The editors posed an interesting question—"What is your day like?" The question might well come from younger colleagues and students who wonder about careers in academic psychiatry.
Let me start with an "official" biography; then I will describe how these duties get transduced onto the clock. I am an academic psychiatrist and do full-time clinical research on the physiology of stress as it affects sleep, blood pressure, and fatigue. I work in a university setting where I teach undergraduates, medical students, graduate students, residents, and post-doctoral fellows. I am active in university administration; currently, I chair the Academic Senate for University of California, San Diego—everything from art to surgery. I enjoy seeing patients and tend to treat patients with both psychiatric and medical problems.
Although the above job description is a reasonable approximation of my official division of labor, it doesn't map well onto my daily calendar. Rather, my calendar lurches from day to day in the service of the various Joel Dimsdales of the moment.
My obligations are so numerous and diverse that over the years I have found the only way I get an opportunity to write is to schedule writing time into my calendar. Otherwise, my administrative assistant can grab any 15-minute block of time and book patients, teleconferences, meetings, etc. I publish about 20 scientific papers/year, and for the most part, I list my trainees as first authors. I wind up spending vastly more time teaching my trainees how to write papers than it would take for me to write the papers by myself, but I love teaching, so I do not mind the one-on-one supervision regarding how to shape an analysis, conduct studies, and write them up.
I also write grants—lots of them. I write because I want to find answers about how stress affects health. Each "answer" winds up raising multiple new questions. When I was just starting out, I wrote grants to cover my own salary. Then I wrote grants to hire staff. With increasing professional recognition, I feel less pressure to cover my own salary, but I have acquired a wonderful and loyal staff. These days, I write back-up grants to insure that my staff will have secure positions in the event that my original grant runs into funding troubles. I get new grants and hire new staff to do that new work and then develop new loyalties to new staff and feel the need to write a backup to the backup to insure that my employees will have secure positions. I think you get the picture. Hey, whoever invented this system was brilliant!
I teach primarily in individual tutorial settings. This morning I made walk rounds on the consultation psychiatry service. We saw a 16-year-old youth who had been shot in the neck and was now a quadriplegic. His mom and girlfriend were anxiously hovering at his bedside; a sheriff's deputy was in the hall disinterestedly reading a magazine. The nurses wondered why the youth was not more depressed. Would he develop post traumatic stress disorder (PTSD)? He had been shot a week ago and was in a halo in bed. The lad was overjoyed because he finally had his tracheostomy capped, and now at least he could talk through his clenched teeth (jaw wired shut). He was coping for the moment with a stoical amount of gracefulness that would have pleased Seneca. The resident and I talked about titrating hope and despair, nightmares and PTSD, sex and quadriplegics, vicissitudes of coping, what goes on in a rehabilitation unit.
Today's other scheduled teaching activities include meeting with a graduate student who wants to apply for medical school, helping a post doc write a new paper, and mentoring a young assistant professor in the department. The assistant professor doesn't show up; I'll figure that out later. I don't mind "no shows"; they give me the opportunity to go to the bathroom, answer e-mails, and phone patients. I am also supposed to be working on a lecture to be given next month in Holland. Nope, no time for it today; I better "book an appointment" for myself to get that done next week.
I chair the University Academic Senate, which means that anybody unhappy about anything calls me. The state of California is having a terrible fiscal year due to the avarice of corporations like Enron and the continuing reverberations from international terrorism. This translates into an enormous deficit. How much "fat" can one cut from an organization so lean it could qualify as "anorexic"? A senior member of our faculty was found to have been dishonest about his academic credentials. I get tons of e-mails and letters, many of them anonymous, from the left and from the right. What is justice and what is mercy in this instance? The administration and the senate are at odds concerning some promotion practices. How can I facilitate a reasonable compromise? Colleagues who study smoking want the university to put an embargo on any grants funded by the tobacco industry; others feel such an embargo violates their academic freedom. The president of the University is retiring; lots of people are lobbying to be placed on the search committee. My email "doorbell" is in spasm; I have so far received 53 e-mails today. I shall cope by logging off the system so I do not get interrupted further. Done!
I see one of my private outpatients, a 40 year old woman with an uncertain major psychiatric diagnosis (why is it that DSM "fits" my patients so poorly?), who is well maintained on medication and supportive therapy. Unfortunately, her husband—her rock—has metastatic cancer. The three of us must grapple with selling the house, estate plans, and considerable existential anxiety. Her managed care company asks me periodically "When are you going to cure her? Don't you think we could save money by having someone else see her instead?" So far, I have prevailed and am allowed to see her once a month.
In my briefcase for work at home are two manuscripts to review for journals, a letter of recommendation for a colleague who hates his job and is anxious to move somewhere, three journals to read, and several dues notices that need payment.
Do I like my job? I love my job. Am I bored? Nope. Every 30 minutes, there is something new to do. I get an abiding satisfaction from the diverse tasks of treating patients, teaching students, discovering new knowledge, and in trying to "conduct music" in a University setting where all of us musicians are all-too-human.