Sure, it sounds like a stupid question, but for a new medical-student-turned-intern, even the most simple of questions can seem incredibly complex. On my third overnight call as a psychiatry resident on the inpatient unit, a nurse approached me and requested permission to chemically restrain a patient. This was my first time, I thought as my heart skipped a beat; I decided to keep that to myself. After she described the patient's belligerent and threatening behavior, I agreed with the nurse's plan and she went about making preparations for the restraint.
I walked cautiously to the hallway where four security guards were busy donning latex gloves. The nurses were bustling around directing the other patients into their rooms or the lounge area. I was unsure about what my role was now that the "decision" had been made. Everyone else seemed so confident. The nurse leading the restraint instructed four officers, "If he resists, you take the left arm, you take the left leg, you take the right arm, you take the right leg," pointing to each of them in turn. She didn't point to me, thankfully, perhaps not needing an extra set of arms but perhaps for another reason…
I trailed the group of six people down to the man's room, all the while starting to wonder if I'd done the right thing. I couldn't see much until the officers moved aside. Then I could see the man sitting in his chair, looking upset, raising his voice at the nurse. He made eye contact with me and I just stood there, unsure what to do. My arms were crossed; it wasn't intentional, it just felt natural.
The nurse standing next to me leaned towards my ear and murmured, "Don't cross your arms, it makes you look confrontational." I uncrossed my arms, stood at attention, and clasped my fingers behind my back. "Don't put your arms behind your back; the patient will worry you have a weapon or something threatening in your hands," she continued, quietly educating me. Finally, I just dropped my arms to my side, earning an approving nod from the nurse. How silly, for a new doctor to wonder, "where do I put my hands?"
The patient eventually took the medication by mouth, averting the need to physically restrain him and administer the medicine intramuscularly. Reflecting on this experience now drives home the myriad questions a new, eager yet inexperienced first-year resident must deal with in his new role as a physician. Maybe that's why they call us "interns." The word implies so much more than just paucity of clinical knowledge; it clarifies for everyone the questions for which we are struggling to find answers.
These questions range from the incidental (where do I get lunch?), to the profound (what is my role in the care of this patient?). This latter question occupies my thoughts often, as I imagine it does interns in other specialties. To the outside world, we're "a doctor," but to our colleagues we're training to become "a surgeon," or "an ophthalmologist," or "a pediatrician." Now I'm supposed to live up to the role ascribed to me on my new hospital ID: psychiatry.
Though attaining the knowledge to become a psychiatrist is clearly my ultimate goal, perhaps for now I will have to settle for seeking answers to more preliminary, if pedestrian, questions, like "where do I put my hands?" Maybe we finally become that to which we aspire only after we vanquish these peremptory questions. Or perhaps they are never really answered, and it is the journey itself that defines who we are as physicians. I don't know for sure, but I'll keep in touch and will let you know what I learn. Until then, just put your arms at your sides…