I took the picture of the little chair one of the residents brought to the psychiatry consult office yesterday. I got a big charge out of it, especially because I’ve been using a version made of wood and leather for a few years now. I think it’s possible that it could be an auspicious chair.
The resident actually used his, too. It was a busy day; I put in about 4 miles and 40 floors on my step counter—which meant the residents did too. The chair is obviously useful to rest our feet, but I think Thomas P. Hackett summed up the best ever rationale for sitting with patients:
“As a matter of courtesy, I sit down when interviewing or visiting patients. Long accustomed to the ritual of making rounds, many physicians remain standing as a matter of course. Standing, physicians remind me of missiles about to be launched, poised to depart. Even if that is not necessarily true, they look the part. Patients sense this and it limits conversation. In addition, when standing, the physician necessarily looks down on the patient. This disparity in height is apt to encourage the attribution of arrogance. Looking down at a patient who is prone emphasizes the dependency of the position. Sitting at the bedside equalizes station. Sitting with a patient need not take longer than standing with him.”— Hackett, T. P., MD (1978). Beginnings: liaison psychiatry in a general hospital. Massachusetts General Hospital: Handbook of general hospital psychiatry. T. P. Hackett, MD and N. H. Cassem, MD. St. Louis, Missouri, The C.V. Mosby Company: 1-14.
I had a little fun with the chair in a YouTube video as well.
The chair I use now is a replacement for the first one I got as a sort of loaner from a colleague in Palliative Care Medicine. That one broke during a consultation visit with a patient and his family (circumstances disguised to protect confidentiality) in the emergency room in which we were asked to evaluate for catatonia. The patient was mute but there was little evidence otherwise for catatonia, one of the chief features of which is the inability to react to any stimulus in the environment. I was sitting on the chair explaining in detail the intravenous lorazepam challenge test for catatonia (which often interrupts the episode of muteness and immobility).
I was sitting in front of the patient but facing the family and the consult service trainees while expatiating on the topic. As I was droning on, I heard a sudden pop—and I fell unceremoniously on my rear end as the chair collapsed beneath me.
My audience exploded in loud laughter, of course, as you’d expect when a pompous ass falls on his ass. But they also pointed to the patient. When I turned to look at him, he was convulsed with apparent mirth although still unable to make a sound.
I considered this a novel test for catatonia, negative in this case. Of course, it would be impractical for regular use.
Where was I? Oh, the little chair the resident brought for consult rounds. I was honored by it. It seemed to show that I was leaving a legacy as I head for retirement in June.
Another sign of leaving a legacy was a New Year’s email message I got from a former resident, Dr. Paul Thisayakorn, MD, who has been making an auspicious beginning in the field of consultation-liaison psychiatry in Thailand. He’s working very hard and is an outstanding clinician, researcher, and teacher. He has a lovely family. He and I respect each other a great deal.
Speaking of auspicious, when Paul graduated from our psychiatry residency and before leaving for his Consultation-Liaison fellowship program, he gave me a necktie with white elephants printed on it. I still have it. I may not have the symbolic meaning of the white elephant exactly right, but I think the white elephant in Thai culture is called “chang samkhan,” or maybe “chang phueak” which means “auspicious elephant.” In general, I think the idea is they symbolize success or at least the promise of success. Paul’s gift showed his gratitude and respect for me because I was one of his teachers. I am still honored to have been a part of his education and his life. I will always treasure his gift of gratitude.
Paul is very hard-working and very successful. And if the residents now start to use the little camp stools to sit with their patients, I would treasure that legacy as well.