Acad Psychiatry 29:397-a-398, October 2005 2005
doi: 10.1176/appi.ap.29.4.397-a
© 2005 Academic Psychiatry
A Day in the Life
Psychiatrist-in-the-Making:
Renee Sorrentino, M.D.
I was assigned my first forensic case on July 1, 2002. Dr. Phillip Resnick, the fellowship director, informed us that he had been hired in an out-of-town case involving a pediatrician mother who stabbed her two children. As would become customary in the fellowship, the fellows placed their hopes on "heads" or "tails" as a coin toss determined which fellow would accompany Dr. Resnick.
In honor of winning the coin toss, I was presented with a box of medical records. The first week of the fellowship was dedicated to the investigation of these records. My task was to summarize any material that would help us to understand why this mother stabbed her children. I found this task daunting. What information would be relevant to why a mother stabbed her children?
Two weeks later, I accompanied Dr. Resnick to Illinois, where we were scheduled to meet with our evaluee, the accused mother. I would come to learn that such a trip was routine in the work of a forensic psychiatrist. The day began at 5:30 am, when Dr. Resnick and I drove to the airport. En route, I reviewed the summary of records that I had prepared. I anticipated a day of interviewing in which I would apply my knowledge from the box of medical records, filling in the gaps in the mother’s history, clarifying diagnoses, and performing a mental status examination in order to answer the question of whether this mother was insane at the time of the stabbings. Over breakfast at the airport, I shared with Dr. Resnick this mother’s life as told by the medical records. I felt confident in my preparation for the interview.
When we arrived in Illinois, our employer, the evaluee’s attorneys, greeted us. We were chauffeured to the county jail, where we would meet our evaluee. Dr. Resnick described the format of the interview. He reminded me that we would complete the interview in 1 day, with minimal distractions such as lunch, dinner or bathroom breaks. I acknowledged his subtle advice and quickly devoured two candy bars during the drive.
At the jail, we were escorted into a small room where we conducted the interview. We remained in this room for 6 hours. During these 6 hours, we listened to the mother describe her experiences from a young child to the afternoon she stabbed her two children.
I listened with an uncomfortable intensity. I waited to hear why this happened. I began to realize I was unprepared for the experience. How could I be unprepared? I had spent nearly a week reviewing a stack of records. Nevertheless, as I sat in the drab, claustrophobic room, I felt a heavy suffocating sadness, which permeated the room. I had not accounted for the emotional experience of the meeting. Had I forgotten what I had learned in my 4 years of psychiatry residency? I struggled to find my role as a "forensic psychiatrist." After all, I had assumed the role only 2 weeks ago.
I was increasingly aware of my new role as evaluator, not treator. I hesitate to share an interpretation with the mother or to acknowledge the tears that slid down her cheeks. Instead, I jotted down what I was feeling in the room.
At the conclusion of the interview, I was exhausted. Yet I had no better understanding of why this mother stabbed her children. I could not help this mother. Was it because I did not fully understand her? Was it because I had not asked the appropriate questions? Was it because I was lost in the sadness? But why did it matter that I could not help her? After all, my job was not to "help" the evaluee. I had a new role and a responsibility to serve justice rather than the evaluee. How would I adapt to this new role?
The day concluded with a late dinner at our hotel. Dr. Resnick quizzed me throughout the meal. Was the mother mentally ill? Did she meet the insanity standard? How did I understand her experience? Although I remained confident in my decision to become a forensic psychiatrist, I was perplexed by how I would arrive there.
In the months that followed, I began to rebuild an identity as a physician. Not unlike my experience as a medical intern who evolved into a psychiatrist, I developed my identity as a forensic psychiatrist. I was guided by my experiences with my evaluees in addition to the supervision provided by Dr. Resnick and my cofellows. Although humbled by a field which straddled two seemingly disparate fields, my fascination and passion for forensic psychiatry intensified. Indeed, my pursuit for excellence in forensic psychiatry training was a decision that I would greatly value.
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