“First impressions. That’s what the initial psychiatric interview is about.” Jane looked briefly into the eyes of each of the eight psychiatric residents. Just two weeks before, they had been mere medical students, not fully responsible for their patients’ outcome—but that all changed at graduation.
She felt their eagerness, excitement, fear, resistance, self-doubt, and, there it is, she smiled, there’s always at least one, cockiness. The tension of their newly realized role gets filtered through their own not yet fully examined character. Jane started to stroll back and forth in front of them again. They scribbled down notes, readjusted themselves in their seats, one cracked his neck, another his knuckles, anything to avoid the scene behind her.
“Why?” She wanted their participation, their engagement. “Bill?”
He sat in the center of the front row—a seat usually chosen to ensure being called upon.
“Your first impression begins the process of forming the diagnosis.”
Jane nodded slowly. “So, one way to see my question is to think about the clinician’s impression of the patient. Good. As doctors we’ve been taught to think about diagnosis. But why?”
“Treatments are always determined by the diagnosis, otherwise you’re just covering over symptoms, like treating a fever without figuring out why it’s there.” He sounded confident. First-year residents arrived so influenced by their general medical training. Her job was to reshape their image of who they were in relation to their patients.
“Okay, what else?” Jane looked around the room. No one moved. “Might we need to be cognizant of the patient’s first impressions of us? Could that also be important?” A young woman in the second row raised her hand. “Cathy?”
“Obviously you want the patient to like you.” Cathy tapped her pen rhythmically on the arm of her chair.
“So they’ll come back, continue in treatment.”
Jane cocked her head. It was interesting how residents started with the same
stereotypes of psychiatry that the rest of the world held. “I suppose that could be one goal for the first session. Any others?”
Cathy’s crossed leg started to bounce. She glanced at the resident seated next to her. John, a large man with an infectious smile.
“Getting the patient to return is the primary goal if you have as many student loans as I do,” John said.
Jane waited until the snickers died down. This was going to be a good group —interactive, not overly competitive. She began to stroll again in front of the class.
“So far we have diagnosis leading to treatment.” Jane nodded toward to Cathy. “And the development of rapport, much like any other area of medicine. But is it the same in our field? Or is there something different in what we do?”
“Actually,” Cathy said, “you can be afraid of a diagnosis. It can feel like you’re being judged. It’s not as clear cut as in general medicine and maybe it’s a matter of opinion.”
Jane watched the young woman avert her gaze. She didn’t want Cathy to expose her sense of vulnerability to her fellow residents, not yet, if ever. They were colleagues, not friends.
“Very good,” Jane said.
Cathy’s leg stopped shaking.
Jane looked around the room. She wanted more from them. She focused on
an attractive curly-haired man in his late twenties at the end of Cathy’s row. He wore khaki pants, loafers, and a pinstriped shirt—casual but professional enough. He hadn’t laughed at John’s joke.
“Mark?” she said. “Any thoughts?”
He straightened up in his chair and looked right at Jane—focused but relaxed. “People want to know that you can be trusted.”
She waited for more. None came. “That’s all?”
“Why?” His simplicity intrigued her. Most fledgling psychiatrists got themselves in trouble by saying too much. Not this guy.
“Because they want to be able to tell someone things they can’t tell anyone else, things they’re ashamed of.”
“So trust is the critical factor?”
“Maybe they’ll like you, maybe not, but it doesn’t really matter, it’s irrelevant. They want to believe you can help them. They like their friends but there’s limitations.” He paused and took a short breath. “Patients need to know you’ll handle their problems, their thoughts, their most intimate secrets carefully—with more respect than they feel for themselves.”
The group sat silent. Jane glanced at the wall behind her. It was a soundproof one-way glass mirror. They were facing what looked like any other psychiatric consultation room—desk, chair, sofa, nondescript art on the walls—but with one big difference. Whoever was chosen to demonstrate the first interview would be observed by all his fellow interns and critiqued by their professor.
“You’ve just earned the hot seat.” Jane nodded toward the door.
……..more from Chapter One in the book!
