• I’ll Sleep When I’m Dead

I'll Sleep When I'm Dead

~ writing my way through motherhood, doctorhood, post-PTSDhood and autism. sleeping very little.

Tag Archives: residency

addicted

12 Tuesday Apr 2022

Posted by elizabethspaardo in addiction, autism, Catholicism, christianity, empathy, kids, residency, Sin

≈ Leave a comment

Tags

addiction, autism, beauty, children, death, empathy, fallen world, joy, laughter, love, medicine, original sin, Possibility, religion, residency, silence, trauma, true love, truth, viktor frankl

all of my patients are physically dependent on opioids. ICD 10 F11.20. some of them are addicted to opioids. a lot of them aren’t.

maybe you’re physically dependent on something. for which there is no ICD 10 code. caffeine, zoloft, dopamine, adrenaline. maybe you’re addicted. coffee, zoloft, social media, shopping, toxic relationships, speeding, gossip, little debbie Christmas tree cakes, work, success, sex, HGTV.

maybe you think I’m being cute. or metaphorical. just making a point. no one goes to rehab for gossip addiction (maybe they should). no one goes to jail for possession of little debbie Christmas tree cakes (maybe no one should go to jail for possession of anything. maybe the jails are a crime)

addiction is an escape from the pain of being human. being human is more painful for some than others. but it is painful for all of us. and if someone tells you it isn’t, that is because they are so deep in their addiction, they have lost touch entirely.

eve and adam ate that apple and it all went to shit, you see. our eyes were opened and sickness and pain and toil entered the stage. we all fell down, down, down. and ever since, we have very logically sought to numb the pain of it. because there is no way up, up, up. not in this life anyway.

we are afraid. to hope, to love, to ask for love, to speak our truth, to share our pain, to need or be needed, to want or be wanted. we are afraid to take up space and that we might disappear, to be silenced and to be heard, to be alone and that we might make a genuine connection. we are afraid we are unlovable and that to be loved would be the most unbearable pain imaginable. or perhaps, worse than that, ecstasy.

in addiction we connect with other people. no we don’t. we are with people and we are less lonely and so we think we are connecting. logical. understandable. but let me tell you a story about the time my friends let G die when he overdosed because they were high too and didn’t want to get in trouble and i knew they loved drugs more than they loved me or each other. and the time i went back to my dopamine adrenaline filled emotional intimacy free relationship because right at that moment i loved it more than my kids and i do not want to tell you that but how else can we do better?

and they told me my son played next to other children but not with other children and that he was too old for parallel play. but tell me how much time adults spend engaging with other people and not engaging next to other people? are we connecting spiritually or are we churching next to one another? and those residents we work 90 hours a week with that we save and lose lives with, do we know them at all? and so pass the pipe and hand me that spoon and we will share a hit of Netflix and yoga and pumpkin spice latte next to one another in this Fallen World.

there is no ICD 10 code for the unbearable lightness of being but maybe there should be

The World is Coming to an End

27 Sunday Nov 2016

Posted by elizabethspaardo in kids, love, marriage, my awesome husband, parenting

≈ Leave a comment

Tags

fallen world, family, original sin, residency, truth

My husband is a filmmaker and he made our wedding video. I am blessed like that. He edited it, picked out the music and even hired an animator to make an animated version of the highlights of our relationship. Impressively, he did this while broke and during a really painful separation I had instigated. #MaritalSaint.

We watch it from time to time and we had been meaning to sit and watch it again for the past few months now. Our daughter Lena loves weddings and kept asking when we would watch it. We finally carved out some time to watch it last week. As Lena sat oohing and ahhing over my pretty dress and the “beauuuutyful flowas,” I found myself crying. Which was odd. You see, I am not a crier. I mainly cry when

  1. flooded with pregnancy hormones
  2. when extremely exhausted or
  3. when extremely depressed and heading into a panic attack. When it feels I am falling into the blackness and my world is coming to an end.

I cried several times during the video despite not wanting to do so in front of my sweet, very empathetic Lena. Unlike my boys, she notices any time I am sad or angry. Sometimes she notices before I do. #HighFunctioningAutism. And unlike the boys, I can never lie my way out of it.

I cried as we watched my father give me away and when my nieces walked down the aisle as little flower girls. My wedding was really the last time I saw my sisters and my nieces. I have since then physically seen them a few times, but it was a hollow, awkward exercise. It only served to remind me of what I’d lost.

