by Kelli Hyland, M.D.
June 1010
June 1010
“These stories both humanize the physician-patient encounter and make physicians feel more like the human beings they are than the “human-doings” they sometimes become. And it is only through being more fully human ourselves that we may convey convincingly to patients our intention to heal“. - Fred Griffin, MD
My name is Kelli Hyland. I am a fourth-year psychiatry resident. I thought I was a good doctor. I worked very hard in my first two years as a resident to be knowledgeable and efficient, to help very sick patients enter and exit the hospital alive and feeling better. Yet in third-year, when I began working in outpatient clinics and doing psychotherapy, I realized there was something my patients needed that my knowledge and experience did not give them. This scared and overwhelmed me. Shaken and anxious that I may not be that good doctor, I set out on a search for what was missing and how I might obtain it. In this process, I developed a conference for junior residents. This is my story conference. This is how I learned to listen, ask questions, feel vulnerable and still be brave.
I started my third year excited to be in an outpatient setting. Part of my original desire to be a physician was wrapped up with the longing to know people well and to know them for a long time; to hear, and also be a part of, important personal stories. By third year, I felt I had the tools to manage medications and symptoms well, to interview, diagnose and educate, to navigate complicated hospital systems and work as an important part of a treatment team. But starting (over) in the outpatient clinic, the intimacy and longevity of the quiet, devastating moments with one other person in my small office, the moments I had actually longed for, surprised and intimidated me. I begun to frantically attempt to wrap my mind around the theories and methods of psychotherapy we were learning in the classroom on Wednesdays - DBT, CBT, Psychodynamics - lecture after lecture every midweek, hoping it would calm and educate me. However, I could barely sit still in the room by the afternoon. I wanted to know them all, and immediately, but I could barely begin to grasp one. The thought that my psychologist-counterparts feasted on years of theory before ever seeing a patient, left me feeling angry and resentful. I was already seeing patients, but felt anxious and desperate, needing to sip and savor, but my face was in the fire hose. I had been through medical school, and the fire hose was not new, but whatever it was I was experiencing here was new. Approaching psychotherapy and patient-doctor relationships with the same learning style I had successfully used to survive pre-medicine courses, medical school and the beginning years of residency was not working. I was humbled and scared,;which actually offered me an opportunity to approach supervision with more openness, and motivated me to participate in demonstration therapy and T-group.
Feeling ungrounded, unmoored, I also began to wonder who else I might be, in addition to (or if not) that confident and competent physician I had worked so hard to become and trust over the course of the first two years of residency. I was a beginner-mom, an independent wife, but these roles had often taken a back seat to my medical training. In the second half of my residency, time and energy became available to contemplate and explore who I was and what else there might be to me. With this question in mind, I asked my dearest friend, Kindra Fehr, a wonderful mother, a talented professional artist and gifted children’s art teacher, to consider teaching an art class for grown-up beginners. Kindra kindly assured me that someday, when the kids are older, she would. Luckily for me, she changed her mind and I did not have to wait. Her figure-drawing workshop, an entire day spent with other women, around a beautiful nude model, gave me an experience of the body, form, line and myself that was intense, exhilarating and entirely new. Poses held only for minutes, moments, disallowed time for my critical, judging self to operate. My linear, analyzing, ordering, knowing-brain was automatically bypassed, quieted, rested. My eye examined a curve which fed my fingers, by way of some place deeper and closer, it felt, to who I am, separate from my brain. I entered a calm, creative, curious place, and it felt like not-knowing. It felt safe. And important. The magic I felt that happy Saturday - inspired by cappuccinos, red wine, Michelangelo, Da Vinci, lovely, open women and dirty charcoal fingers - would begin to forever change the way I approach learning, my work and my patients.
I began to feel more comfortable asking questions, hard questions, of my patients, and of myself, feeling satisfied even if there were no answer, or a terrifying answer, or if the answer was diaphanous, shifting, complicated, multi-layered and made ”no sense“ at all. Not-knowing became less frightening, more exciting, bringing me closer - closer to me and closer with others - in a way that felt like a difference was being made, a real difference. The mystery of the quiet unknown between us began to feel magic, instead of mercenary.
