November 2019
Here we are, the end of 2019. Seventeen months into residency. 48 hours off in a row (not a “weekend”, but contiguous time off nevertheless) and feeling inspired to reflect on this crazy journey in some way. If residency has taught me one thing, it’s that our time is immensely valuable, and that the amount of time we dedicate to an activity is a proxy for its relative worth in our lives. Therefore, in the setting of a season of life in which a – one might say – “rather sizeable” proportion of my time is spent in pursuit of professional goals, I thought I would take at least an ounce of the time I have while functionally an insomniac undergoing yet another transition from days to nights to days to reflect on this past year in a way that feels authentic to the intense personal and professional transitions I have undergone while simultaneously spending time on – and therefore assigning value to – intentional reflection.
Without further ado, let’s step right into the thick of it. At the risk of introducing unintentional irony by a sideways nod to Dickens, this year – 2019 – has simultaneously been the best and the worst year of my life. I was recently asked by a friend whether I felt “emotionally equipped” to be a physician. At the time, I believe I gave an unsatisfyingly concise version of “well, yes…most of the time?”. The true answer, upon further reflection, lies somewhere closer to “I’m not sure there is any way of preparing yourself fully for the mental, physical, and, yes, emotional demands of being a resident physician, and yet, nevertheless I am – even in those moments where I feel like anything but”. Much has been written and spoken on both imposterism, burnout, and so-called “moral injury” within medicine. While all of these ideas have considerable analytic utility, and indeed have contextualized my own experiences in deeply substantive ways, none feels as though it fully encapsulates the strange myriad of emotions that may accompany a single day – or even a single hour – of being a resident. So come along with me, if you dare, as I do my best to recount a mere fraction of the tragedies and triumphs of this year.
I shall proceed, as I am wont to do, with anecdote. I could list a series of rotations completed and accolades garnered, but I don’t want to communicate the curriculum vitae version – I want you to know the real version, the version-as-experienced-by-a-human-version. To set the scene: it is July, and I am a freshly minted junior (second-year) resident in the NICU, or neonatal intensive care unit, at BMC: Boston Medical Center, the primary safety net hospital in Boston. I am on a “light” rotation – one in which I have elective time interspersed with a 13-hour night shift every 4th night, which is actually a 25-hour shift if that 4th night falls on Saturday or Sunday. The rub of such a setup is that, as the so-called “cross-covering” resident, I do not know the patients nearly as well as their primary teams do, and miss substantial updates in their clinical progression in the 72-84 hours that transpire between my shifts, which, on a unit in which the duration of the patients’ lives is measured on the order of days to weeks rather than months to years, is not an insubstantial period of time. Indeed, on the night in question, I receive sign-out (a structured part of transitioning care from one healthcare provider to another, in which a summary of the patient is given with a list of to-dos overnight alongside a noble attempt at contingency planning) on twins who, at only 3 days old, are entirely novel to me. These twins were born far too early – for fear of oversharing patient details, I will refrain from sharing just how early – and were consequently, as the gallows humor-infused slang goes, SAS: sick as shit. Scanning down their problem lists (hemodynamically significant patent ductus arteriosus, respiratory distress syndrome, pulmonary hemorrhage, metabolic acidosis, hypernatremia, acute kidney injury, intraventricular hemorrhage, coagulopathy, hyperglycemia, hyperbilirubinemia, concern for sepsis), I become simultaneously aware of both the gravity of their clinical condition and my own nagging fatigue, for it is already 6 PM and I have been at work since 7 AM, when I started gathering data for patients on the nephrology service as part of my elective across town at BCH (Boston Children’s Hospital), an elective on which I wanted to demonstrate dedication given my current career interest in nephrology, and therefore did not take the afternoon off to nap pre-call as many sane humans might opt.
