doctor mother.
And yet it was a cool way to grow up. I got to spend a lot of time at the hospital and check out all the nifty equipment. Once I volunteered to let everyone look in my ears through a new machine that required you to lie on a table while they lowered a giant piece of machinery down on youâ€”all the medical students were too scared to try it out.
One Thanksgiving when I was six or seven my mother was on call, so we spent Thanksgiving at the hospital. That meant I got to eat at the hospital cafeteriaâ€”which, as you may know, means you get to choose your dessert first, and you get the mashed potatoes that come out in a perfect circle from an ice cream scoop. The nurses let me draw on the white board, which was a novelty back then, and type a story on the computer, another novelty in the mid-1980s, and they made me popcorn. I got to sleep on a Murphy bed, which I am afraid means my mother, whose bed it was supposed to be, got no sleep at all, as I was a restless sleeper and kicked in my sleep, but I had never slept in a bed that folded out of a wall.
I could tell many more stories like that, but I didnâ€™t just come here to talk about being the daughter of a psychiatrist: I also came because I am a psychiatric patient and have been for twenty-two years. I have what we now call treatment resistant depression. But I have been lucky, as all your family members have been and will be lucky. When I was twenty years old and it was 8 pm on Christmas Eve and I needed to talk to a psychiatrist, my mother was able to get Dr. Barbara Struss on the phone to talk to me, and she was able to get me an appointment with her for the morning of the day after Christmas. Because of my motherâ€™s connections (and income), I have been able to see, often on short notice, such amazing practitioners as Dr. Struss, Dr. Sharon Koele, Dr. Peggy Baker, Dr. Laurie Kenfield, and many others.
But not everyone has those advantagesâ€”in fact, most people donâ€™t. And some people donâ€™t have any access to those doctors and services at all. I know that because I work at a public library, and I see those people every day. We had a patron who was terrified she was going to look up child pornography. She would call us multiple times a day asking if this or that site contained child porn. She lost her job at a big box storeâ€”unsurprisinglyâ€”for obsessing over this question. We see paranoia, depression, obsession and compulsion, anxiety, and other hallmarks of psychiatric illness from people who donâ€™t have jobs, much less health insurance or connections, every day. While itâ€™s true that the Free Mental Health Clinic may help provide excellent training to medical students and residents on helping just such patients, its real purpose is to help those patientsâ€”those patients that weâ€”or our insurance industryâ€”have decided are not worthy of our help. Iâ€™m very proud that my mother had a role not only in founding it but in ensuring its success over the years.
In addition to being a very privileged psychiatric outpatient, Iâ€™ve also on two occasions been a psychiatric inpatient. Now I know from talking to my mother that in reality your psychiatrist spends more than five minutes a day on your case: in addition to talking to you, they talk to members of your treatment team, write daily progress notes, and keep a close eye on what is happening to you. But what it feels like when youâ€™re an inpatient is that your doctor talks to you for five minutes a day and thatâ€™s it.
But your nurses! Your nurses are there when you wake up in the morning. They are there when you go to bed. Theyâ€™re there when you wake up in the middle of the night and canâ€™t sleep. Theyâ€™reâ€”[interruption due to applause, so Iâ€™m not sure what I was going to say next]. Basically, the less money you make on the psych ward and the more time you spend with patients, the more respect you get from those patients.
My mother started her speech by quoting the maxim that every encounter is therapeutic. It can be, and it should be, if you choose to make it so. I know that sheâ€™s been making that the case for patients here for decades, for, as I always tell her, whatever she felt she may have lacked as a medical student and a resident by not having started out life wanting to be a doctor, by not having majored in biology or chemistry, I think that she more than made up for for her patients by having lived and experienced life. She has been a better doctor because of being a single mother, not despite it. Iâ€™m very proud of her today and always.