Published onChildren's View
Catharyn A. Turner II, MD, MEd , is a psychiatrist in the Behavioral Health Integration Program (BHIP) within the Department of Child and Adolescent Psychiatry and Behavioral Sciences. When CHOP opens its first-ever inpatient psychiatric hospital in West Philadelphia next spring, she will be its medical director. This is a day in her life.
By Zan Hale
Wakes and gets ready for work, ordering her hot tea and bagel via an app so they’re ready to pick up.
Settles into her office. Quickly wraps gifts for the Holiday in July celebration she planned for her BHIP colleagues — a group of psychiatrists, psychologists and social workers who provide urgent assessments and short-term interventions for children in the Emergency Department or who have been admitted for medical treatment.
Leads the morning huddle, a teleconference review of current patients. The most frequent condition? Disordered eating. “More than half of our patients at any time have an eating disorder.” On this day, there are 69 patients under the BHIP team’s care, 21 who require 24/7 observation and nine who have been prescribed a set of measures designed to keep patients safe from self-harm.
Meets with the fellows, residents, med students and nurse practitioners to preview patients they will visit on patient rounds.
First stop is a teen with an eating disorder, pancreatitis and mania who is being discharged. Dr. Turner asks: “When can you stop taking your medication?” “When you say so,” the patient answers. Dr. Turner responds: “Right — not until a psychiatrist says you can.”
Visits a teen who has been in and out of CHOP for two years with debilitating abdominal pain and gently asks: “Any thoughts of wanting to hurt yourself? Of wanting to die?” The patient answers, “No.” After few more questions, Dr. Turner asks the teen if she would play her keyboard, which is in the room. The patient demurs, so Dr. Turner spontaneously raps a couple of lines for her, eliciting a smile.
Sees a 3-year-old who has been hospitalized a total of 590 days with a complicated and elusive medical concern and delirium. The girl, who has developmental delays, waves and says “bye-bye” as the group leaves.
Treats her group to coffee before heading back for a meeting with other BHIP attendings. A discussion of two older teens with eating disorders who refuse to follow their treatment plans dominates the meeting.
Teaching time. A trainee summarizes each patient visited, and Dr. Turner asks probing questions. Explains a “capacity consultation,” when a patient is refusing treatment but fully understands the consequences of their decision. “We’re a children’s hospital, so we want to heal everyone. But sometimes that isn’t possible, and a patient may decide they’ve had enough.”
Conference call with Penn Medicine and Public Health Management Corp., CHOP’s partners at the planned Cedar Avenue hospital. “We have three institutions with three procedures for everything. There are some growing pains.” They discuss topics such as medical waste disposal, training for building repair staff (tool belts could be a danger for patients) and fire protocols. “I’m very excited for this, but there are a lot of details to figure out. I like the complexity of inpatient psychiatry. You create a care plan and see people get better.”
Enters notes from morning rounds into patients’ electronic medical records and consults on new patients over the phone.
Races to the conference room with snacks and decorations for the staff party, then leads the afternoon huddle so clinicians are up to date on patient developments.
Cupcakes, cookies, fruit, a gift exchange and a lot of gratitude expressed for the hard work of the BHIP team.
Signs on for a virtual meeting of CHOP’s Narrative Medicine Group. Here, clinicians and staff use the power of art and literature to better understand the perspectives and emotions that may influence their patients’ health. With a degree in English from Bryn Mawr College and experience as a teacher and a published poet, Dr. Turner is uniquely qualified to lead the session.
After finishing her patient notes, then heads home to Ardmore, where she cooks dinner, catches up on the news and Words with Friends, reads a young adult novel, and thinks about the new facility before finally falling asleep.