In any case, I muster the requisite energy and tell myself to focus and enumerate a list of tasks to prioritize my work for each patient for the evening. The work becomes almost comfortingly mechanical:
XX, Twin A
[ ] monitor blood pressures via arterial line, titrate Dopamine PRN (as needed) to maintain MAP (mean arterial pressure) > 30
[ ] follow up 8p blood gas, adjust amplitude PRN for goal pCO2 55-70
[ ] follow up q6h (every 6 hour) electrolytes, adjust total fluids PRN for goal drop in Na by 8-12 over 24 hours
[ ] follow up q1h D-sticks (point of care measurements of blood glucose), adjust insulin PRN to maintain BG (blood glucose) between 120-200.
[ ] follow up 4a bilirubin, stop phototherapy (jaundice treatment) for bili < 5
[ ] monitor neurologic exam closely, low threshold to involve neurosurgery immediately for concern for worsening intraventricular hemorrhage (IVH)
XX, Twin B
[ ] follow up 12a blood gas…and so on.
In retrospect, something was noticeably absent from my to-do list for each of these patients, though at the time triaged away in a frenzy of work: get to know the parents and let them know how their babies are doing. No time for that, there were numbers to follow, lives to save. The night passed as do many nights on call: a sleep-deprived frenzy as events inevitably unfold not exactly as planned and new plans must be derived on the spot from a combination of experience, study, improvisation, and intermittently paging the attending a PG version of “what the hell can we do about this?”. The night is busy, and full of firsts: my first successful intubation (placing a breathing tube into the trachea to facilitate mechanical ventilation), my first time placing an umbilical venous catheter (yes, we use neonates’ belly buttons to get fast access to their circulation), and my first time having a medical student on call with me (both nice to have someone around to share in the work, but also laced with the inevitable awkwardness of trudging through a night shift with a near-stranger). Things are proceeding more or less as usual: a few deliveries, minor adjustments to ventilator settings, drips, and fluids in response to nascent lab changes, a 2 AM caffeine pill as I realize that an all-nighter is almost certainly inevitable (with a concomitant longing for the days in which 200 mg of caffeine would have made me hyper-alert and even jittery, rather than “something resembling basic human functioning”).
Around 4, as I commence a halfhearted shamble towards the call room, hoping that against the odds, I might catch 20 minutes of sleep while awaiting the results of labs drawn at 4 AM, I am paged back to the bedside of one of the twins, who has begun to spurt blood out of his endotracheal tube. Amidst the fogginess, my brain slowly pieces together the pathophysiology: the PDA is open, so blood is rushing straight from the aorta through the pulmonary artery into the lungs, overwhelming the fragile capillaries and filling the delicate, underdeveloped air sacs with blood. Well then, time to use medication, indomethacin, to close the ductus! Except, wait, the patient already has profound kidney injury that indomethacin would simply worsen, not to mention coagulopathy that would only worsen from NSAID use. Surgical ligation? No way, the child was far too fragile. The child’s mean blood pressure is dropping from the 30s into the 20s, even dipping into the teens (and recall that the goal was 30 or above). The extant multisystem organ failure is sure to worsen. Nevertheless, we up-titrate the vasopressor of choice in the NICU, dopamine, and in so doing watch the blood pressure trickle back up to the high 20s. Not ideal, but a band-aid had been placed. I breathe a shallow sigh of relief and reflexively go to update the sign-out – the written document summarizing the events of the evening to update the daytime team. After a moment of doing so, my attending, very appropriately, prompts me that now might be a good time to let the child’s parents know that their baby is on the verge of death. “Oh, yes…” I think to myself. “The parents…”.
