When the anniversary of 9/11 comes around, I often think back to one patient who had an appointment with me on that day. In 2001 I was working as a psychiatrist in a rural clinic several hours away from New York City.
As the awful news broke, I asked my scheduled patients how they were handling the day's events. I didn't really expect that in this small town, my patients -- people with serious illnesses such as schizophrenia, manic depression, and severe depressive disorders -- would have any personal connection to the tragedy that was unfolding. Maybe I assumed that my patients were not educated or privileged enough to have social connections stretching that far. Or maybe in my own distress about the day and my own personal connections in the city, I was not considering my patients' lives.
So when Mr. B. replied to my question about how he was feeling, I was surprised. Mr. B. revealed that his adult daughter worked in Wall Street, that her office was right near the World Trade Center, and that he had been unable to reach her by phone before his clinic appointment. I could see the worry all over his face. I asked him if he would like to try calling her again from my office. He quickly answered yes, and successfully reached her on her cell phone. She was with her co-workers, they were safe, and they were walking away from the neighborhood. Visibly relieved, Mr. B ended the call and returned to his appointment with me.
I had previously known Mr. B. as a quiet man in his early 60's with schizophrenia. I knew that he had a family, and that he had worked for many years as an accountant, but talking about his past had always felt like pulling teeth. After our 9/11 experience, he opened up, and in later visits I learned more about Mr. B's life.
He had been an accountant in a large firm. He was often bothered by voices coming into his small office through the ventilation system. The voices would say bad things about him and tell him that everyone thought he was a loser. The voices bothered Mr. B, but he knew on some level that they were not really there, and thought that if he told anyone they would think he was crazy and he might lose his job. Mr. B really needed his job to support his wife and young daughters, so he kept his head down, concentrated on his work, and ignored the voices as best he could.
After his daughters finished college and Mr. B and his wife were alone in the house, they realized they didn't have much in common and decided to divorce. Mr. B felt sad about this but could see his wife had made her mind up and so didn't protest.
Going back to work after the divorce was intolerable. The voices in his office were louder than ever. The motivation Mr. B had had to keep his job for his family's sake was gone, and Mr. B took an early retirement.
Home alone, with no structure to his days, Mr. B's symptoms overwhelmed him and he had his first psychiatric hospitalization at age 52. Although it was a low point in his life, as a result of the hospitalization he finally got medication that stopped his voices.
Mr. B. entered the next phase of his life, as a single person, a retired person, and a person diagnosed with a serious psychiatric illness. A person who doctor-types like me might see and assume that was the whole story.
So 9/11, a massive wakeup call for our whole country, was also a strong reminder for me as a physician. It reminded me to not assume anything about my patients, and that a person's life story is as important as their symptoms in determining what will happen with their illness.
It was also a reminder that sometimes, as on that horrible day 13 years ago, a phone call can be more therapeutic than any medication or psychotherapy.