On my psychiatrist

Nary a green juice or vanity podcast for this man

Dr. Y****  is the first psychiatrist I've trusted. One quality that makes him trustworthy is that he clearly loathes talking to patients. I would loathe it too, given how annoying and/or drug-seeking most psychiatry patients are. His translucency in this regard is novel.

A second is that he offers a sliding scale. This became important to me during the year 2014, when I visited my first New York City psychiatrist. That particular man drank a green juice during intake and told me I was "very glamorous!" and asked me to come on his podcast to discuss mental health—my own, specifically—before prescribing the wrong medication and sending a bill for $750. 

A surprising number of psychiatrists in New York City have a section on their website called Appearances or Media. I am suspicious of medical providers who prioritize Appearing in the Media.

A third advantage of Dr. Y**** is that he has memorized every drug study ever published. You can, and indeed I have, named two random drugs and Dr. Y**** will robotically recite every observed interaction in descending order from “contraindicated” to “serious” to “significant” to “minor.” It is thrilling.

He is a whiz at food-drug interactions, too. Did you know that fava beans can cause an adverse hypertensive reaction up to and including death when absorbed with MAOIs? Now you do.

(I prolonged one session with so many questions about grapefruit juice that Dr. Y**** cut me off with a terse statement that he would send a PDF of major food-drug interactions via email. It arrived two days later, 41 pages of 9-point type. I reference it often and to no purpose, since I take exactly 1 pill that happens to cooperate harmoniously with all foods.)

The relationship goes like this. Four times a year we videochat for ten minutes. His office resembles a detention camp. Based on the image quality I believe he uses a webcam. The webcam is positioned so as to cruelly highlight the doctor's bald spot—a decision, or lack of decision, that sends my affection for him soaring to almost painful heights. Nary a green juice or vanity podcast for this man!

At no point does eye contact occur. He could be blind or have spinning pinwheels in place of eyeballs; if so I will never find out.

The doctor begins by asking if anything has changed. Absurdly (but accurately for his purposes) I say "No." 

Then he moves through the standard questionnaire. Do you have excessive energy, have you experienced hallucinations, has your libido increased, has your libido decreased, have you recently experienced thoughts of harming yourself...

My favorite question is "Do you have racing thoughts?" because it is bafflingly poetic. If “racing” refers to velocity, then what is the appropriate pace of a thought? Or, even better, does the word indicate that two or more separate thoughts are battling each other in a competition and only one shall prove triumphant?

Either way, no. 

At the end of each session, having verified my sanity, he asks if I have any questions. I know from the internet that Dr. Y**** previously served as chief psychiatrist at M***** hospital, and thrice now I've used this remaining minute to ask if he has any interesting stories from his time at M***** that he could share. (I’m careful to use the word "interesting" rather than "crazy"— to be respectful.)

"That's not something I can discuss," he says. 

Perhaps the reason I keep asking is because my brain adds a phantom "...at this time" or "with a patient" to the end of the sentence. Most professionals would soften the blow of "No" by adding a little phrase such as that, or by sighing or smiling or otherwise acknowledging the unstanchable geyser of curiosity that flows from a healthy human mind. 

My opinion is, if you learn someone has served as chief psychiatrist at M***** hospital, you'd have to be a real sicko not to try digging for stories. After the initial failure I mentioned this opinion to him— partly to be funny and partly to exonerate myself. 

"Okay," he said.

A decent proportion of any psychiatry practice necessarily consists of patients like me. The ones who answer “no” to all the alarming questions and present nothing of clinical significance and require only a licensed finger to greenlight a 3-month refill of a generic substance sold over-the-counter in many nations worldwide.

The purpose of our quarterly videochat, I realized, was for Dr. Y**** to confirm the unfluctuating quality of my boring little signal. For purposes of noise-reduction he had fashioned himself immune to jokes, hostile to charm, exempt from small talk. Or perhaps no fashioning had been required; perhaps he’d emerged from the womb experiencing personality as obstruction. I know he is the one for me.