I very vividly remember sitting in the children’s wing of the hospital, IV in my arm and wrapped in blankets waiting to be called back for my endoscopy. I’m sure I looked like the picture of health…or not. My mom was in the locker room putting on the disposable bunny suit so she could come into the OR with me, despite my insisting that I was totally fine going in on my own. At 15 years old, I had been through plenty of procedures and tests, ranging from simple bloodwork to more invasive studies like endoscopies under anesthesia.  I had been feeling like hot garbage for months, and at that point I was used to being poked and prodded. I assured nurses and doctors that yes, my blood pressure is always low, and yes, my hands are always freezing. I was just over 100 pounds, and had little round bruises down my back from where my vertebrae were close to the surface and getting pressure from the hard desk chairs at school. I had been gluten free despite normal celiac testing, I was avoiding 7 different foods that had resulted positive on allergy skin testing, and yet my symptoms were no better. I was constantly nauseous and in a state of heightened anxiety that I was going to vomit, though I never did. I was exhausted, I was defeated, I was hopeless. Doctors told me that it could be a virus, it could be a metabolic abnormality, it could be constipation, but they weren’t really sure. I tried several different medications, including one we had to import from Canada because it wasn’t FDA approved in the US. I nibbled on pretzels and sipped on Gatorade throughout the day because I couldn’t get down a regular meal. Some days were better than others, and I somehow managed to stay on top of my schoolwork and play on the volleyball team despite my illness. I did miss the first round of SATs after waking up feeling too sick to sit for the exams, and I’m pretty sure I skipped a homecoming dance for the same reason. I went to well respected (aka expensive) doctors in NJ, NY and even at Children’s Hospital of Philadelphia, one of the best children’s hospitals in the country. Some providers were nice, compassionate people who just didn’t have clear answers for me; others were terse, rude and didn’t seem to give a darn because all my testing showed nothing wrong. Needless to say, it was a stressful, stressful time in my life.

Fortunately, all that is in the past. I look back on those years with both sadness for all that my younger self went through, and relief that I made it out the other side. I never did get a conclusive diagnosis, just a positive slow gastric emptying scan which suggested gastroparesis of some unclear etiology. Slowly, very slowly, as I learned to cope, and got into therapy, and became more hopeful, my symptoms improved, until senior year of high school when I felt back to normal for the first time in a long time.  

Whew, that was an uncomfortable trip down memory lane. Anyways.

Fast forward to last month, when Dr. Nikki undertook an adolescent medicine rotation. I was looking forward to working with the teenagers, getting better at taking a social history, and learning about the unique issues that adolescents face in terms of health and wellness. Well, it took me less than a week to realize that adolescent medicine was emotionally exhausting. While some of it was super interesting, including gender clinic and school based health care, I found myself struggling with a lot of the visits, and I didn’t realize initially that what I was hearing from patients was hitting a little too close to home. I learned more about myself and was able to reflect on my past with each passing day, which I guess is a good thing, but in the moment it was really hard.  I found the eating disorder consultations the most difficult. I listened to the stories of the young women (all of them happened to be women, though eating disorders can affect men too), who described what I now know to be body dysmorphia and disordered eating thoughts, and immediately the alarm bells in my head were triggered. I saw my past self reflected in their faces, my intrusive thoughts in their words, my anxiety in the way they tensed up when stepping onto the scale. I discussed with my attending that I felt challenged by these visits, but I didn’t necessarily tell her that I felt triggered. It’s my job to put my own emotions and biases aside to provide the best care possible for my patients, but it’s definitely a work in progress. I did a little better with the mental health visits, partly because I feel like I have largely made peace with that part of my past (and present), but there were definitely times I wanted to word vomit my entire life story when I had a patient expressing suicidal ideation. That, or I imagined my heart breaking into a million agonizing pieces when I remembered what that felt like, back when I was in their shoes. Then, there were the patients who expressed uncertainty about their gender identity or sexual orientation, or worse yet, those who felt that their identity was not acceptable to their loved ones and were fearful of expressing their true self. As a lesbian woman I could certainly relate to the process of coming out, but I found myself angry and frustrated knowing there was very little I could do for those who didn’t have a safe place to be their authentic selves. I reminded myself that at the very least, I could be a safe person to them for the hour or so that they were in the office, and tried to be very diligent about asking for, and sticking with, preferred names and pronouns. Did I mention the part about adolescent medicine being emotionally exhausting?

Okay, so now to connect those two pieces of the story. When I was a teenager, I was unwell in every sense of the word. However, I realize now that back then I really lacked insight into just how much I was struggling emotionally and mentally, and what a toll it was taking on my body. Over the course of this past rotation, I came to realize that many of my physical symptoms were a reflection of, or honestly, a direct byproduct of, my emotional symptoms. I wasn’t letting myself eat well, so my body forgot how to digest. I was depressed as all get out, so I felt tired and wanted to spend my days in bed. I was so anxious, of course I felt nauseous and had no appetite. I do believe the gastroparesis was real, and of course there is a chance that it was caused by a virus or something else unidentified, but I really think that anxiety and depression and disordered eating was a huge part of why I got as sick as I did. I say this to emphasize just how crucial it is to treat mental health as importantly as physical health. I mean, I was sick. Physically it was obvious, but mentally, I didn’t want to admit that I was very far from okay. Eventually, I saw many different therapists, and worked with an incredible psychiatrist that really turned things around for me. I got through, on the shoulders of my support system and the effects of medicine and therapy. I’m okay now, almost 15 years later, but that doesn’t make me immune to the visceral reactions I have when looking back at that chapter of my life.

Long story short, my adolescent period wasn’t great. It took me seeing adolescent patients and looking in from the outside to realize that, and honestly, it’s hard. Not to be dramatic, but sometimes it feels like I’m mourning the loss of who I could have been back then. At the end of the day, my story is the way it is and there is no going back now. However, I believe that the events of my past have led me to this point as Dr. Nikki, and hopefully a compassionate, empathetic person. I feel like I can connect to my adolescent patients on a deeper level, all while feeling grateful that I am not in their shoes anymore. I strive to foster the integration of physical and mental health treatment, and advocate for a greater emphasis on the mind-body connection. I’m sharing this piece of my story as an adult who, as a result of new lived experiences, has gained incredible clarity when looking back at my adolescence. You learn something new every day, and you certainly learn from difficult situations, but when what you learn helps you better understand yourself, that’s the most valuable lesson of all.