Social Phobia

My step 2 studying attempts are progressing nicely (mostly thanks to habitrpg.com, which allows me to incentivize my daily study habits and my lengthy to-do list). 
My friends and I went out to dinner tonight and we mutually commiserated on how awful studying for huge tests is. But I really think studying for step 1 was worse. I have terrible flashbacks of skin flaking off of my face and my ears bleeding.
Step 2 is better if only because it is more interesting:

Did I know that I meet the criteria for having both social and specific phobias? No!

Although it makes sense. As much as I love talking to patients, I dread actually introducing myself to people. I frequently find that I yell at myself for missing an opportunity to talk to a stranger, or engage with a patient longer. Little things will bother me for the rest of the day, like when I missed an opportunity to say thank you to someone at the park who helped me figure out how to work the water fountain.

The treatment for social phobias is cognitive behavioral therapy (CBT) and SSRIs.

Cognitive behavioral therapy really fascinates me, but I think that's mostly because it's always listed as an efficacious treatment for many psychiatric disorders which I think is pretty counter-intuitive. Psychiatrists (they can prescribe you drugs because they are doctors) are thought of as superior to clinical psychologists (they can talk to you because they are Ph.D's), yet both medicating and therapy are equally effective for a lot of mood and anxiety disorders.

Regardless, I guess I could start trying to enforce CBT on myself. I could assess why I avoid talking to strangers and how that behavior is affecting my life. I could try to change it. I could slowly mold myself to become the person I've always wanted to be--gregarious, friendly, fun--using various tricks I've found on the internet or in self-help books.

On the other hand, I could just ask my psychiatrist to switch me to an SSRI.

Out of Bounds

I’ve never been a huge fan of babies. Toddlers are cute and "children are our future", but neonates are really boring. In comparison with other newborns of the mammalian order, human babies are completely useless. Utterly useless… 30 days in and they can only coo? And they don’t start speaking intelligible words for at least 270 days? Not impressed.

But several weeks ago, a patient on the floor was a five month old and she was puffy-cheeked, bright-eyed, and adorable. A complicated perinatal period had ensured that she would require intensive additional medical attention indefinitely, and now she was back in the hospital with r/o aspiration pneumonia after a two week reprieve at home.

At five months of age, she was operating at a one to two month old level. There was no social smile, no babbling of words, no raking grasp. But she was able to grip my pointer finger whenever I placed it near her palm, and I thought that was a good sign. I spent a lot of time with this baby. Partially because I was trying to figure out what milestones she had missed as a way of quizzing myself on infant behavior, but mostly because she was adorable.

And I never saw the parents. For an entire week I watched this baby--rotating her head to help her plagiocephaly; baby talking at her so she could hear words; setting her on her stomach for tummy time to develop motor skills; smiling into her face so she could see facial expressions. And I never once saw the parents.

I checked in her files to figure out her family story. Several young children at home, maybe they weren’t ignoring her. Maybe they weren’t bad parents.

But I still worried. It’s weird how attached one can be to a thing that never smiles. And I wanted to guarantee her safety. I wanted to tell people about my frustrations and my fears for how this baby might grow up. But who would I tell? And in a hospital full of sick kids, was this kid any more special than anyone else? 

Yes. Of course. She was my patient. I was her hospital guardian. Every minute of free time I had on the wards I'd gown up, put my gloves on, and hold her hand while I tried to get her to smile.

Miraculously, somehow, I finally met the parents. Or rather, the patient did. They were a flurry of excitement as they entered the room, mother and father and brother. And suddenly her face was being kissed and her mother was pulling out tiny matching outfits from a shopping bag for her to try on before she was discharged home.

I was fortunate this time. This baby was going to be a burden on this family--no question. But this family had a lot of something that I wish I had seen more of as a child: love. I no longer felt a need to voice my concerns. But I wonder how distant I’ll be able to keep myself the next time I see a patient in need of more than just medical care.