I stumble into the mother’s hospital room at that darkest pre-dawn hour of 4 AM, unsure of how best to communicate the gravity of the situation while remaining both professional and compassionate. My attending accompanies me for support, though she appropriately encourages me to play the role residency is designed to facilitate of acting as the primary clinician for the patient, to really be the doctor. I gently shake the mother awake and introduce myself. “¿Se habla español?” Quite conveniently, Sí, yo hablo, though this creates the awkwardness that my attending cannot actually understand what I am communicating to the family and is thereby ill-equipped to step in to offer directives when they might be helpful. Oh well, it wasn’t my first time breaking bad news. I begin by offering that I had difficult news to share, and offer to turn on the light, a request which receives ready assent. I launch in as taught in medical school by asking what the parents know of their child’s condition. “El equipo del día nos dijo que estaba estable, ¿no?” The day team told us that he was stable…right? I then elaborate by communicating that likely what they meant to say was stable for that moment, but stably SAS – excuse me, stably gravely ill. Like, gravely, as in, the grave.
I proceed further, again as coached, by expressing “concern” – “I am concerned that your child’s status is continuing to deteriorate. Things are again somewhat stable, but stable at the cost of significant interventions: medications to support blood pressure, blood transfusions, maximal settings on mechanical ventilation, artificial nutrition, etc. … and I am concerned that his condition may deteriorate further over the course of the evening.”
I pause. A pregnant pause, so comes an intrusive thought. Except wait no, she’s not pregnant, she’s post-partu—RHODES, this is no time for humor as a coping mechanism. Focus. Exude empathy even though you are exhausted beyond belief and feel you have none left to give.
“Have you given any consideration to what you might do if oxygen saturation were to drop so low that his heart stopped beating? We ask because we envision this could happen within the next hours to days. If that were to happen, we could try giving chest compressions and artificial breaths with a bag, but we do not envision that these measures would be helpful, and indeed we anticipate that they would be quite painful and prolong suffering. We will do that if that is in keeping with your wishes, but we want you to know that many loving parents would choose to take out the breathing tube and hold the child in their arms during these last moments, and that may be a choice that does not prolong suffering.”
Here’s to hoping that my sleep-deprived medical Spanish – which allowed me to pass the exam to be a certified bilingual provider but which is nevertheless always and forever a foreign, second language – communicated the above half so eloquently.
“Por ahora, queremos que hagan todo.” For now, we want you to do everything.
An understandable response. I’m not sure I would be able to say much more if a 27-year-old total stranger were speaking to me in heavily accented English at 4 in the morning 3 days after the birth of my premature child.
“We understand. We will keep you updated. Just so you know, this is always an open conversation – we recognize your wishes may change and that there may be a moment in which you feel differently. Just keep communicating with us. I’m sorry. I’m so, so sorry.”
As I walk out of the room, running through my mental checklist yet another time, I sense a vague glimpse of regret that my primary sensation is not empathy, but rather exhaustion. I should care more, this baby is dying, so goes my self-admonishment.
Minutes pass. I check in on Twin A a few more times. Stable, for now. I update the sign-out a bit more. I titrate some more ventilator settings. I obliquely acknowledge the sunrise over the as-yet-quiet thoroughfare of Massachusetts Avenue.
5:45. My pager goes off again. The baby’s MAPs are dropping to the teens again, and oxygen saturation is dipping into the 70s. I page the attending. “What else can we do?” “We can give epinephrine via the endotracheal tube. It will help tamponade the pulmonary hemorrhage…”. We do so. The numbers improve. Another half-sigh. I return to the workroom, finishing updates to sign-out. The day team arrives and notices my obviously harried appearance: “are you OK?” “Well, not exactly – Twin A is in bad shape. I guess let’s start signout, there’s a lot of updates…” How quotidian. Signing out like any other day.
Naturally, just as we have reached the child in question in our discussions of each patient, the charge nurse runs in. We are officially coding the child. This time, I jump in: “you all go to the bedside – I need to go tell the parents what is happening.”
Back in the room, I cut to the chase: “I think it’s important you come back with me. He is very sick, and there’s not much else we can do.”
As dad wheels mom (for few women who are 3 days post-C-section are exactly raring to walk) back to the NICU, my eyes glance down and I can’t help but see what mom is texting to her own mother: “They’re telling me my baby is dying, and that there’s no hope. Jesus Christ, what can I do?”
