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A Second Second Opinion

Twenty years after the event outlined in “The Importance of a Second Opinion,” I found myself face to face with another young psychiatrist whose wisdom I questioned.

This fellow was tall, handsome, and had an air of self-importance about him. He had a reputation in Marin County as the best adolescent specialist, recommended to me by several friends and doctors. I was too distraught to notice anything about him when we first met, I just wanted him to take care of my daughter who was clearly in serious trouble.

I had received a call from Brown University that Jennifer was not able to continue her first week at college. She needed psychiatric treatment, and someone would have to come to Providence and pick her up. Her Father happened to be on the East coast and he immediately went there and brought her home. She was wringing her hands, fretting about being such a bother, but clearly not in any shape for school. She had put off college for a year, studied art, and taken an extended trip to Europe just before leaving for Brown. I had worried about her not leaving any resting time after traveling, but she assured me that all would be fine. It wasn’t. She left in a nervous flurry, and apparently all the new experiences she was facing just pushed her anxiety over the edge. She couldn’t make a decision about anything, and the powers that be agreed that she was not able to start her classes.

Back at home, there was now the added anguish over disappointing us and causing us worry. She paced, she cried, she wandered around the house. She had trouble sleeping, and I’d find her huddled in a dark living room in her nightgown at 3 AM. All was not well. I found the best psychiatrist I could. He immediately hospitalized her and started treatment.

But now I had serious reservations about this treatment.

I walked into Jennifer’s room at the in-patient facility in Ross, CA. She sat on the bed jerking and shaking. I put my arms around her and held her tight. The shaking persisted, not affected at all by my tight embrace. I stepped back and stared. She looked frightened and exhausted. I walked right out of that room to the nurse’s station. Where is Dr. M? He just finished his rounds, she said, and you might catch him in his office. She pointed. I ran down the hall, knocked once, and opened the door. He was at his desk and before he could speak, I asked him if he thought Jennifer might need less medication. The Haldol was clearly racking her body. He told me to sit down and went on to explain that she needed a high dose for a while longer and he didn’t want to risk tapering too soon.

I’m worried. I said.

Don’t be, he reassured me. I’ve handled many cases just like hers. She’ll be ok.

I want another opinion.

Eyebrows raised. You . . . what?

I don’t want her to spend any more time shaking uncontrollably. I want another opinion about her medication.

Well, we can arrange that. But I know that even though it seems harsh, Haldol is the best recourse we have.

I want someone right now.

Well, that’s impossible, I have to leave for my office, I have patients waiting.

You’re off the case.

Off the . . . I think you should think about this for a while. We have established a relationship, and any change now could upset the course of her treatment.

I was astonished to hear myself say as I stood up and turned to leave, You’re off the case!

As the door closed, he called out --- You’re making a terrible mistake!

I walked up to the nurse’s station again and touched the arm of a nurse who had been kind to me in the first few days. I think my daughter is over medicated. I’m taking Dr. M off the case. Can you recommend another Dr.? She looked at me and nodded slightly. I can’t recommend anyone now, but . . . and she handed me her card. Call me tonight.

I did call, and she gave me the name of another Dr. with the caution not to tell anyone, as it was against protocol. She had noticed how the medication was affecting Jennifer and agreed it was too harsh.

The other doctor was a sweet older man who immediately changed her medication. The shaking went away. In an oddly similar story, he had her out of the hospital in a week, applying to other colleges within the month, and by Spring she was enrolled in UC Santa Cruz. She was still shaky and worried about what had happened to her, but, off she went, and this time she thrived.

I am not someone who makes decisions without looking back and wondering if I did the right thing. But in my dealings with two young psychiatrists, I never looked back.

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