These new experiences, tempered with time and a slower pace, breathing into the less-urgency - just breathing - helped. Third year was not what I expected, it was a lot more. Tentatively, I moved through it, blessed with great help, gaining new skills, including patience. As I entered my fourth and final year of residency, I was fortunate to have the unique opportunity to develop a training conference for junior residents rotating through the VA inpatient and consult teams. Previously a multidisciplinary case conference, I was excited to create something new. After my difficult adjustment from the first half into the second half of my residency, I wondered what might feel nurturing to our young residents. With Wednesdays devoted to didactics, plus two other case conferences every week, I asked myself what might bring balance to the science and biology of medicine and still be meaningful and important to their training. Finding that art had been such an important personal discovery for me, and a place to learn and practice being curious and brave, impacting my professional development, I considered incorporating the art of medicine and art in medicine.
My original conception was to create a "salon", continuing the spirit of the multidisciplinary nature of the prior conference, but widening the net by bringing together artists, therapists, community members, physicians in practices outside the academic sphere, introducing doctors, of any specialty, working particularly at the VA, people doing innovative and interesting things, whom the early residents might not otherwise meet or work with. I wanted to bring the three residents (rotating each month through the VA) together with interesting, creative people further along similar, parallel or completely different paths, in a non-academic setting, and invite discussion about the arts, and its possible impact or importance in medicine. This started as a broad and vague notion. Unsure how to begin, I studied the growing research in the medical humanities and its role in resident training. I wanted to integrate this data with my vision, to create something original.
I decided to sit down individually with each of the three residents prior to their month at the VA to hear ”their story“. Initially with the intention to tailor a discussion group around their interests. I asked each resident four (simple) questions: (1) Why medicine?; (2) Why psychiatry?; (3) What are your interests in psychiatry?; and (4) What do you love to do outside work/medicine? Witnessing these tentative, lovely, meandering, passionate stories, surprised and touched me. This made me want to capture and honor the courage, willingness and intimacy these brave residents offered me. My huge important idea, my "salon", grew into what became my precious, quiet, tender story conference.
Each month I had three special stories and four weeks with these residents. I held, carried, inhabited each story best as I could; loved the lines and form, held them close. For each resident and their story I found another person, often an attending physician, but not always, with a bit of story that matched in some way or ways. I used what I knew and intuited, and often relied on other trusted supervisors to help me get a "feel" for the right invitee. We (the 3 residents, me and the invitee) always met as a small group, intentionally outside the hospital - in a cafe, restaurant, gallery or outdoors. I simply asked the person I invited to share something personal. I would explain briefly and broadly why I had thought of them in particular association with one resident's story and invited this person to meet with all of us. The willingness of all the residents, as well as all the people I invited, continued to amaze me greatly throughout the year. People continued to say ”yes“ to this strange idea, usually with very little idea of what to expect. Inevitably, incredibly important conversations took place. Questions arose; hard and easy, answerable and not, and vulnerabilities were shared, always. I had hoped to model curiosity and an experience with relationship and intimacy, and it was continually modeled for me.
The final week of each month, we met, just the three residents and I, to give and get feedback about how the month went. I had also asked the residents to prepare something important and personal to share with each other, just as they had shared with me, and just as the attending had shared with the group. I offered suggestions for creative ways they could present the story they chose. Residents shared personal stories - improvised, journalized, with photographs, collages, scrapbook pages. Each as unique as their creator. The residents continued to show up, and bravely, for me and each other. The feedback was always gracious and grateful. Consistently, repeatedly, the residents, as well as the invitees, expressed their pleasure and gratitude for the opportunity to really get to know each other. Trainees found mentors. Others moved closer to their personal passion or calling within psychiatry. More questions arose about what is meaningful in medicine and training. I documented all of these stories, and questions.
As the year and my residency ends, I am fortunate to continue to explore in the company of rich, engaging, smart, brave fellow psychiatrists. This learning, listening, story-making, storytelling, scientific, collaborative, curious, creative exploration brings meaning to me and my work, as a mother, wife, physician, artist and teacher, and continues to be a work in progress.
