1217 Miles

As part of my work as a psychiatrist, I did a stint in Telepsychiatry. This is providing psychiatric care via Skype, to those in need, to individuals who do not have physicians that are easily accessible. Montana, called ‘Big Skype Country’ in jest, is one of those places.  There is a major shortage of physicians there and I was recruited to see patients via computer in an outpatient facility in Montana.

I received my license to practice medicine in Montana after a few months. my laptop was programmed to see patients and made HIPPA compliant (the Health Insurance Portability and Accountability Act, for protecting sensitive patient data). I removed all of my Brett Favre and Green Bay Packer photos from the wall and replaced them with my medical diplomas to serve as a more appropriate Skype backdrop as I sat at my desk at home.

I was skeptical. Would I be able to “connect” with my patients, to recognize all the subtle nuances that are so crucial to diagnose and treat patients? As psychiatrists, we have no blood tests, procedures or sophisticated means to make a diagnosis. We rely on self report, on our own perceptions and clinical judgment.

The experience montanathere was fascinating and I feel like I really made a difference. Instead of driving for 3-4 hours or waiting months for an appointment, they came to me. I wrote this poem to convey my thoughts about my work there.


1217 Miles Between Us


Strangers facing each other
On a screen.
A leap of faith
taken by both sides

Many have never seen
their reflection on a computer screen,
They are reassured.
She is there,
You just cannot touch her.
They talk.
Asked about what they eat,
how they shit and
how they sleep.
Asked about
alcohol and drugs.
work and
They talk and
the barriers of miles fall.

Grizzlies, black bears, floods and spiders.
And ‘green cards’,
their psychiatric diagnosis
a license for medical marijuana.
Extolling the merits
of Mary Jane,
to calm shattered nerves.

In the end of the day
it is love and work.
Love and work.
Not enough of either, or too much work
1217 miles
and yet,
Love and work
unite us
as the central theme.

40 minutes later
we part.
They marvel at the technology,
in their own ability
to open up.
To a total stranger.
Twelve hundred

Written by Anne Koplin, MD


Lung Cancer: A Lonely Place

Ever since I was diagnosed nearly 10 years ago, my life has gained a sense of surrealism. I am not exactly sure how to be. There are few guidelines for those of us who are faced with our own death in such a concrete way. Even before my diagnosis, as the daughter of a holocaust survivor and a mother who died within four months of her lung cancer diagnosis, I already understood the urgency of enjoying life to the fullest.

I worked hard and played harder. As a doctor, I never felt the need to measure my worth by my income. I refused to work like crazy, to be seduced by the money I could make by squeezing more and more patients into my schedule. I passionately traveled the world, absorbed different cultures and tried to bring a sense of connection to whatever room I entered.

Now, when I head out the door, I know that friends and acquaintances will scrutinize me, looking for signs that things are changing. Does she look tired? Has she lost weight? How are you doing?  Then they can report to others that they saw me and give their analysis.anne looking into future

I am 58 and surrounded by people complaining about this and that; peri-menopausal woes in particular, insomnia, weight gain, back pain, wrinkles. Admittedly I have little tolerance for those benign concerns these days. As time since my diagnosis grows longer, I may also join them in worrying about these things, thinking at times “hey, I’ve lived this long, maybe I should try botox?” Stress about aging is a lovely, welcome luxury. Nothing compares to a spot on a chest x-ray, a lump in the breast, a suspicious mole.

Lung cancer is a tough one. It isn’t breast cancer with a massive support system, pink ribbons, tons of research money. Is it because it’s a boob thing? When it comes to lung cancer patients, survivors are few. Early detection and treatment options are not even close to those available for breast cancer patients. Almost everyone knows someone who died the painful, horrifying death that is associated with lung cancer. In Dr. Christine Northup’s best selling book on women’s health, lung cancer does not even appear in the index, while it is the number-one cancer killer among women  – more than all of the reproductive cancers combined. The number is rising, particularly among non-smokers. I wrote a letter to Dr. Northup, noting this serious omission, but predictably never received a response.

Our society is built on planning; we are penalized with high fares if we decide last minute to hop on a plane. We work and work to save for the future. We live with the delusion that we have the luxury of putting things off. When I retire, when the children leave, when I can get a bigger pension, whatever it is. ‘Save the Date’ notices appear more than 6 months before an event. All I can say is that I don’t buy green bananas.

Since my diagnosis, I understand that the future is now. I wake up every morning and first try to shake off the post-traumatic thoughts of my illness and months of treatment. I know each day is a challenge, trying to be ‘normal’ when nothing is normal anymore. I am grateful to wake up, to delight in the achievements of my children, to continue to explore the world as long as I can. I feel empowered to call others out on actions I find hurtful. I have a stronger voice.

I can begin my lifelong dream to write, and although I never imagined I’d be writing about this, I may never write about it again. This marks the start of that dream.


1*ngSya_x-boD9SlUupI0-kA“Your present circumstances don’t determine where you can go; they merely determine where you start.”

Nibo Qubein