Wednesday

 October 2nd, 2022

Dear Nandini, 

    One Wednesday, a few Wednesdays ago, I met a teenager who was admitted to my team.  A college student majoring in chemistry and interested in bench research -- the first day she was unable to tell me any of this.  Found in her dorm room by her roommate, she was completely out of it.  Thrashing around, totally agitated, unable to say anything meaningful -- it took her a full two days to recover from what we found out was some combination of cocaine and an intentional overdose of her antidepressant.  Not able to get a story from her, I met her mom in the emergency room.  Tired, weary, terrified -- she seemed so familiar and at the time I somehow couldn't piece together why.  I explained what to expect medically and was met with the same questions we used to ask about you: "Is there something else we can do?", "She doesn't want the help -- how are we supposed to help her?", "How long can she go on like this?".  Obviously, I had no answers and certainly nothing I said was reassuring to her mom in the slightest.  I get that. 

    A day passed and she was still somewhat out of it -- this time, though, that might've had more to do with the medications we gave her to calm her down -- perhaps now a bit too sedate.  I remember on this second day reflecting on what made Wednesday so difficult and I finally started to figure it out.

    She wrote a note -- saying "goodbye" and maybe also the reasons why she was.  I went back and forth about reading this note -- both feeling as if it were an invasion of privacy but also feeling appreciative that her mother trusted the team enough to share it with us.  Ultimately I decided to and it turns out she has a little brother.  A little brother she talks about the way you used to talk about me.  I was reminded of all the times I snuck into your room to read your poems and lyrics -- often regretting it afterward but this was the only real way I could try to understand you. 

    They call it counter-transference...I think.

    Her note -- laced with sadness, hopelessness, and guilt -- made me realize these might have been all the feelings you probably shared.  She talked of video games with her brother and how proud she was of him -- and maybe I was too young to remember what it was like when you were her age but I imagine that perhaps it was the same.  Not that I have done anything spectacular, but I know you were proud of me in some way.  So what did she need now that you probably needed back then?  When I used to read your work, I remember poring over every detail: your word choice, your sentence structure, the way your handwriting would change in response to your moods.  The angrier you were, the more rushed your writing became -- the letters running together, sometimes becoming illegible.  If I asked her the questions I had wanted to ask you, would I find the answers I was looking for?

    So I did -- to some extent.  We sat and chatted for an hour -- about her favorite books, television shows, and bubble tea flavors.  She's just a kid.  A reminder to me that you were just a kid when this all began.  Her parents -- concerned, attentive, sweet -- your parents the same.  The more time we spent together the more I realized maybe I was getting a little too invested.  I felt responsible for this girl somehow and it took me a bit to realize that, aside from being her medical provider -- I wasn't really responsible for her.  And by that, I mean, if she were to have a poor outcome in life -- that wouldn't be my fault.  In a way, I think this helped me reconcile some (a tiny bit) of guilt I felt about never being able to "fix" things for you.  I certainly could've done many things differently but "fixing" you wasn't necessarily my task.  

    I feel like we create a lot of rules to set boundaries with our patients -- for good reason.  We protect them but we also protect ourselves.  And while I still maintained a professional boundary with this patient I maybe let the walls break down a little bit.  I can't imagine that was a bad thing.  She did well and went on to be transferred to another unit -- and I guess I healed a little bit too. 

    All this to say, I hope she does okay.  It seems like she has parents and a network of friends to be a support structure for her and maybe sometimes that isn't enough.  But she has her whole life ahead of her and I hope she can do something with it.  I'm sure she doesn't realize that she helped me just as much as I hoped to have helped her.  Just as you did, actually. 

Love, 

Nilima