Indeed. Jesus Christ. What can we do? Oh, that reminds me – would they want a chaplain present? Is that too dramatic? Are they religious? Again, I have known these parents for mere hours. I inquire. They would like a chaplain. I puzzle through the BMC directory listing until I figure out how to page the chaplain on call. I wonder whether there is even a chaplain in the hospital at 6 AM.
Back in the NICU, Twin A’s status has sadly, if predictably, only deteriorated further. There is now a veritable crowd in the corner of the four-bed hospital room: the isolette holding the baby, the baby’s nurse, the charge nurse, another nurse, the respiratory therapist, me, my attending, two medical students, the daytime interns and resident, and now, mom and dad. The mechanical ventilator has been disconnected, and one of the nurses is administering breaths via bag-mask. It strikes me that it is unclear who is in charge, who is in control. “This isn’t how we’re taught codes should operate in simulations,” I ponder. Except, of course – this isn’t a simulation. This is actually happening. And it was clear to me by that point that it didn’t matter much who was in control: there was not much left that could be controlled, even with the best team dynamics.
My attending asks for the first time: “will you ask mom if she wants to take out the tube and hold her baby?”. I ponder whether we should get an interpreter. And add another human to this circus, when I am already certified to communicate in Spanish? Probably not….
I ask. Mom sits in presumably stunned silence. I become grotesquely aware of the blaring of the alarm indicating the child’s vitals are abnormal. I try in vain alongside a nurse to silence the alarms. They override our attempts at silencing, informing us that the child’s vitals are critically abnormal. “MD aware of abnormal vitals,” goes my sardonic inner dialogue. If only this stupid machine would quit making noise, maybe these parents could have a moment to contemplate what’s happening. That is, that the unthinkable is happening. That their child is dying.
My attending prompts again. “Ask mom if she wants to take out the tube.”
Internally: she needs a moment. Let her watch us give heroic efforts for a moment. Let it be. Externally: “Many loving parents…”
Again, silence. That is, silence from mom. The alarms still reverberate shrilly and unhelpfully. Alarm fatigue, indeed.
The chaplain arrives. We bring her up to speed as to the situation. She asks if I will interpret a prayer. I am taken aback, incapable of saying no while simultaneously afraid to say yes and finding my Spanish stonewalled by the likely non-medical vocabulary of a prayer. I say nothing, and she starts speaking in English. After a few sentences, I throw together a hopefully-acceptable-rephrase-paraphrase-rewrite of the prayer as I lay my hand on the mother’s back. I hope she finds this comforting and not intrusive.
My attending prompts a third time: “Ask mom if she wants to take out the tube.”
This time, I speak up: I think she just needs some more time. My attending nods solemnly.
It is now 6:50. Someone – I now forget who – helpfully suggests that everyone leave the room except for essential nursing staff, RT, the chaplain, the night team and the daytime intern and resident whom had taken care of the patient previously. The crowd disperses slightly. The heart rate and oxygen saturation monitors continue their unhelpful whirr.
At last, I ask again. I ask in a somewhat motivated way: “At this point, we are afraid we cannot save his life no matter what we do, and that he may suffer less if you hold him rather than have us continue to push air into his lungs artificially.” “Can I hold him while he is still connected, even for a moment?” “Claro.” Of course.
Finally, with a note of anguish, mom declares: “puede sacar el tubo.” You can take the tube out. The chaplain utters another prayer. Do I translate or do I watch as he dies? I translate. The alarms clang on. We get it, he’s dying. You don’t have to be so gauche about it.
What happened next has been reduced – or stolidly blocked out – into a blur. Traumatic memories are encoded strongly, though erratically. I remember scattered bits: mom’s gentle sobs, the chaplain’s ongoing oration, the alarms’ final silence, the bedside nurse’s furtive glance at me, blithely acknowledging the drama of the evening. Before too long, we leave mom and dad alone. After all, it’s time to finish sign-out.