I watched my two nieces in their pretty little dresses walking down the aisle. The older one was 6 1/2 and the younger one 4 1/2. Smiling and sweet. At the reception the younger one danced with abandon and ran around, often times chased by her father trying to get her to do something. She was quick and evaded capture often. As I watched them, I realized they will forever be caught in this age in my mind. They will never age. Forever sweet, spunky little girls.

I saw them for the first time since the wedding (the first time in 5 years, in 60 months, in 1,825 days) this past summer. 11 1/2 and 9 1/2. They were hard to recognize. They looked so much like their mother now. They looked so grown up. They did not talk to me or my boys.

My boys, especially the Axe, had been asking to see them for five years. He never gave up. He couldn’t understand why he wasn’t allowed. I didn’t understand either and couldn’t figure out how to explain it. I told him, my sister is mad at me and doesn’t want to see us. He asked why she was mad and I said, I don’t know. Because I don’t.

Now, they were strangers.

My sister gave her older daughter my name as her middle name. Because I had helped her through her very long, very difficult, downright heroic labor. It meant a lot to me. An overwhelming lot. I wonder now what she tells her when she asks where her name came from, as I often asked my mother when I was a little girl.

I cried because I will always miss them. Because they will forever be little girls in my mind even as they grow. And that is a very sad thing, to never grow up.

I cried too to see my parents. My father giving me away.

“Who gives this woman to be married?”

” I do.”

But they didn’t really give me away. They couldn’t bring themselves to let me go. They couldn’t stand the thought of letting me grow up. I was forever a little girl to them. *Their* little girl. They could let no one take me away. It did not occur to them I was choosing to go away, that no one was taking me. In their mind, I was theirs and now he was taking me to be his. After all, a little girl is not able to make such decisions.

If they’d let me go, I would have. I really did want to marry my husband and have a home of my own. Every time I’d left my home as an adult I always came back. I went away to college but then transferred to the local school and lived with them. Then I met my first husband and moved away with him and got married. But then I divorced him and again lived with them for four years during medical school. Then I met my forever husband and moved away again. If they’d let me go, I would have stayed with him. But they couldn’t and I didn’t. I left him twice. I left him in a sudden, jarring, couldn’t see it coming way. Twice. And each time returned to them. The first time I physically moved back in with them. The second time, only emotionally so.

And a man shall leave his parents and cleave to his wife. No mention of the wife in that one.

My husband would say to me I was too attached to my family and our marriage wasn’t going to work until I grew up and left the nest and learned to put my kids and marriage first. I kept insisting I had and offered up various bits of evidence to support the patently untrue assertion. He was never convinced.

They had made clear while we were dating they didn’t like him. My sisters broke off with me after the wedding. My parents remained and put up a show of liking him. When I left the first time, it was at my family’s urging and we sat discussing their true feelings about him. When he and I attempted to reconcile shortly after the separation I kept it a secret as I knew they’d be upset. I was right. When they found out from reading text messages on my phone, my mother kicked me out. Me and my three kids. Me with nowhere to go. I remember calling my oldest sister crying uncontrollably, panicking, terrified. Terrified because I had nowhere to go but mostly because when this side of my mother came out, I felt that black hole feeling. That I was being sucked into the abyss. The world was ending.

Our mothers are the source of life. They are supposed to be the safe womb we can always return to in times of distress. Mine was not. It was in times of distress she was most likely to turn from a seemingly sweet cookie baking, nurturing mom to an ugliness words cannot describe. A cold hate would flow from her and destroy me. My world spinning around me, closing in on me, suffocating me into non-existence.  I would go from being a sacrificial devoted mother in her eyes to a crazy, unfit mother who put men before her children. She would threaten to give my ex-husband money to get a lawyer and take my kids away. Crazy. Unfit mother. Woman who puts men before her children. These were the things I feared most. These were the demons that haunted me. Was she right? Is that who I truly was? That doubt, that possibility, was an endless source of shame deep within me.

You never really knew when she would turn. I grew up in a minefield. Trying so hard not to set her off. And always failing.

I remember going back to my bedroom, the room I had slept in all my life, that I had returned to once again, and calling my husband. Speaking in hushed tones and sobs about my mother kicking me out. He couldn’t understand what I was saying. I was terrified for my mother to hear me so I spoke quietly and ended the call quickly. He had no idea what had happened.