The bus jolted from side to side along the dirt road, stopping at regular intervals to let off a few schoolchildren at a time. The kids jumped down and ran from the vehicle as fast as they could to avoid the clouds of dust that would coat their blue and white uniforms if they walked at their usual dawdling pace. The rains had been particularly hard on the roads this year, providing months of work for local young men during the dry season.
Katura looked out the window at the deep potholes and smiled. Tafadzwa wouldn’t be among the road workers this year. He’d finally gotten away. Other girls must have been thinking the same thing.
“So, when will your brother be back?” The voice came from several rows behind her.
Katura didn’t turn around. She insisted on being addressed directly.
“Katura?” Direct, also loud and demanding.
She turned slowly to confront the girl three years her senior. Massassi was hands down the most beautiful girl in Rakops, and she knew it. Beauty commanded power.
“Which brother?” Katura asked.
“Don’t do this,” the girl sitting directly behind her whispered.
Massassi puffed out her checks and let out the air slowly. She stared at Katura, waiting.
Katura just stared back.
“Ta-fad-zwa,” Massassi said.
“Oh, I thought you’d know,” Katura said. “He’ll be back whenever the apprenticeship is over, probably six months, maybe a year, maybe two, depends on how he does.”
“Six months, then.” Massassi turned back to the group of older girls sitting near her. “He could’ve gone straight to Chobe, could’ve made a lot of money there, but wanted the best training first. I’d have been scared, but…” She put her hands together to imitate the mouth of a crocodile, the Shona symbol of virility.
The other girls giggled.
“Don’t let them get to you.” Kagiso said. She was Katura’s closest friend and they had sat together on the bus since they started school nine years ago. She tugged on Katura’s long black braid. “They’re just stupid.”
Katura pulled her hair out of Kagiso’s hand.
“Tafadzwa this, Tafadzwa that, everything is about Tafadzwa. Japera and I are nothing around here except Tafadzwa’s younger brother and sister.”
“Not to me, not to anyone who has a brain.”
“Tafadzwa couldn’t have worked in Chobe.” Katura lowered her voice. “He didn’t have the grades, he had to get trained back in Zimbabwe. Good looks and charm don’t get you everything.”
Kagiso glanced up at Massassi, who was walking down the aisle as the bus slowed for another stop.
“Not everything, but…some things.”
Katura laughed louder than she meant to. Massassi turned around to glare at her before stepping off the bus.
Katura put her hands over her face, suppressing more laughter. She turned to her friend and gave her a big hug.
“What would I do around here without you?”
“Get yourself in a lot of trouble, that’s what. You know, girl, one day you’re going to be on your own and you’ll have to watch that smart mouth of yours.”
Katura sat back and crossed her arms. “Don’t desert me now, you made a promise. We’re going to university together, remember?”
Kagiso looked down briefly at her bag of books. “Has Japera heard anything yet?”
“Not yet. Any day now. He’s got to get in. It means everything to him.” Katura stood in the aisle for her stop. “I’ll let you know if we hear. See you tomorrow.”
Katura kept glancing over her shoulder. She was hoping Japera would come riding up on his bike and walk the final half-mile to their thatched house. It was the time of day she enjoyed most, a few moments of private talk with her older brother before they both got hit by questions from their parents about school, homework, and chores. She startled when she heard something come up quickly behind her.
“Oh, it’s just you.” She leaned down to beckon the skinny brown neighborhood dog closer. The dog inched in, but just as she was about to pat its head, it backed away. She laughed.
“Every day the same. Come on, we’ll sit under the tree together.” Katura continued her walk with the mutt trotting along a few yards behind. She looked back at him. “So, what do you think happened to Japera? Did he dump us for his friends today? You know boys. Can’t trust ’em.”
The dog trotted up closer to her on the familiar route and began wagging its tail. They rounded the bend and cut across her family’s property to a large sprawling acacia where she dropped her book bag and plopped down in the shade. The dog circled and lay just near enough to be petted. She complied, then took out her history book and began reading. She had almost completed the assigned chapter when Japera surprised her from behind.
“Looks like you already have company.” He laid his bike down and stretched out on the grass.
“Brownie here figured you were too busy for little sisters, so he volunteered to take your place.” She reached over to pat the dog’s matted fur. He wiggled in a little closer.
“Brownie, huh? Such a plain name for such a distinguished canine.”