Moments after finishing sign-out, I text one of the chief residents whom I know best to let her know that there was a death in the NICU – and a bad death, at that. Within moments, multiple of the chiefs have reached out to me, letting me know they are available should I want to talk. No, I assure them, right now I don’t want to talk. Right now, I need to sleep.
I call an Uber in the BMC lobby. I notice obliquely that there is surge pricing, and it will be $21 to get home. Whatever; the privacy is worth $21. I think back to the last time I had to tell a family their child was critically ill – in December, when at sign-out I’d sobbed in front of the entire workroom upon reliving the experience. This time I held it together. Was not crying progress? Or numbness? Unclear.
I text my family and my closest friends, baldly: “a baby died in the NICU last night and it was Really. Bad.” “Are you OK?” “Yes. I mean, no. But like, I’ll process. I just need your support right now.” Insert outpouring of love. “Yes let’s talk soon…I just need to sleep…wanted to tell you now…”
That evening, I board a flight to Indianapolis to make a family reunion. I greet my parents at the airport as I arrive and a sense of normalcy returns: I guess life goes on, after all?
The next morning, my cousins, uncles, and aunts inquire: how’s medical scho—oh wait, residency, Rhodes? Are you still in New Yo—oh no, Boston, right?
“Oh man, residency is certainly a ride. I’m on a tough NICU rotation right now…I’m learning a lot, though! Yeah, Boston is a nice city to live in – definitely easier than New York, but a little less exciting, not that I have that much time for excitement anyway, ha ha…”
Is it passé to bring up a baby dying while sitting poolside in mid-July? Probably. I avoid the subject. I am able to enjoy swimming and water balloons and hot dogs and ping pong without too many intrusive thoughts. Am I coping, or compartmentalizing? When does the adaptiveness start and the mal-adaptiveness begin when we compartmentalize? Should I be unpacking this more? Can I leave the bag packed?
The chiefs very appropriately arrange for a debrief for all medical providers involved in the patient’s care. Naturally, I am post-call (i.e., I have worked for 25 hours in a row) when this debrief happens. It helps, but in the sort of way that shaving through a foggy mirror might help. The general idea is there, but some patches could use a bit more attention.
So as is often the case in residency, I leave the bag mostly packed, thrown in with the remainder of the baggage accumulated over months of vicarious and personal trauma: being yelled at by parents for daring to perform a lumbar puncture on their child while in my first year of residency. Hearing a 16 year-old explain that she had been sexually assaulted but was too afraid to get the police involved. Feeling like not exactly the doctor I’d envisioned I’d be when I resent a 10 PM page regarding a “family who wants an update” because it will add to my already considerable workload for the evening. Having to tell a family that their son might forever have difficulties maintaining erections because he had not sought medical care for an erection lasting longer than 4 hours, which poses a substantial risk of ischemia, or interruption in blood flow, for patients with sickle cell disease, as he had. Enduring verbal abuse for events outside of my control so shrill the ED charge nurse asks me if I want her to call security – “oh actually, I’m just gonna go ahead and call them, just in case.” Feeling so depressed and lonely while on a stretch of nights in January that I briefly contemplated what might happen if I just crossed the road without looking both ways first, only to banish the thought as “derived from contextual depressors and not indicative of how I feel when at my best” then arrive at work minutes later only to admit a patient who had attempted suicide via Tylenol overdose.
