It was my first night of my psychiatric residency and I was assigned to the emergency room. I was feeling quite disoriented altogether as I had just moved to Pittsburgh a few days before with my wife and four month old son. Everything felt strange, and so, for reasons I didn’t understand, I started freaking out, I started panicking : is this the right work for me? What if I can’t handle this? Is psychiatry for me? So I went to a back room and in my troubled state I called my wife. She immediately comforted me, gave me support, and advised that I simply focus on the specific patient, “the human being”!, that I was to evaluate. “Don’t get global or think of the long run, my sweet husband”, she said to me. “There’s a person there who wants to be heard; you can do this, I know you can.” And so I met with my first psychiatric patient. She was nice and gentle, it turned out, but filled with anxiety. She told me she grew up in Indiana and went to college at California University. I then asked what brought her to western Pennsylvania and she responded that she’s always been in western Pennsylvania and why am I asking her that question…… Aha!!, I thought to myself - she’s not just anxious. She’s delusional! Indiana and California are thousands of miles away! I quickly arrived at my diagnosis: Delusional Disorder, or probable Schizophrenia. Thinking I had this nailed down, I proudly reported my findings to Dr. S, the attending psychiatrist. After listening to my enthusiastic assessment, Dr. S hesitated, looked at me, welcomed me to Pittsburgh, and kindly informed me that there is a city in Pennsylvania called Indiana (where the famous actor Jimmy Stewart is from) which is about 60 miles from Pittsburgh - AND that there is a university in Pennsylvania named ‘California’, located about 40 miles from Pittsburgh. “Nice work, Dr. Guterson!” Dr. S smiled at me, “maybe you should go back and talk with her some more.” So - the patient was correct, absolutely correct - and not delusional - and so in one big swoop I was delighted that she did not have Schizophrenia, delighted to learn something about western Pennsylvania geography, and absolutely delighted to go home the next day and laugh about all this with my dear wife.
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