All That Jazz with Matthew Hirschtritt, MD
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What is the main topic discussed in this episode?
At the Nocturinous, we are careful to ensure that all stories comply with healthcare privacy laws. Details may have been changed to ensure patient confidentiality. All views expressed are those of the person speaking and not their employer.
Every doctor wants their patients to get better. But sometimes our patients' clinical trajectories are not linear. One moment they seem to be improving and the next they take a sharp turn and it seems like they're getting worse again. I'm Emily Silverman and this is The Nocturnus. Stories from the World of Medicine. In this story, psychiatrist Matthew Hurstrit describes what it feels like to treat a patient with severe depression who just isn't getting better. After the story, Matt and I talk about the unique challenges to the field of psychiatry and how we can provide palliative care to patients with severe mental illness. Have a listen to Matthew Hirstritt.
As a young, nerdy, neurotic New Yorker, I spent a lot of time in my own head as a kid. Thinking about my own thoughts, thinking about the thoughts of the kids around me. And so when it came time to choose a major in college, naturally I gravitated to psychology. And growing up I was also very much influenced by being in a Jewish household. Being also morbid, one of the stories that stuck with me from Sunday school was about death. It turns out that in Jewish custom, when a member of the community dies, other members of the community who come to prepare the body for burial are not able to converse with one another when they're approaching the body nor when they're leaving, and they're not even able to pass objects over the body.
It's as though the soul lives on, even though in Judaism we really don't talk about the afterlife. After college, I decided to go to medical school with the high hopes of being able to forge deep connections with my patients, to be able to walk with them through some of the most difficult times in their lives. And in many ways, medical school was amazing. I got to learn about the intricate physiology of the human body, about diseases and illnesses that plague it, about treatments and about cures. But at the same time, it felt strangely alienating, as though we were talking about some other species when we were on rounds, instead of talking about the flesh and blood that we were actually working with, that these people could have just as easily been our family members.
So for me at least, when I got to my psychiatry rotation, it felt like a breath of fresh air. Here we were talking about things like quality of life and the things that make us us. So when I started residency, I was excited to finally be able to feel like what I imagined a healer would feel like. Whatever that was. And I started right down the street here at San Francisco General Hospital, which is an incredible institution, and happens to see in its inpatient psychiatric ward folks who deal with probably the most severe of psychiatric illnesses of any hospital in the city. And not only do they have to contend with these serious psychiatric illnesses, but also many of them with homelessness and ruptured social ties, but with a very
very large treatment team, we were able to give a lot of these patients the skills that they needed to survive outside of the hospital setting. And I did for that first time really feel at least a little bit like a healer. So I was excited to move on to outpatient psychiatry. Here was my opportunity. to be able to work with patients who would not only survive but thrive in the outpatient setting. Here were people who just needed, you know, a little bit of extra help, maybe just a little boost. And then I met Julia. Julia was one of the first patients that I met, and actually, as is typical nowadays, I met her on the electronic health record before I met her in person. She had had a series of successive suicide attempts, which ranged from attempted overdoses, attempted hangings, running into traffic, wrapping bags around her head.
It's as though if there were a book of suicide attempts, she would have tried everything from each chapter five times.
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Chapters
5 chapters
1
What is the main topic discussed in this episode?
0:00–6:41
2
How does Matthew’s Jewish upbringing shape his view of patient care?
6:41–10:48
3
What motivated Matthew to pursue medicine after his psychology studies?
10:48–15:45
4
Why did the psychiatry rotation feel like a ‘breath of fresh air’ for him?
15:45–24:15
5
How did Matthew first meet his patient Julia and what was her clinical picture?
24:15–29:26