Don’t get me wrong, there were plenty of bright patches: some so bright they dazzled. Realizing, in moments of reflection and repose, that just one year into residency, I had already made lifelong friends whom it seemed impossible I had not known for years. Sending them letters saying as much, and my heart growing three sizes larger. Delivering Grand Rounds with a co-resident at the nation’s top ranked children’s hospital while only a first-year resident. Parties where I laughed until I cried and thought how am I so lucky to be surrounded by such truly excellent humans? Workout classes where the endorphins were so potent the world seemed alive with color and vivacity, if only for a few hours. Hosting my sister, her husband, and their kids, whom I had left behind in New York, and realizing oh, I guess this does feel like home now – I am welcoming them into my home! Scoring the same on the final Step of the US Medical Licensing Exam as I had on the first Step, despite studying less than a fourth as much. Securing housing for a mother who’d fled domestic violence in Haiti, and watching as she and her newborn began to thrive as she began a new life here in Boston. Getting a card from two medical students with whom I’d only worked a week stating I was the best teacher they’d ever had. Realizing mid-way through stretch of nights in March, as I churned through 7 admissions like clockwork and was asleep by 2 AM, that for many conditions I could actually come up with a plan without asking anyone, and a solid one at that.
And so progressed junior year. In a moment of relative repose in August, I branched out and made *gasp* new friends outside of residency. One such friend, and yes you know who you are, literally gave me a free 3 hour sailing lesson on the Boston Harbor upon first meeting. What?!I went on several dates – inevitably short-lived, but nevertheless an intermittent reminder: “oh, you are desirable!” “oh, there’s a life outside of the hospital!” “Oh, you can be charming and witty and silly and play the trombone and dance your pants off to 90’s music, and still be a doctor.” I go on a date with a dude who’d flirted with me from across the country on Instagram for several months, and it’s actually not awkward (but when, two weeks later, he told me he was starting to see someone else, the awkwardness escalated – let’s just say we haven’t talked since August). I actually made it to that posh peninsula known as Cape Cod and realized that yes, there is a gay mecca in New England and yes, its name is Provincetown. I go on a date with another dude who turns out to be a staunch Republican (which I conveniently realize far before falling for him) and while our voices briefly escalate to an inappropriate-for-indoor-dining clamor, I (we?) ultimately de-escalate the situation and end up leaving the date with a hug (if more polite than genuine, a hug nevertheless). I venture out and see friends in new contexts – Denver and Princeton – and realize that long-distance friendships are possible when there’s a genuine bond there: and Julia and Carrie, I know you know we are friends forever.
And professionally, things continued with the strange admixture of fulfillment, confusion, satisfaction, and stress as always: I take care of a patient who has a first psychotic break while admitted to the hospital for a vaso-occlusive pain episode from sickle cell disease, and he threatens me for requesting to obtain additional labs (“You could get jumped for that”). I get such high unsolicited praise from supervisors for how I handled that situation that I nearly want to crawl in a hole for how exaggerated it seems. (Why can I believe the negative but invariably discount the positive?). I spend nights staring into the computer in a call room, lonely, watching the minutes tick by while wondering “was medicine the right choice? Is this all really worth it?” I then make it to sign-out and leave each day buttressed by hugs and laughter as we recount the travails of the evening and think, well now, how the hell else would I have access to experiences like that? I feel stressed out of my mind attempting to stay afloat amidst the complex medicine that is bone marrow transplantation, and again get such nice feedback it’s uncomfortable – “Rhodes, you’re so good! What do you want to do again? Oncology needs you!” “I hope you feel like an essential member of this team – because you are.”
And yes, here we are again, it is October, and another child is critically ill. This time, not a neonate, but rather a teenager whose body had been ravaged first by cancer, then by cancer treatment, then by a second cancer developing from her cancer treatment, then by a bone marrow transplant, including “conditioning” which is less like jogging three times a week before the sports season starts in earnest and more like destroying half the cells in your body in an effort to clear out the immune system so that you can get someone else’s in its place, then by such bad liver disease her kidneys fail, then by an attack of her new immune system on her old body causing massive bleeding in her gut, then by unexplained brain bleeds, then by worsening fevers and worsening heart rates, then by a second recurrence of cancer, and finally, a family meeting in which I see bad news broken in such expert fashion I can hardly choke back tears: “Before we go any further, I just want to make sure we are on the same page. Your daughter is sick. Very sick. Sick to the point that even if recurrence of cancer were not on the table, I’m afraid she will never make it out of the hospital alive. So while we are happy to pursue a bone marrow biopsy to further stage this cancer if that is in keeping with your wishes, I have to communicate that any therapy we could offer would not, at this stage, be curative. It would be palliative.”
