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


Most of All


Audry Hepburn



He’s got it right, the friend who wrote
about a woman wearing a man’s shirt,
the way she can pull his scent to her
and feel his arms around her again.
I think a man likes to see a woman
dressed in his shirt: the sleeves
dangling and the buttons and holes
that go together backwards, the stupid
grin on his face when she tells him
she’s going to pee, and he asks to watch.
She wraps the shirt more tightly
tries to fit her body into every
stitch and seam. She likes the way
the shirt holds her, so soft and so manlike:
that, and the sigh of his breath
in every thread, Yes, that most of all.

Karla Huston, Wisconsin poet


Shadow Cookies

Black night, sliver of moon making
no promise.
The small sliver, barely noticed by humans sheltered in their homes. If it seeps into their field of vision, they may glance from their heated hibernation.
Tell a stranger on the street to look up at the moon and they will curl a perplexed, patronizing brow for your unsolicited order. For the moon misses nothing, and holds it’s secrets tight.

Others are more than mere gawkers. They brave the cold to make a visit to the moon. Even when it appears the moon has turned it’s back. They intrude, not allowing for withdrawal
and silence.
They love, no matter if the object of their love is constantly changing. And they get little in return. And are often ignored and pushed away. Their egoless selves keep coming back.

And then, out of the darkness,
a crescendo of light flows back into
the empty sphere.
With each day, pieces of shadowed crevices are bathed in a silver glow.

The full moon, the ‘grande dame’ receives the highest of praises.
Bright, fearless and unflappable;
the delusion of perfection.
Seeing the earth below and
Shedding light onto remote
sacred spaces.
To continue on, to surrender control,
recognizing its weightless suspension in space as an opportunity to explore.

– Anne Koplin