June, not April, is the cruelest month for residents in training. In June we change year and rotation. In my case, I went from an inpatient unit to an outpatient practice when I finished the second year of my psychiatric training. Well, every change in routine or service causes anxiety, but moving from an inpatient, fully supervised, safe practice to an outpatient clinic, with psychotherapy and medication responsibility is a special case. When the patients are in the unit they have 24 hour/day monitoring of their activities. Now I have to see the patients once, perhaps twice, a week. They go home with bottles of Tylenol shining in the bathroom cabinet, knives hanging in the kitchen, ropes and rat poison filling the attics and family members sleeping at night. There was the benefit of not having night call, but I sometimes found that I had a hard time sleeping anyway.

Then, in the last week of June of 1999, my sleep was disturbed by a vivid dream. In the dream, I was in a room with my classmates. We were listening to a lecture and there were lines of soft white chalk on the blackboard. In the interval between classes, one of my classmates came in the room to announce that she wanted to transfer a patient to me. This young woman is a tall, charming and intelligent colleague, whom I respect tremendously, so it was with joy and pride that I accepted the transfer. She then began to leave. I asked for details about the case. She turned back and answered, "Actually, I am going to bring her in here." She left the room and, some minutes later, returned with a huge, hairy, black spider in her hand. I looked at the animal and was puzzled by it. My colleague commented, "Now that you know the patient, I will take her back." In distress, I saw her leaving the room and cried, "Can you tell me at least what medication is the patient on?" She turned back and said with an ironic tone, "Do not worry about medication, it is for psychotherapy only!" Needless to say, I woke up in despair.

How could one describe the year? I learned that cliches turn into cliches because they are mostly true. ‘The patient will teach you best,’ ‘listen to your gut feelings, ’ ‘the best way to learn is to do it,’ ‘sometimes doing nothing is doing something,’ ‘never underestimate your patients or their illnesses,’ and I would like to add ‘never underestimate your supervisors.’ Actually, after the patients, my supervisors were the ones who taught me the most. I had the privilege of having three brilliant and experienced supervisors. I would present the same patient and listen to two or three opinions on the case, and this was often helpful.

That year, the resident who appeared in my dream became pregnant. In late May she gave birth to an active and healthy boy. Maybe this is a good metaphor for the year: we started with dreams and fears, and reality gave us hope and life. A baby is a gift to the future; his is the light of the day. The spider is somewhere in darker areas of the mind, spinning its webs and spreading its long legs to smaller prey.

And now it is June once again.