Shredding the past

At the beginning of each calendar year, I perform a somewhat sad ritual that I have been carrying out since 2015. That was the year at the end of which I retired from the practice of psychiatry, although the timing of that milestone actually had no direct bearing on this activity. In fact, in a sense, the activity could be traced back to 1994.

What I am referring to is the disposal of medical records of one's private patients. Upon completion of my psychiatric residency in 1984, I undertook to maintain a small private practice. Initially, I saw individuals of all ages, from pre-school to seniors, in rented office quarters. I did all my own record-keeping and my wife helped with scheduling, paperwork and billing, for which she was paid as an office manager.

I had left private practice, my own patients, when I moved from Brandon, Manitoba  to Richmond, BC, in 2005. The Manitoba college of physicians and surgeons rules indicate that one must keep one's records for 10 years from the last date the patient was seen, hence the ritual's beginning in 2015, as 10 years earlier, it was when I last saw private patients. This is not quite as simple as it sounds, as patients who were of the age of minority, which was under 18 in Manitoba at the time, are required to have their files kept for 12 years from the time they turn 18. This means, for example, that if I saw a five year old patient in 2005, which was entirely possible, I would have to keep their records for 12 years after they turned 18. This imaginary patient of 2005, a five year old, would turn 18 in 2018. I would therefore need to keep his or her records until 12 years after that date, namely, 2030, which is still seven years from the time of this rating. I will be 83 at the time, if I am still living.

Some physicians appear to have kept some of their records to use as a basis for stories about their patients. Somehow, I never got into that, perhaps because I thought, in retrospect, possibly wrongly, I did not have very amazing stories of general interest to tell. I could still provide some brief vignettes from memory of a few of my patients, but other than perhaps some general interest, I am not sure that there would be much benefit in their brevity for anyone wanting to learn anything of psychology or mental health, let alone psychiatry.

At the beginning of this year, 2023, when I retrieved the files, which were due to be destroyed presently, I came across a forgotten stack of artwork that had been done by some of my young patients. I believe it was as part of a day program and not that they were my individual patients, although they probably were, for me to have kept that artwork as part of my private records. Most of the drawings, done with pencil, pen, marker, or pencil crayon, were on large sheets, sections of EEG tracing paper (I was obviously into recycling). My little patients put their names on these documents, so I know that they were created by Shayna, Jamie, Jessica, Nathan, Cory, David Drakeley, and possibly Steven Drakeley and maybe yet another David, with some possibly being drawn by a girl named Cylina.

I would not say that I had by any means trained adequately in interpretation of these drawings, but I had some exposure to this method of analysis in my training. Given my own interest and ability in art, I did therefore find it interesting to see what these young students drew, and wrote, and what that might indicate about the dynamic forces at work within their short lives; struggles that I could try to help them address.

In the first place, when considering these drawings, one must keep in mind the context. As such, there are some common elements in them. These were drawn in the late 1990s and early 2000s. One of the recurring sketches is of video games. This is clear both from drawings of such entertainment centres, sometimes named, sometimes accompanied by drawings of screens with pictures on them that came from the games. It was also a time when the manga art form was introduced to video games and comics for the youngsters in America, coming from Japan. Some of the drawings of some of the students reflected that influence. Another theme that surfaced was the drawing of schools, which were sometimes named. School personnel, such as the principal, we're also sometimes identified. Not surprisingly, since most, if not all of these patients would've had difficulty in school, and perhaps even have been referred by the school, causing a disruption in their ‘normal’ school year trajectory, there is considerable conflict around the inclusion of schools in their drawings. Needless to say then, some of this refers to drawings of violence directed towards the school, such as the use of weapons against it, fires being set requiring the attendance of fire engines and emergency vehicles. There are also drawings of swat teams and their instruments, including helicopters, attacking the schools. This obviously shows again the influence of video games, possibly cartoons, or even movies. Some of the drawings also depict violence between individuals, including perhaps, between some of the students themselves. Some of the drawings depict homes and family members,  often pictured standing in a row, identified by position when it came to the parents, but names for siblings. For the most part, there is little scenery, other than a nod at the sun in the corner of some drawings, and really little of a positive nature. This should not be surprising, given the artists and their lives. I do not remember anymore, whether the patients were given free reign as to what to draw or, more likely,  instructions to draw the things that were of current significance or bothered them in their lives. If the latter were the case, that would go further in explaining what surfaced in their drawings.

I have retained the looseleaf binders of the databases of all the patients I have seen. I hope to be able to go through them to identify these patients that I have named so that I can perhaps have some more background to add to the interpretations I might wish to make over their individual drawings. 

In any case, this is the time of year, when the files of those patients, whose ages meet the criteria for disposal, are shredded. Through the shredder are pulled stacks of documents, 1-3 sheets at a time for my home shredder, making this a somewhat tediously drawn out and time consuming practice. The pile of papers can easily top 6 inches in depth now and would have been much higher in earlier years, reflecting the care of adults whose I sometimes saw for lengthy periods of time. These files include, of course, referral letters, databases of patients’ demographic information, consultation and follow up notes, reports from schools and other agencies, including assessment instruments, ranging from those used to assess, for example, attention deficit hyperactivity disorder, to psychological assessments of intelligence and ability such as Wechsler Intelligence Scales. Knowing that records are one's best friend when it comes to any trouble, particularly legal, related to practice, I also religiously stapled to my progress notes any notes made on the basis of phone calls from physicians, family members, involved personnel, and other agencies such as pharmacies. Many of these pages were stapled together as the result of being a complete report or consultation. This then requires as the first step the removal of all the staples to make it easier for my home shredding machine to do its final and dismissive work. By the time I have finished each year, I have several bags of shredded information to be emptied into the paper recycling dumpsters in the recycling and garbage room of our strata. Then, there is a 12 month wait to repeat the process all over again with a different group of patients, a ritual which I am destined  - doomed? - to continue for another seven years - if I live that long.