My mother soon summoned me to the living room with an offer. She would not kick me and my babies out on condition that:

  1. I send my two boys to live with their father as she did not have the energy for them. My daughter could remain and she would watch her while I completed residency and
  2. I was to cut off contact with my husband. Any time we met for visitation with our daughter, I was to be chaperoned by my father. They didn’t want my manipulative evil husband sucking me back in. After all, I was just a little girl and easily tricked.

I agreed, so scared. I cut off all contact with my husband without even explaining why. They soon rescinded the demand I send my boys to live with their father, but not the second. We met for visitation with my father awkwardly standing with us. My husband brought me gifts, sweet gifts. A CD he’d made me. Sweet, thoughtful gifts and cards. My family rolled their eyes and laughed. How could he think gifts would make up for what a horrible person he was?

In time, I began communicating with my husband again and we decided again to reconcile. This time, I knew I couldn’t let them find out as we prepared, finding a house to live in and meeting as often as we could (he was living 3 1/2 hours away). My parents rarely left the house, but in August there was a family reunion they would be at for a few hours. In those few short hours we packed up my belongings, disassembled my boy’s bunkbeds and moved all of it out to the new house, an hour away, where I was completing residency. I left them a note saying goodbye.

Their little girl had once again been stolen.

In time, I unpacked the dysfunction of my family in therapy. I began slowly to set boundaries and view my family and my childhood for what it was. I realized there was no emotional intimacy. I realized I had been raised to trust no one but the family. I realized how afraid I had been all these years of my mother disowning me, as she had other people in her life. I realized my mother and I were enmeshed and yet not close at all. Not in the ways that matter.

I left my husband again this past summer just as suddenly, just as secretly, just as heartbreakingly. We reconciled again. And my parents said they were fine with it, but began to punish me in subtle unspoken ways. But still I kept them in my life.

The breaking point came a few months later with the dog incident I have explained in previous posts. I found after I broke with them, my marriage was suddenly so much better. My opinion of my husband so much better, my love for him unconditional. I was not expecting this. I came to see all the subtle ways they had undermined our marriage while, on the surface, appearing to be supporting it. How incredibly cruel. To me and to my kids. Crazy. An unfit mother. Projection.

I no longer have my family in my life and so I cried as I watched my father giving me away in my pretty white dress. They say in Catholicism that we are not waiting for the world to end when Christ comes. The world ends many times in our lives. When we get divorced, get a bad diagnosis, lose a loved on. It ended for me when I found out my son was sick at 6 days old, when a guy I’d been in love with broke my heart, when my medical school tried to ruin my career for turning in a child molester. The world ends but a new one begins. It prepares us for death, they say. For it is in dying that we are born again.

My world has come to an end once again as it has before. But this time I can see clearly the new world that has been created in its place. My children growing up healthier and happier than I, my marriage finally solid, my body and mind stronger than they’ve ever been, my connection to God growing.

They couldn’t give me away and so now I have left of my own will. I am not a little girl. I have grown up.

Better Living Through Science

21 Wednesday Jan 2015

Posted by elizabethspaardo in autism, doctors, empathy, kids, medicine, parenting, Sin, special needs

≈ 2 Comments

Tags

addiction, autism, forgiveness, medical school, natural parenting, residency, truth

I’ll admit I spend a good amount of time on Facebook. I like to see what politcal/social justice type things my friends from college are up to. I like to post pictures of my kids for distant friends to see. Sometimes I’ll take one of those quizzes: Which Golden Girl are you? (I got Rose, in case you’re wondering. I was really hoping for Dorothy but I guess I haven’t matured to her level of sass and pith quite yet). One thing that dominates my feed is posting from my fellow doctors and nurses bashing parents who don’t vaccinate their kids. And yes, I mean bashing. I don’t mean expressing concern for their children. I don’t mean seeking to find ways to turn the tide of increasing numbers of people not vaccinating their kids. I mean, bitching about them and how they’re screwing up herd immunity for the rest of us because they are bad people who ignore science.

I have issues with this.

Ironically, these people of science are not being scientific at all. The whole argument is that these crazed non-vaccinators are ignoring science. They’re irrational. They’re backwards. They’re stupid. They’re ignorant. The problem with this argument is that the accusers here are ignoring the fact that *they* themselves are not being scientific. Let’s look at the facts:

-By and large, non-vaccinating parents are highly educated with average to above average intelligence. That’s what the research shows us. Most of them have read everything their doctors have read and come to the decision that it’s not compelling evidence to them for one reason or another. So, calling them stupid or irrational simply isn’t accurate.