“He wouldn’t want to seem arrogant.” She crinkled her nose and stuck it into the air.
“No, not in this town.” Japera’s eyes scanned their house, down the street and back toward the strip that served as the town center. He let out a sigh.
Katura sat straight up and studied her brother. “Have you heard from the university?”
“Why do you ask like that?” His face gave away nothing.
“You have!” Her raised voice had the dog’s ears at attention.
“Are you sure?” Japera’s voice was calm. “What’s your evidence?”
She sat back. “It’s obvious. Every other time I’ve asked, you say something
kind of superstitious. Like if I ask again, I’ll jinx it. But today you focused on the way I asked—subtle, but a shift all the same.”
“Very good,” Japera said. His face was relaxed, but his steel-gray eyes looked intently into hers.
“Well?” she said.
“All I know is that you’ve heard, not what you’ve heard.”
Katura jumped on her brother’s long, stretched-out body and pinned his
hands to the ground. She then quickly brought his left arm down to his side and wedged it under her knee as she sat on top of him, her right arm now free to do her search.
“I know the answer,” she said.
He raised one eyebrow.
“You’re letting me do this.” He laughed as she searched each of his pockets
until she withdrew a long white envelope, rolled off him, and jumped to her feet. “But I still have to see it.”
He sat up and brushed the dry yellow grass off his clothes. “You still missed a clue.”
“What?” She slid a letter from the envelope.
“I was late. Obviously, I went to the post office.”
“Agh, I always get so close, but…” She froze. “Oh, my God.” She looked up from the paper. Tears began to form in her eyes. “You’re in, you’re really in!” She jumped on him again, this time hugging him tightly. “I can’t believe it! This is incredible!”
“Don’t act so surprised. In my moment of glory I could get offended.” He pulled her off him and they both laughed, staring at the paper in her hands.
“Thuto Ke Thebe,” she said. “Education is a Shield.”
Japera drew back, his eyes narrowed.
“It’s the university’s motto. See, below the emblem?” She pointed to the upper right corner of the paper.
His eyes narrowed to see the small writing. He then glanced at his sister as the corner of his mouth twitched approval. They sat quietly for several minutes.
Suddenly Katura jumped to her feet. “Come on, let’s go tell Mom.”
Japera smiled and grabbed his sister’s arm, pulling her back down to the ground beside him. She didn’t resist.
“Not so fast. We need to wait.”
“Okay.” She folded up the acceptance letter and handed it back to him. “But
as soon as he comes, I’m running in with you. I have to see their faces.”
“No, we’re not running in as soon as he gets home.”
Katura sighed heavily.
“We’ll let him put down his things, greet Mom and relax.”
“They’ll wonder where we are.” Her voice was pleading, but she felt herself giving up. When he had a plan, she knew he wouldn’t be swayed.
“They’ll know exactly where we are,” Japera said. “We’re where we always are—under this acacia, talking and doing homework. They’ll call us to dinner and we’ll come, just like usual. Then they’ll—”
“They’ll ask us how our day was and you’ll tell them the news and it’ll be so exciting!”
He laughed. “No, they’ll first ask you. He always asks you first. And you’ll tell him.”
“I can’t.” Katura was shaking her head. “No way, I’ll squirm too much, I’ll give it away and ruin it. You can’t ask me to pretend like this.”
“You’ll do fine. And when they ask me, I’ll pull out the letter and—”
“They’ll both start crying. You know they will, Japera. It’ll be great.”
He shrugged. “Mom’ll start crying. Dad will get a serious look on his face. He’ll take out his glasses slowly.” Japera pretended to put on reading glasses and cleared his throat. He spoke with a deep voice. “What exactly does it say here, let me see. Hmmm, well done, boy, well done.” Japera slipped his imaginary spectacles back into his pocket. “Then he’ll set down the letter and quietly tell mother to get dinner on the table in his usual contained and understated manner.” He looked at his sister’s pouting face and smiled. “They’ll both cry when it’s you.”
“That’s not true. They’ll both cry, only Dad’ll try to hide it.” She turned away from Japera and scratched Brownie’s neck again. She spoke softly. “We’ll all cry.”
Hopefully this leaves you wanting more!