May 31, 2019
A few weeks ago I shared a stories of emotional exhaustion. Call it what you want: fatigue, burnout, depression, nonspecific cynicism, the take-away is the same – a whole lot of nothing where there was once light, once magic, once music, once creativity in its truest sense – a drive to create, to generate, to make more life where there was once none.
As I now sit on the bus from Boston to NYC today, on May 31, 2019 – exactly one year from when I drove my hopeful and comparatively naïve self from NYC to Boston to begin residency – I am confronted now with the strange and invigorating experience of having several emotions. This turn of events was likely multifactorial in its genesis – actually having the same sleep-wake cycle for a few weeks in a row, seasonal depressive disorder going into remission during the brief months of light that a nascent Boston summer provide, a recent Memorial Day Weekend so pervaded with friends and family I nearly burst from gratitude, actually feeling something remotely resembling a sense of mastery in primary care clinic yesterday when I saw 5 patients and finished all my documentation within 2.5 hours had a preceptor who didn’t micro-manage my plans, the prospect of reuniting with old friends this weekend in the city…I could go on.
Regardless, this moment of being in better touch with Rhodes-as-a-whole-human in the place of Rhodes-the-efficient-resident-automaton has given me a moment to reflect that as much as complaining and venting and whining are cathartic, necessary, and OH SO JUSTIFIED, there is some truth to the principle that finding space for intentionality in gratitude can be rejuvenating and improve your outlook, even amidst the bleakness, the exhaustion, the 3 AM FYI page about normal vitals, the six-years-of-life-lost-at-least-according-to-your-telomeres slog that we’re 12/13ths through enduring.
The stories that follow are my own, but I know I am not unique in having done more than I ever could have imagined for and with patients and co-residents throughout my first year in residency.
When I started intern year, I hardly knew what OTC deficiency was – somewhere in the cobwebs of my step 1 knowledge I knew it had something to do with the urea cycle, but would have been hard pressed to know what the hell to do if I had a patient’s ammonia come back at 95 right before morning rounds, other than, perhaps, gently excuse myself to go to the bathroom to wipe the sweat off my brow from the ensuing panic attack. Fast forward to October, when suddenly in this exact scenario I don’t blink twice, call the bedside nurse to check on the patient’s mental status and advise her to switch to no-protein feeds while getting some D10 around for extra anabolism “just in case”, and FYI page metabolism to see if they have any additional thoughts. What the hell? Wasn’t my crippling impostor syndrome supposed to prevent such competence?
Two weeks later, I find myself sharing in excited Spanish the news that at last, a liver has become available, that a cure – or, at least, the replacement of one disease for a more manageable condition – is within reach. The next day I am scrambling into scrubs right after rounds, dashing down to the 3rd floor, eager to watch as this precious patient, my daily responsibility for the past month, has a new liver sewn into his tiny abdomen, granting him a life free from the prison of unending hospitalizations for hyperammonemic crises. I was, obviously, far from the only provider responsible for this triumph. Yet if I deny myself a sense of satisfaction from the fruits of my daily labor out of a sense of misbegotten humility or insidious imposterism, then to what end am I continuing to force myself through this self-flagellating flog of medical training?
Of course, most triumphs are smaller, both in terms of lead time prior to fruition and with regard to their ultimate impact on patients’ lives. Yet triumphs they are, nevertheless.
I hold the hand of a mother as a child is admitted to the ICU step-down unit with his first asthma exacerbation, assuring her in gentle tones that it will be OK, that our treatments for this disease are extraordinarily effective, even as tears of fear and worry splash down her sleep-deprived face while her 3 year-old breathes at 40/min through his continuous albuterol.
I keep a child with acute severe hemolytic anemia from suffering unnecessary treatment with high-dose steroids by asking his mother whether or not he’d eaten any fava beans, and have the unique-and-probably-not-reproducible experience of having the hematology fellow thank me for paging her at 3 in the morning.
I spend hours per day in the room of a patient with severe psychosomatic pain and a functional neurologic disorder, urging her to focus less on the etiology of her pain and more on how she can live despite it, and one day I am told “my brain won’t let me believe you, but I trust you”.
I counsel a young woman with a positive pregnancy test that the decision to attempt to carry the pregnancy to term or have an abortion is hers, and hers alone, and she makes the brave decision to keep the pregnancy notwithstanding the protestations of her husband.
I ask a third time mother at her newborn visit whether she has a preference for her PCP, and she asks “are you an option? I felt like you listened to me”.
I watch a child with a new diagnosis of multiple sclerosis regains his ability to walk as the pulse doses of methylprednisolone mark out their anti-inflammatory crusade.
I shed tears of joy as I witness the gradual filling in of the cheeks of a young girl with multiple autoimmune endocrinopathies as she receives ever-more-appropriate doses of insulin and regains the energy to make music and enjoy simple pleasures even amidst an impossible burden of care and a problem list longer than any pre-teen should ever endure.
I advocate for an urgent echocardiogram for a patient with diffuse body swelling months after a repaired TGA, and facilitate an urgent ICU transfer for the acute decompensated heart failure that this study discloses.
I break the news to a family in the ED that we are concerned about a serious condition known as aplastic anemia, and will be invoking the input of hematologists, later sustaining this relationship throughout inevitable ensuing admissions for fever and neutropenia.
I round on the day of discharge for a child with relatively minor bronchiolitis, then am mildly taken aback when the mom asks to have a picture with the medical team that saved her child’s life.
I spend countless sleepless nights in the NICU worrying about the fluid balance and sedation wean for twins with severe lung disease of prematurity, then months later exchange a simple smile of recognition and joy with their mother as she wheels her infants, alive and well in room air, to routine follow-up with their pediatrician.
I find 15 minutes a day for teaching while on a busy sub-specialty rotation, and a week later I arrive at work to find a handmade card of gratitude for my prioritizing medical student education.
I counsel a young woman with chronic back pain that her pain is likely related to her weight, and is certainly not a neurologic emergency, and she sheds tears of gratitude and relief rather than anger of frustration.
I could go on, but that’s not the point. Or maybe – that is exactly the point. I don’t mean to be Polyanna. I don’t mean to invalidate suffering. I don’t for a second take back a word of what I said in my previous reflection. At the same time, in reflecting on how beautiful that opportunity was for us to bond over shared trauma, I also wonder if we might benefit from persistent efforts to reflect on our triumphs, not merely our stressors?
Dr. Rhodes Hambrick 