Sara Yacoubian

Medical Profile - Mike Tomaszaewics

November 8, 2016

Psychiatrists and practitioners typically have contingency plans for medical or mental

health emergencies, but few have one prepared for when the Russians attack. Michal

Jan Tomaszewics creates one for all of his patients.

Of course, Tomaszewics does not really mean the Russians will attack - this is his

version of Paul Reveres The British are coming! This foresight is unrelated to his

Polish heritage, but rather a nod to tension between the United States and Russia in

relation to Syria. Tomaszewics treats this as a way to keep his patients attuned to

reality: the idea being that a patients personal apocalypse could occur at a moments

notice.

Tomaszewics does not like to prepare people for the worst, but its part of his job

description. As a psychiatric nurse practitioner, he often handles patients at their worst

and extinguishes emotional fires.

For many of my patients, things are under control until they are not, Tomaszewics

says. He diagnosed himself with Attention Deficit Hyperactive Disorder 10 years ago,

citing the birth of his twin sons as a personal apocalypse.

I had never been more disorganized in my life. I couldnt read; I couldnt finish

things. Directions constantly changed, he admitted. In his clinical rotations, he noticed

Yacoubian
Medical Profile - Mike Tomaszaewics
2

other people with ADHD and identified strongly with them. This empathy proved

advantageous later in his career.

One of Tomaszewics assets that doctors frequently miss is his understanding that

people can be completely functional until something in their lives changes; at that point,

anxiety, ADHD, depression, or other mental illnesses can put an end to coping

mechanisms that formerly worked for patients. He is no exception.

Despite his ADHD and self-proclaimed disorganized nature, the lack of papers or

coffee cup stains on tables show a meticulous nature that many doctors lack. His office,

part of Serene Minds LLC in Wilmington, Delaware, has few frills to perpetuate a

calming environment. He and his business partner, Sandeep Gupta, try to avoid

overstimulating patients while keeping the office from feeling too sterile, unlike their

former space in the emergency psychiatric ward at Christiana Care Health Systems.

Tomaszewics recalls his time at Christiana Care as favorable and fast-paced, but he

says the stress felt taxing at times. He is no stranger to difficult situations; having

emigrated from Poland to the United States at the age of 29, he understands trying

times, both in professional and personal life.

Tomaszewics found assimilation and steady job acquisition difficult, despite being

two years away from receiving his MD while living in Poland. He faced homelessness

twice, but he was able to get back on his feet with the help of colleagues and a job as a

nursing assistant. At that point, he elected to get more schooling. After acquiring a

bachelors in nursing from the University of Delaware, Tomaszewics attended the

Yacoubian
Medical Profile - Mike Tomaszaewics
3

University of Pennsylvania to earn a masters in healthcare and business administration

from the Wharton School.

Despite the prestigious nature of the Wharton School, Tomaszewics said this degree

didnt open any doors for him. It soon became evident that he needed to create a job

for himself rather than rely on someone else to hire him.

There is a lot of bias because of my accent. Being foreign damages his credibility

with potential employers, and being a nurse practitioner instead of an MD makes his

case even worse, he said. Moving from Christiana Care to Serene Minds ended up

being the boost his career needed.

Penny Zappacosta, who also works at Serene Minds, says that there is little

difference between Tomaszewics and Guptas professional experiences and abilities to

treat patients. The pair met as colleagues, after all, and Zappacosta notes Tomaszewics

can perform all of the same services despite his different medical background.

Tomaszewics notes some differences in schooling between himself and Gupta,

aside from the degrees and titles. As a nurse practitioner, Tomaszewics admits he

knows less about balancing mental health treatment with physical ailments - something

he insists MDs have more experience doing. He also struggles to treat patients who

suffer from chronic conditions and are almost completely out of options in terms of

medication.

At this point, I feel like I know almost all there is to know about psychiatry, but

medical problems are different, he said, I medicate and believe every single time that I
Yacoubian
Medical Profile - Mike Tomaszaewics
4

will provide some change for the better for my patients. He takes the idea of do no

harm very seriously; neutral measures are not a solution.

For patients who have had limited success in past mental health treatments,

Tomaszewics tries to convince them to try again and trust him; trust is an issue for

many people who consider nurse practitioners to have less experience or training than

MDs, so he is careful to explain his treatment rationale whenever deciding on a

treatment plan.

If peoples sleep is off, something else will be off too. Some symptoms will fade if

sleep is back in order. His treatment plans are holistic in terms of mental health, but

Tomaszewics often elects to treat insomnia or sleep deprivation first.

You be with me, he often says to patients before explaining his rationale for a

treatment process. This phrase is often repeated as encouragement or a note to get

back on track and focus on practical solutions rather than the looming mental illnesses.

It is used as a way to talk patients off of cliffs or shift their attention back to what

matters: health. After tackling sleep problems, he generally asks the patient to decide

what hinders them the most.

While the linearity of this tactic seems logical, Tomaszewics says that it has its

issues as well; he cites exaggeration and objectivity as roadblocks to determining what

is actually best for a patient. He recalls a patient who was insistent that he had

Obsessive Compulsive Disorder but actually had severe anxiety. Tomaszewics says it

can be difficult to look past patients desperation for assistance and remain distant, and

that case is a prime example of such.

Yacoubian
Medical Profile - Mike Tomaszaewics
5

Another issue Tomaszewics encounters is patients who come to his practice seeking

drugs. While the bulk of his patients do have real mental illnesses, he says he has to be

prudent of those who will treat him as a pill pusher, especially since he lacks an MD.

Most of the time, he can see through the act; Tomaszewics has the rare and coveted

ability to say no when patients come in and demand certain drugs.

Sometimes the demands are legitimate, especially with patients who changed

providers for insurance purposes or other concerns, but he worries about anti-anxiety

and ADHD stimulants falling into the wrong hands. This goes back to his concerns

related to objectivity: how does he know when and how to say no?

Tomaszewics says he has seen over 400 patients in his career, and he has only felt

that he made the wrong choice regarding care twice - both of which he attributes to

clinical calculators that help convert doses between two different medications.

I just called them and told them I changed their prescriptions. I had to explain

myself and what went wrong, Tomaszewics said, adding that honesty is the most

beneficial route for both his reputation and the patients health.

Tomaszewics honesty and tact are what keep his patients coming back. When he

enters the waiting room to greet them, their eyes illuminate considerably; their

practitioner can act as their guide in the midst of confusing mental illnesses and learning

disabilities. Despite having a lesser educational degree according to some,

Tomaszewics feels qualified to prepare his patients for any and all obstacles - even the

Russians.

####