“I LOVE YOU” IN CANTONESE | Chloe Nazra Lee
I sat in my attending physician’s cramped office, awaiting his advice on how to improve my interviews with patients. It was the second week of my psychiatry clerkship, and I had just made a paranoid patient even more paranoid with my stilted questions. I was certain Dr. Hattan thought I was a mess who should stay far, far away from psychiatry.
To my surprise, he was kind. Not critical. “The way to make your interviews better is to stop worrying about a mental checklist, and to just talk to the patient," he said. "You in particular would benefit by relaxing on this clerkship. The point of every interview is to get a second interview, and the act of talking is itself therapeutic. Stop worrying about asking all the right questions.”
Stop worrying? I’m a medical student. Worrying is my baseline. Just talk? Shouldn’t I be learning about antipsychotics?
I knew he was right, that the simple act of expressing one’s feelings was somehow liberating, even healing. That's especially true when sorting out difficult situations and complex feelings. I thought about my family and our codes of silence. I thought especially about my relationship with my father, one that invariably frames the way I listen to my patients.
My father and I don’t say, “I love you,” to each other. We communicate in different ways: If I knew he were coming to visit, for example, and could find Ben and Jerry’s cannoli or pistachio ice cream at the Wegman’s down the road, I’d buy three pints for him. He’d be as excited as a child at Christmas and request a large bowl after dinner. And though I know he’s one gallbladder short after years of indulging in the rich meals he loves, I’d give it to him without question. In turn, he’d have brought my favorite dim sum up from Canal Street for me. “Excited to see your old daddy? Look, we have har gao, char siu bao, mango lo mai chi for my beautiful daughter.”
But we rarely say “I love you.”
Emotional restraint is a virtue in my culture, and we become even more closed-off when mood becomes a disorder. Rarely is mental health a subject of discussion in the Chinese community. Emotional turmoil and mental illness are perceived as a weakness or “instability,” and so you learn to suppress strong feelings and soldier on. It's ironic that my clinical calling is one where I call upon people to open up and reveal their inner thoughts and feelings to me.
My paternal grandmother was quietly regarded as “unstable,” notorious for erratic moods that ran the gamut from loving, attentive, self-sacrificing mother to raging maniac who cursed for hours on end, slamming things, and terrorizing everyone within reach. This could happen at any instant for any reason. You might call it “lability.” If she needed a diagnosis, she never received one.
A year after my grandfather passed from cancer, my father, then a young man, had moved an ocean away from his mother. Their relationship transformed from affectionate to fractious, each call ending in a fight. One afternoon, he received a wildly disorganized voicemail message from her. Hours later, his sister called to tell him that she had found their mother’s body, hanging, in her apartment.
My mother said that she had never before, or after, heard him scream the way he did.
He refused to discuss it. He never told me about it himself, remaining as stoic as ever. It was my mother who told me years later once I was old enough to understand. The only acknowledgment of the act that my father ever offered me was a short, “So, you know about my mom, right?” once when I was 18. He left the room, tears welling in his eyes.
When I decided to relocate temporarily to China for the first time, my father’s eyes lit up. He offered to travel with me and suggested, with tentative hope in his voice, that I might take a week to explore Hong Kong with him. I agreed, then spent the next week listening. He took me to every place he had frequented together with his mother – the noodle shop where she would take him specially, buying him a bowl and nothing for herself; the British quarter of Happy Valley, where he would help her with her day job collecting trash for wealthy European expatriates who mocked the “Chinese pig” and her disheveled son with his thick hair that still won’t lie flat; finally, to her grave, enthusiastically hiking up the mountains to the cemetery, solemnly paying his respects. “I miss you, Mama,” I heard him whisper.
On a nighttime trolley up Victoria Peak, he recalled how she encouraged his education and helped with his homework in her own way, despite her illiteracy, sharpening his pencils and bringing him food. How she gave her life savings to him for his university education without reservation. He hummed a little tune to himself contentedly as we meandered around the Buddhist monastery of Lantau Island, periodically offering tiny insights into his childhood. With each story he revealed about the mother she had been, I saw my father become slightly more open, a little happier. I’d never before seen this tranquility in him, my ever-active father who can’t seem to stop going and going. I welcomed it, listening throughout, tacitly inviting him to tell me more.
I won’t claim that a week of talking about his mother to his daughter was entirely curative for him, and to this day, I have no idea how his mother’s death affects him. But I think he found that week cathartic, and I suspect he asked to travel to Hong Kong together in pursuit of some sort of inner peace and healing. Now, he regularly hints that he wants another visit to his home country, bribing me with all the dim sum I can eat and the wonders of the Dragon Boat Festival. I suspect he would like to relive more memories, or even the same memories, and that he needs to do it with family. One day, I’ll return with him to the grave in the mountains. Perhaps I’ll take some roses to my grandmother, who shares her name with me. I love roses; maybe she will too.
Days after that conversation with my attending, I visited Liz, one of my patients. We heard the daily announcement for “fresh air groups,” where the patients could take a supervised walk outside. Her roommate stuck her head into the room, asking if Liz would join the group. Liz, a victim of domestic violence diagnosed with schizophrenia and recovering after a suicide attempt, loved her walk. I told her I’d gladly check in with her later; she should enjoy the sun. She shook her head and shut the door. “I’d prefer to talk with you. It makes me feel better.”
My attending’s advice is still my framework today, even now that I am a psychiatry resident. Just talk to the patient. The act of talking is itself therapeutic. I breathe deeply, I stop overthinking, and I listen, as I would for my own parent trying to make sense of loss.
Chloe Nazra Lee, MD, MPH, is a resident physician in the Department of Psychiatry at the University of Rochester Medical Center in New York. Her professional interests include narrative medicine, trauma disorders and working with survivors of domestic abuse. Her writing has appeared in MedPage Today, Doximity, Ms. Magazine, Women's Media Center and The Baltimore Sun.