The Weight of Medicine

I have a confession to make: I sometimes look forward to my trips to the bathroom at work. Being a busy pediatrician, it can be the only alone time I get to myself; and on occasion you just need a quiet place where babies aren't crying and phones aren't ringing. The other day as I was leaving the bathroom and returning to the bustling clinic, I did something strange. I knocked on the door before I exited the bathroom. It has become so much a part of my routine to knock on doors as I enter rooms that my brain apparently now knocks on doors as a reflex of sort. Luckily, no one saw me do this, and I left the bathroom pretending to have done nothing abnormal.


While the aforementioned story is obviously light-hearted, much of healthcare is not. Practicing medicine is rigorous; it consumes the person that you are in many ways. What is often overlooked in medicine is the emotional heft of dealing with hardship that the doctor himself or herself experiences. A doctor, nurse, or anyone involved in the healthcare of people is often at the eye of the proverbial storm.
San Diego at Sunset- Photo by Me!
I remember a blistery winter day while I was in medical school in Ohio. The snow covered the streets and I felt lucky to be on my obstetrics rotation in the warmth of the hospital, where I wasn't paying the heating bill. Suddenly the senior resident said we had to run down to the ER for an emergency. The moments that followed have never left my memory. A pregnant mother had gotten in an automobile accident and her car flipped several times. She was rushed to the ER and in front of my anxious eyes and racing heart, the medical team tried to resuscitate her and her baby. Neither of them made it past that ill-fated day. An hour later I was there to witness the moment that the father of the baby learned of the tragic news in the trauma bay. I will never forget the sound of his scream as his body went limp and fell to the hospital floor.


Unfortunately there are many more of these memories that haunt me. My journey in pediatrics has been lit by the laughter of children, but the moments where they cry or suffer bear a turbulent burden on my soul. Nobody really teaches a physician how to deal with the emotional consequences of being involved in such poignant moments. I know that personally my emotional gas tank only holds so much fuel. There are days after work where I seem like a zombie to my friends and family. Occasionally in the midst of my day, I find myself being warm and friendly with my patients and their families, but rather cold and removed in my relations with the office staff.
Flowers- Photo by Me!
I certainly don't mean to treat anyone poorly in my personal life. However, trying to calm everyone’s worries is more draining than I would have imagined. Some days I have 40-50 different patient encounters of various kinds, and each of these requires me to be emotionally available. In the process of training to become a physician we are rigorously instructed to have the tools to weather the storm (i.e. diagnose and treat conditions). Sadly, we are poorly taught on how to keep ourselves afloat after the storm has passed.


Medicine is a grind on the heart. We need more resources available to physicians and healthcare employees to ensure that the ones giving treatment are being treated themselves. It is also vital to create a culture where seeking help in dealing with the emotional toll of medicine is encouraged, and not looked down upon. Many doctors (myself included) are too stubborn to seek out such therapy, because we are trained to see ourselves in the provider role, and don't quite understand how to be patients.
I love lamp- Photo by Me!
I don't want to suggest that I've gained some kind of privileged understanding of all the moments I have encountered as a doctor. In fact, I don't know if I ever will fully comprehend the seemingly random events that make up our lives. I do know however that I am not ashamed to admit that these encounters affect me and shape the person I am. They lead me to laugh at myself when I knock on a bathroom door, and to shed a tear when tragedy unfolds. Hopefully, they will also lead me to a better understanding of myself and everyone else who touches my life in one way or another.  

There's a lot I've not forgotten
I let go of other things
If I tried they'd probably be

Hard to find
The National "Hard to Find"

Comments

  1. Awesome blog! Great work!

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  2. Well said. I have been surprised to learn from our colleagues in the mental health fields just how much support and training they get in how to deal with the toll that their field takes on them. Imagine, getting training on boundaries, instead of just being told "you can't let it get to you." I've spent a lot of money on counseling to learn how to maintain some measure of sanity in this field. Still working on that...

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  3. Great blog; as a fellow pediatrician, I've felt the same thing.

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  4. As a, emergency physician and author with 20 years in busy, high-acuity ERs your post resonated deeply with me. Healthcare providers are involved in so much tragedy and loss. The oft-stated notion that "doctors and nurses get used to it" is fiction. We are impacted emotionally by the blast furnace intensity of what we experience.
    Per our caregiver culture we "tough it out" and keep on going but your comments are truth - we are significantly affected. Accepting the burden is part of what makes our occupations noble - dealing with it in a healthy fashion is something we struggle with. Thanks for sharing your feelings so eloquently. All the best to you!

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  5. I have inculcated to my 5 sons that NO job is worth dying for/from despite the pay.
    Reading the emails and blogs about burnout caused me to write this note.
    Having a high-paying government job was initially satisfying. Then the stress from the Energy Vampires mounted. I came home exhausted. They had sucked the life out of me. 15 “chief complaints” at each visit is intolerable. The disingenuous games by the drug seekers burned important time keeping up with my electronic charting.
    One of the final “acts” of the bureaucracy had me decide not to renew the lucrative job.
    I got a communication from the Diabetic Monitoring RN that my patient had an A1c level over 9 for more than 90 days. A WRITTEN response was DEMANDED. There were at least 11 executives who were cc’d.
    My explanation was “I am unable to attend the dining table of ALL my noncompliant patients with diabetes. I am open to advice on controlling a 420 pound man who has no desire to lose weight.”
    I now make much less. I do telemedicine from home. My wife was 7 months’ pregnant at contract end. We have an 8 month precious little girl and another due in April 2016.
    The monthly schedule requires my availability from 3-11 LOCAL time 12 days a month.
    Always in a good mood. My girls always within sightl

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  6. I am glad I came upon your blog through my Twitter feed today. I appreciate reading a piece such as yours, written by a physician infused with humanity. I am a family physician and blogger with a significant interest in physician health and actually work in a physician health program. I really believe in changing the culture of medicine that you speak of where we support one another through the difficult times in the practice of medicine and life.

    Thanks for sharing!

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  7. Totally understand what you are saying and I wish more people would listen.
    I had taken a far more blunt approach a few months back and eventually ended up on BBC for it :) People need to stop seeing doctors as magicians and realise that we are just normal human beings like everyone else. We do our best but we are not Gods...
    http://www.godyears.net/2015/05/why-i-will-never-allow-my-child-to.html

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  8. This so struck a chord with me. I'm a practising paediatrician too and I so totally get your need for that bathroom break where there are no phones ringing or babies crying��. We really are taught to deal with the storm but learning to keep afloat AFTER the storm is also equally important and somewhere along the line we have to learn to do this so we can recharge and come back to 100% for ourselves and our patients.

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