Notes from a Medical Student:

Do You Want to Know a Secret?

As evidenced by the unwelcome layer of frost on the windshield, winter is approaching. And as I drive to the hospital, passing churches that stand like European castles on the still-empty streets, this morning is certainly colder, darker than yesterday.

Unfortunately, the sun won't rise for at least another hour, maybe two. Instead, I notice the constellation of Orion looming above the hospital, the moon presumably somewhere nearby, obscured for now by clouds.

It's Monday, which means last night's episode of AMC's Mad Men is on my mind. Of particular note were the haunting closing credits, which rolled solemnly to an instrumental rendition of the Beatles' song "Do You Want to Know a Secret?" The question implies two qualities at once: the great responsibility of knowing a secret and the profound sense of trust conveyed by sharing one.

I soon arrive on the mental health inpatient unit, where I am spending my six-week psychiatry rotation. Here I often find myself in the privileged position of being entrusted with other people's secrets-deeply personal information that patients choose to share with my colleagues and me.

This trust, of course, lies at the heart of our daily interactions. Within minutes of meeting a patient, we ask questions about substance use, sexual history, and bodily functions-not typical small talk.

But the power of trust allows patients to answer those questions, despite the fact that we are often complete strangers.

Particularly in psychiatry, patients share horrific secrets-about childhood sexual abuse, or multiple attempts to commit suicide-secrets about their past that, in many cases, not even their closest family members know.

And they certainly don't preface these stories by asking, "Do you want to know a secret?"

Nor should they.

After all, a crucial aspect of treating mental illness, at least from my observations, is providing a safe environment that encourages patients to confide in their physicians. In doing so, the treatment team can better understand the precipitating factors that led to the patient's arrival at the hospital, as well as predisposing factors from the patient's past, and perpetuating factors of the patient's current life.

Mental illness carries with it a stigma-even today, when diseases such as depression, schizophrenia, and bipolar disorder have been shown to be biologically, neuro-chemically, and even genetically influenced.

But the science behind mental illness means little when a physician stands in a room to interact with a patient. At that time, the emphasis is on the art of being empathetic-understanding a patient's emotional pain as a genuine experience that is qualitatively different from physical pain.

This Monday morning, as I stand in my patient's dimly lit room, just minutes before the sun finally rises outside, she tells me about the suicide attempt that landed her in the hospital, the stressors in her life, her children, and her own childhood, which included being severely bullied in school.

"Is your daughter the same age now as you were when you were bullied?" I ask.

"No," responds my patient. "But she's the same age I was when I was molested."

She says this so bluntly that it catches me off guard.

I look up, and she has a familiar, distant stare that I have seen often during the last six weeks, most notably in patients with depression. But she has told me this secret for a reason, and it hangs in the air, like so many secrets spoken by patients who have sat in this room before her.

"I appreciate you telling me that," I say, and I mean it. "I can tell these memories are really difficult for you."

Similar interactions fill the remainder of the morning, and each time, I feel that being empathetic, even in a small way, is the least I can do.

Other times, it's the most I can do.

At the end of the day, I walk back to my car not with a heavy burden of knowing other people's dark secrets, but with a feeling of appreciation for their willingness to share them.

I drive home along streets much busier than they were so many hours ago. The frost will return tonight and will bring another cold morning tomorrow.

But do you want to know a secret?

With a little warmth, I know the frost always thaws. And I look forward to doing it all again.