Adam Stern - Committed: Dispatches from a Psychiatrist in Training

Copyright 2021 by Adam Stern, MD

All rights reserved

For information about permission to reproduce selections from this book, write to or to Permissions, Houghton Mifflin Harcourt Publishing Company, 3 Park Avenue, 19th Floor, New York, New York 10016.

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Library of Congress Cataloging-in-Publication Data

Names: Stern, Adam (Psychiatrist), author.

Title: Committed : dispatches from a psychiatrist in training / Adam Stern.

Description: Boston : Houghton Mifflin Harcourt, 2021.

Identifiers: LCCN 2020057716 (print) | LCCN 2020057717 (ebook) | ISBN 9780358434733 (hardcover) | ISBN 9780358450351 | ISBN 9780358450511 | ISBN 9780358435488 (ebook)

Subjects: LCSH: Stern, Adam (Psychiatrist) | Harvard Medical School. | PsychiatristsUnited StatesBiography. | Residents (Medicine)United StatesBiography. | PsychiatryStudy and teaching (Residency)United States.

Classification: LCC RC438.6.S75 A3 2021 (print) | LCC RC438.6.S75 (ebook) | DDC 616.89092 [B]dc23

LC record available at https://lccn.loc.gov/2020057716

LC ebook record available at https://lccn.loc.gov/2020057717

Cover design by Lynn Buckley

Cover photograph Roman Sigaev / Shutterstock

Author photograph Kate McKenna / Crabapple Photography

v1.0621

Version 04222022KO

For my Golden Classmates,

our teachers,

and our patients

This book is based upon my experiences during psychiatry residency training. When possible, I have obtained permission from, and I have also changed names and identifying characteristics of, many of the people represented to protect their privacy. Ive also created composite characters. Patient descriptions and patient encounters in this book have been deliberately altered to make them unidentifiable.

I have a recurring dream in which I look down and notice for the first time that Im soaring above the earth. Im exhilarated but also filled with fear. I dont know how I made it off the ground, and the act of looking down seems to cause me to lose whatever momentum it was that propelled me upward. I need to figure out how to keep moving before gravity pulls me back to earth, ending in a terrible crash. Sometimes I awaken just as I begin to fall, and other times the dream ends with my discovery of an unexpected solution. The version that gives me the most comfort is when I look to one side or the other and notice that Im not alone. In those moments, when I see someone floating right next to me, my fear still exists, but its more surmountable. Maybe we can figure this out together.

In my conscious life I feel this way too. I became a psychiatrist, which was, at its core, an education in the value of human connection. Psychiatry is the field of medicine aimed at helping patients to find and become the best versions of themselves in spite of, or even because of, the immense challenges they face. Inherent within the field is the assumption that were more capable together than we are apart.

Psychiatrists are trained to give people a push forward when theyre stagnating and to catch them when theyre falling. We learn through experience that the parts of our lives we can see and hear and feel may be only a sliver of our inner world. In fact, our minds are generally so focused on the complex task of making sense of our precarious existence that sometimes we can misunderstand parts of ourselves that exist right out in the open. Here, too, psychiatry can be useful in illuminating the unseen.

Those of us who become psychiatrists face these same challenges in our own lives. I chose it as my specialty because I wanted to become an expert in the human condition, but I had to figure out how to square that with the gnawing sense that sometimes I could just barely get by myself. I couldnt fathom how I might grow into an intellectual and emotional guide for patients when I felt completely overwhelmed by my own rudimentary life.

Coming from a state medical school in upstate New York, I had matched into a residency program at Harvard Medical School. Everyone around me at the new program was so bright and already accomplished that I didnt see myself belonging. I felt like an impostor.

A version of my dream was playing out in my life then, but I couldnt see how it would end. I had found myself soaring into one of the most prestigious residency programs in the country, but I couldnt imagine a scenario that didnt involve crashing back to earth.

This book tells the story of how I was transformed over those four years alongside my peers with the guidance of our extraordinary teachers. It describes how we all came together to overcome the unimaginable challenges of psychiatric training. Like many of the patients who taught us by way of their own care, my classmates and I changed and strove to be better. Together we learned the meaning of failure and appreciated the preciousness of success. As a group thrust together and inseparable by circumstance, our class was taught what it meant to connect with one another and our patients. We faltered often, but still, and always, we found ways to move forward together.

The room was dimly lit. The curtains hung with too much slack, letting in light from the streetlamps outside the window. We stood in a patients room at the far end of the locked psychiatry unit on the Longwood medical campus. I held steady in the center of the room hoping that the adrenaline rushing through my veins was evident only to me. I was flanked by three hospital security guards. One seemed to yawn in my ear as I stared up at a man, no more than twenty, who was admitted to the unit in a psychotic state. His world did not conform to reality, and his instincts or terrified thoughts had led him to climb to the top of a six-foot bureau. He perched completely frozen, crouching in fear.

Come on down. Were only here to help, I said in a quiet voice.

Youre an agent. Youre an agent of the Devils CIA, he replied.

Please, I pleaded even more soothingly. I need you to come dow But before I finished my sentence, he had leapt toward us.

Two of the security guards intercepted him midair and guided him to the floor safely but with a thud. A nurse entered and proceeded to inject his buttocks with a sedative as the guards held him in place. Shed had it ready from the moment she walked in.

Im so sorry this has happened, I said, kneeling on the floor and trying to make eye contact with the man. Were going to get through this together.

The group escorted the man to the Quiet Room, where he was physically tethered to the bedpost in accordance with Massachusetts legal code and the murky ethics of involuntary treatment when there is an imminent safety risk. I watched the man be tied down from eight feet away.

I felt a nudge in my rib.

First time? It was the nurse. It gets easier.

Im not sure that I want it to get easier, I replied.

Well, now, thats your stuff getting in the way. She sighed and slumped her shoulders. Come on, Doctor. Weve got mounds of paperwork and three admissions waiting to be seen.

Have you ever seen anything like this? I asked like an amazed child.

Eliana paused to take in the immaculate surroundings and shook her head.

I dont think theres any place quite like this, she replied, fixing her gaze upon my Harvard-issued ID badge.

Seeing that name next to mine feels like a lot of pressure, I said.

Good thing youre wicked smaht, she retorted with an exaggerated Boston accent.

I smiled meekly and continued examining the main quad at Harvard Medical School.