The View From the Other Chair

Every once in a great while, a story about an encounter will come back to me. Something that happened today may trigger something from many years ago. This is one of the main reasons I decided to embark on a journey of telling some of the stories about what my patients have taught me over the years.

One night, back when I was working on an inpatient unit, I went out to find my new patient Ann (not her real name). She had just been admitted. I needed to get her history and do a brief physical exam to get her neatly tucked in for the night before I went home for some much-needed rest. One of the nurses helped me locate her. We found her wandering around the back hallway, dirty crumpled clothes in her hands, looking for a washing machine. She wore a faded hospital gown, a black knit cap pulled down over her face so that I could barely see her eyes, and large black boots with white athletic socks pulled up almost to her knees. She shuffled along, never picking her feet up. Her eyes stared out blankly from behind thick round plastic glasses. She was mumbling softly to herself.

“Ann, may I talk with you for a few minutes?” I asked, stopping directly in front of her to make sure she could see me.

Mumble mumble mumble.

“Ann, can you speak with the doctor for a few minutes, hon?” the nurse tried to help

Mumble mumble mumble.

The nurse took Ann gently but firmly by the arm and began to walk toward the back of the unit where the physician’s office was. I followed dutifully. We got to the door of the office and a strange thing happened. Ann walked in, turned around and sat down in the high-backed executive chair by the big desk. She crossed her legs, looked around the room a few times, then continued her conversation with herself and whatever voices she was obviously listening to. She leaned back toward the desk, much like I would have, propped on her right elbow, much like I would have, and waited.

Well, what was I to? I crossed in front of her and took my seat in the hard student-sized desk chair with the laminate topped arms that was used on blood drawing days. I squeezed into this cramped little chair and tried to make myself comfortable. The next fifteen minutes or so were not pleasant. Not only was the chair extremely inhospitable, but my patient was determined to say as little as possible to me in as few words as she could muster. It was like every young psychiatrist’s nightmare board exam back in my day, when the “live patient” you are assigned never says a word and you are being tested on your interviewing and diagnostic skills. I tried several angles and leads and specific questions and open-ended questions. Ann was having no part of it. She propped on one elbow, then the other, talked softly to her voices and paid me no mind.

I learned very little from Ann that night about what had brought her to the crisis unit. I had to rely on the thick green paper chart that the staff dragged out of its slot in the metal chart rack (yes, this was years before electronic medical records)  and the paperwork sent over by fax from the outpatient clinic.

I did learn, however, what it felt like to sit in the other chair, hard and unwelcoming, looking at someone who would not respond to me or give me any feedback at all. Someone who appeared to not know that I was in the room. Someone who was thinking about anything and everything but the person sitting in front of them during that interview.

It made me once again evaluate my own role when I am in the high-backed chair behind the doctor’s desk, even today when I see patients “live” in my office or via video when I am doing telepsychiatry in the emergency departments around the state.  Do I pay enough attention to what people are telling me? Does my mind wander, especially late at night when I’m tired and I’m thinking about the leftover dinner or the warm bed that are waiting for me at home? Do I show that I care? Do I really listen and take in everything that is being communicated to me? Do I let the person in the other chair know that I hear what they are saying and that in that moment it is the only thing I am focusing on?

Ann taught me something that night many years ago, as my patients always do. You’ve heard the expression “walk a mile in my shoes”? In mental health work, there’s always something new and interesting to see and learn when sitting for a time in the other chair.

Have you been in any situations lately that shook up the normal order of things and made you look at life from a different perspective? Did you stop, think, listen, and really pay attention? Did you learn anything from that experience?