400th Post! This Psychiatrist was Admitted to Inpatient Psychiatry
A story from 2013, about your author, when he was a resident physician.
Welcome to the 400th post of the Frontier Psychiatrists Newsletter. I have been writing this more or less daily since July 1, 2022. I met my wife almost 10 years ago. That was about two months after the events described in this article.
Still, in August 2013, I was a third-year resident physician in the Donald and Barbara Zucker Hofstra-Northwell School of Medicine General Psychiatry Residency Training Program at the Zucker Hillside Hospital. That is the real name. I was engaged to be married. I started getting depressed at the beginning of my third year—July—and it got so severe that I walked myself into an inpatient unit—this time, as a patient. It was not in the hospital in which I worked, although, in retrospect, I might have been okay with that. It was in another hospital in the same health system. It was a difficult time, and I learned crucial lessons about what that locked door feels like when you don’t have the keys.
I will tell more of this story over time because self-disclosure among health professionals1 can de-stigmatize in a way little else can. Stigma has been associated with suicide risk2 in some cohorts.3
I am Owen Scott Muir, M.D. I identify as an Interventional Brain Medicine physician…but I trained as a child and adult psychiatrist.4
On the advice of my psychiatrist, after a very long night in the psychiatric emergency room as the physician on call, I walked back into the ER. The trip was humiliating. I knew I had to go. Lenox Hill Hospital is part of my employer’s health system. This is the same health system in which I worked. This is the only health system that my insurance covers. At the time, my outpatient doctor was an inpatient psychiatrist at NYU. The “work for a hospital” health plan didn't cover a “not their own hospital” medical center. Even though my psychiatrist was an inpatient at another hospital, I had seen him for more than a decade of outpatient visits in his office, physically attached to that inpatient unit. According to my health insurance, I couldn't go there through my job, which the National Residency Match Program legally assigned. I had no choice. When I eventually saw the bill, it amounted to $10/minute for every minute of the 7-day admission.
The in-networkness of Lenox Hill Hospital was appealing because it meant, as a General Psychiatry resident, I wouldn't have to be admitted to the hospital where I worked. It turns out this was a pyrrhic victory.
Walking into an emergency room is awkward. If you're walking in this emergency room, you must walk halfway up a long avenue. In New York City, avenues are much longer than streets. There is a giant rotating door, and it's big enough—and rotates slowly enough—that wheelchairs can get in. You then have to walk up to a desk. You have to tell them while you're there. I did my best.
“I've been thinking of killing myself.”
Beat.
“Can we have your insurance card?”
This exchange, years later, would prove fundamental in my understanding of everything wrong. At that time, I handed the person an insurance card. His face? I cannot recall.
The nurse came out; she sat me in a chair. My temperature was taken. My blood pressure was taken. They were within normal limits. I was escorted back into a bed. I only got to spend about 30 minutes in a bed, until there weren't enough beds left. They plopped me in a chair in what was the hallway. This was at around 11 in the morning. I hadn't slept. I completed a shift the night before. The psychiatric nurse practitioner on-call evaluated me. I remember kindness. I don't remember anything else. Two years later, I would staff on-call shifts as an attending physician in that same emergency room.
I changed out of my clothing and into a gown. This is for safety. People can have weapons on their person. They might try to kill themselves. I’ve watched it happen. The gown is for safety— I promise. Blood was drawn from the antecubital vein in my left arm, which, I have to say, is a winner. That blood vessel? Always the best. Others look tempting. Some daring phlebotomists will attempt, quixotically, to “access” other blood vessels. I know something they don't. I know the blood vessels that look good have awkward valves in my arm. Those awkward valves prevent a decent blood draw. Every other blood vessel that isn't that particular blood vessel is a nightmare. I warn them. It doesn't always work. I took Depakote from age 16-26. It required regular blood draws.
Sometime later, and I don't remember how much later— not remembering things is a feature of being depressed. Attention is also…Where was I? You get the point.
In a hospital, they have to reduce the risk of falls. I sit in a wheelchair to get wheeled around, and somebody else has to move it. I was re-plopped into a wheelchair after about an hour and a half in a bariatric chair. This was rapid, for context. The elevator button was pressed— the eighth floor. The button had an adorable baroque quality. The worn etching of the E and the broken illumination behind it was… quaint.
The ding of the bell before the door is opened — almost perfectly 440 Hz, with overtones in a harmonic series emphasizing even-numbered harmonics. The overtone sequence for any note determines how you perceive it. 440 Hz was the fundamental frequency—an “A” note— and it wasn't until the fifth overtone that we got something out of the sequence that sounded nice. Clear as a bell. The doors opened.
The unit is called Uris 8. I was rolled in.
There is a ring on the bell next to the door that leads you into the locked psychiatric unit, but this bill did not ring in a consonant tone. It was at least 300 Hz higher than the elevator. I used to be a recording engineer. It had a raspy quality.
Nagging. We. Are. Waiting.
About 120 seconds elapsed. There was a turning sound inside the lock on the door, and it opened, and I was welcomed— slowly— inside the unit by a tall, bespectacled social worker with a physique that said, “I played JV Football in high school as my sport.” This man would later marry a residency classmate. I didn't object. He is a good, good man.
“You are Owen?” He said, checking my wristband because patient identification is a national patient safety goal.
“Date of birth…” I responded.
To be continued…
It has been 400 articles I’ve written in just over a year. Please consider subscribing. I value my readers and their feedback! Many of the articles I write are the result of requests from subscribers. The above experience inspired a series of podcasts as part of my NYU Rudin Master Scholars in Ethics and Humanities Fellowship.
Consider supporting the work! There are also now hundreds of articles available in the archives, many of which are worth your time.
Are you looking for help?
988 exists. It’s a national crisis hotline. Use it if you need it.
I write about novel interventions. Many of them are available at Fermata in New York City. I also work at Acacia Clinics in Sunnyvale, California. We have teams of humans ready to help. If you need it, or someone you care about does. Insurance coverage is a real issue for much of the care I’m advocating. Your advocacy can help change that.
Howe E. Should psychiatrists self disclose? Innov Clin Neurosci. 2011 Dec;8(12):14-7. PMID: 22247813; PMCID: PMC3257982.
52. Yoo T, Kim SW, Kim SY, Lee SY, Hang HJ, Bae KY, et al. Relationship between suicidality and low self-esteem in patients with schizophrenia. Clin Psychopharmacol Neurosci (2015) 13:296–301. 10.9758/cpn.2015.13.3.296
Sharaf AY, Ossman LH, Lachine OA. A cross-sectional study of the relationship between illness insight, internalized stigma, and suicidal risk in individuals with schizophrenia. Int J Nurs Stud (2012) 49:1512–20. 10.1016/j.ijnurstu.2012.08.00
I'm trying this label on for size…let me know what you think!
Congratulations, you prolific devil ❤️
Self-disclosure (from your citations): considered very tricky for therapists too! I would rather use myself as an example (when I think it will help a client understand something--analogies are good!) than say "I once knew someone..." or "I once had a client who..."