Where are you from?
I hail from the metro Detroit area (my family moved several times while I was growing up), but I have lived in Ann Arbor since arriving for my undergraduate studies.
Why did you choose U-M?
When applying for residency programs, I sought to explore many different corners within psychiatry. U-M offers broad exposure beyond excellent inpatient and outpatient experiences to other practice settings such as a VA hospital, ECT program, and dedicated psychiatric emergency department.
What is your current focus?
In our third year of residency, we transition from primarily working in the hospital to the clinic. I am learning how to care for patients in the outpatient setting both for medication management and psychotherapy. In 2020, that means I am also learning how to provide telepsychiatry.
What is most rewarding about your work?
I am always honored to sit with patients and listen to their stories. Of course, in medicine we endeavor to offer cures; it is satisfying when our treatments help pull someone out of depression or psychosis. So often, however, psychiatric illness is chronic or intermittent, and I find it deeply rewarding to be present with someone in their suffering so that they are not alone.
What future direction do you see for your career?
I have found that I especially enjoy working with hospitalized patients and older adults, so I am considering a geriatric fellowship after residency. Academic psychiatry is appealing because I see attending physicians whom I admire caring directly for patients, teaching trainees, and working on projects that improve patients’ access to high quality mental health care — all at the same time!
Dr. Tamarelli authored a narrative writing piece about seeing a patient in the hospital with COVID-19 for Pulse — voices from the heart of medicine (pulsevoices.org).
The Threshold
I suit up. Hand sanitizer, gown. Hand sanitizer, mask and goggles. Hand sanitizer, adjust the goggles that have steamed up from the mask. Hand sanitizer, gloves.
Through the door of the ICU, I see my patient, staring off towards the windows, and his hand grasps at the air. I lean forcefully to drag open the suctioned sliding door. I enter the room and introduce myself. “I’m Doctor Tamarelli with psychiatry! Your doctors asked us to check in with you!”
I recently learned of the concept of a “thin place:” a Celtic term for those rare situations where the distance between heaven and earth collapses, or where a threshold appears as entry to a new world. I hope to find these places with each of my patients, but it is not easy in the times of COVID-19.
When I introduce myself, I speak loudly because I am under water. My voice is muffled. Already my armpits are steaming up. The air surely is too viscous to be therapeutic. This place is a thick place.
My patient’s head bobs back and forth, and I see that his forehead is shiny with sweat. He looks at me, but his eyes do not register mine. His voice is gone because the ventilator is pushing breaths down the hole in his throat. He mouths words at me. I apologize that I do not understand what he communicates. I continue to speak too loudly, and I am irritated by the grating tone and volume of my own voice. He nods and shakes his head to my questions, but sometimes he tries to talk to me. I guess aloud what he says, and he shakes his head no, no, no. His hands are too weak to grasp the marker that I offer. Finally, he gives up, closing his eyes. A drop of sweat slips from his brow.
“This stinks,” I say. “You must be so frustrated with me and all these other idiots who cannot understand you.”
He smiles.
I do not ask any more questions about anxiety, hallucinations or suicide. I start to talk with him about what has happened to him so far in the intensive care unit. His eyes are vacant. I tell him he is recovering from the coronavirus. He does not know this illness. He also cannot choose his own name from a list of multiple choices I give him. He is very delirious.
So, instead, I get close and hold his hand. Suddenly this is not such a thick place after all. I feel the warmth of his body, and he squeezes, just a little.