Silence falls, as do tears. “I just want her to be able to see her dog again before she dies.” “Well technically dogs are not allowed on the unit, but…well, is it a small dog? Yes? Well in that case…I think she should see her dog again.”
That evening, in the setting of worsening respiratory status, we call the ICU to evaluate her for need for transfer for the third time in three days. This time, her condition has deteriorated to such an extent that this is necessary, and I must sign her case out – a project that takes a mere 15 minutes.
Before leaving at 7 PM that evening, her nurse for the day stops by my workroom: “you did a really good job caring for her today. You should be proud.” Proud? But she’s dying! Nevertheless, I manage to grab a few hours of sleep on call that evening, now that my sickest patient is in the ICU, and I am not.
I return Monday to find her name has greyed out on our patient list – a designation normally associated with discharge from the hospital to home. In her case, the terminology was different: “discharged as deceased”. Even death has its bureaucratic flair.
Yet again, the complexities wash forth: days ago, I had spent hours perseverating about each detail of her care and coordinating multiple consultants to engage the multiple interlaced aspects of her diseases: nephrologists, hepatologists, general gastroenterologists, neurologists, surgeons, endocrinologists, and, of course, us, her oncologists. I watched the oncology and nephrology fellow argue passionately about the need for daily dialysis mere days before.
And now, there was no arguing left to be had. There was no anything left to be had. Maybe this one wouldn’t have hit so hard if I hadn’t seen pictures from her father’s iPhone of her just before her diagnosis on the same day we had the family meeting: a body ravaged over the course of two short years, unfair, unspeakable, yet…grim reality.
I return to the emergency room the very next evening and am again inundated with a breadth of human experience, often simultaneously: suicidal teenagers next to colic-y babies next to a young adult who lapsed into a fatal arrythmia while on a run only to be shocked back to life by her implantable cardioverter-defibrillator next to a child so unlucky as to have developed new autoimmune hemolytic anemia in the setting of ulcerative colitis and primary sclerosing cholangitis, all by the ripe age of 8.
And then comes the question: do you think you were emotionally prepared for this?
Is there any preparation?
A follow-up: but wait, you can still enjoy your personal life even when work is hard, right?
Yes, and – there’s something about medicine that makes drawing clean boundaries between “work life” and “home life” difficult. When you traffic in the health and the actual lives of other humans, it’s hard to just shut that off when you sign out and submit your last note. You can stack that baggage awfully high into the designated compartment, but eventually you have to sort it through and just Marie Kondo your way into finding what brings you joy by acknowledging, accepting, and thanking the parts that don’t, then moving beyond them.
And so this reflection – a letter to no one and to everyone all at once, a letter to myself and to my community – is an effort at doing just that. I don’t desire pity – or praise. I merely desire to be heard. Because amidst all the medications and randomized controlled trials and evidence-based practice, it’s easy to forget that sometimes the most therapeutic tool we have is our ability to lend a patient, listening ear. Indeed, I distinctly remember commiserating with an attending in the emergency room a few nights ago that we “hadn’t really helped anyone we’d seen that night” – not in the strict medical sense of helping with specific disease-targeted therapy, that is. Yet as I went to discharge the last family from the ED, a family for whom we’d simply provided reassurance that having one episode of vomiting after eating a bunch of Halloween candy was no, probably not an intra-abdominal emergency, the grandmother remarks “now I’m glad we came here! Y’all were helpful!”
We were? But what did we do? Our plan was just reassurance!
In the end, it would seem, we listened. And that was what made the difference.
Thank you for listening.
Dr. Rhodes Hambrick 