-Most parents who do not initially vaccinate will vaccinate their children within a few years. The vast majority of patients questioning vaccination cite their doctor as their most trusted source of information. But here’s the rub: the research shows that if their doctor comes at them with the attitude most doctors hold, these parents actually become *more* likey to not vaccinate. What has been shown to work, scientifically, is for physicians to engage in respectful, open minded dialogue with them and not engage in scare tactics etc.

We have an obligation as physcians to pediatric patients of these parents and also to the greater community and society. We’re tossing aside evidence based medicine and compromising both with our attitudes towards these parents.

Why? Basically because this topic makes most doctors really really mad. And we allow really really mad to get in the way of our obligation to these kids. We find it emotionally comfortable to get angry and make it into a moral failing in these parents. Some of it is righteous anger in defense of community health. Some of it is control issues. We don’t like it when patients don’t do what we say. We got into medicine to help people and now they’re not letting us help them. Maybe it makes us sad to see them hurting themselves. Maybe it pisses us off they’re messing up our plan.

I was discussing a law recently with some fellow residents that I read about going into effect recently in a southern state. They were starting to arrest mothers who did illegal drugs while pregnant once the babies were born. Two of us thought it was a terrible law because addiction is a disease and criminalizaing it really wasn’t the answer. Putting a baby’s mother in jail soon after birth is incredibly obviously not good for a baby. Knowing she’ll go to jail if she delivers her addicted baby in the hospital will inevitably lead to some of these mothers delivering their babies at home and not getting proper medical care. They’re certainly going to be more likely to lie to their physicians about what drugs they’ve been doing. The resident in favor of the law was adament that these women must be punished. They’ve harmed their child and they must be punished. The fact that this law was only going to hurt these babies further was not the issue here. Addiction was not a disease, it was a moral failing.

The truth of it is, it is simply easier and more satisfying to write these non-vaccinating parents off as kooks and lost causes. But if you truly believe not vaccinating their children (your patient) puts them at risk, you have a moral obligation to not write them off as a lost cause. You are that child’s advocate. You are a physician practicing evidence based medicine. So act like it.

Parents who are simply questioning vaccinating may or may not know much about it. So, guage how much they know and offer them education in a respectful way. Talk when appropriate and listen when appropriate. Don’t engage in scare tactics. Show them some compassion. This will maximize the chances they will vaccinate today or soon therafter. In case we’re not clear on this: making them sign a release recognizing they’re placing their child’s life at risk by not vaccinating is not productive in this regard.

Some parents are at the point where they are refusing to vaccinate and have probably read up on a lot of what you have to tell them about vaccine safety and efficacy. If you can tell they’re already familiar with the information you have to offer, it’s time for you to sit and listen. Ask them why they don’t want to vaccinate and listen respectfully and compassionately. If they’re open to your responding, then go ahead and respond. If they’re not, then thank them for sharing with you and let them know you truly believe vaccination is the best thing for their child and that you hope the dialogue can be kept open at future visits.

If the above approach chafes your chaps, if it seems just plain wrong, that’s a perfectly valid feeling you’re having; but it certainly isn’t scientific.

Instead of reading self-congratulary after self-congratulatory article on how awful these non-vaccinators are, you’d be better served to read up on why parents make that choice. Better yet, try talking to a few of them. As a mom of a child with autism, I can tell you there are plenty of parents in that community who would be more than willing to talk to you about it. Step back from the moralistc thinking and consider all the psychological and social reasons parents might have to make this socially unpopular choice. What life experiences have they had that have led them down this path?

One thing I try to stress to my interns starting out in residency is that there’s a place for book knowledge but most of what you need to know about being a good doctor comes from experience. Your experience as you go along and learning from the experiences of the doctors teaching you who’ve been at it so much longer than you. If you’ve seen a child suffering from a vaccine preventable disease, you’re most likely eager to share that with your patients. But, you’re better off trying to find out about their experiences affecting this decision. Scientifically speaking.

One common misconception amongst the American public that upsets physicians is the idea that vaccines cause autism. How can so many people believe this stil?! It’s been scientifically disproven! Heck, it’s even been anecdotally disproven in the case of thimerosol. Let’s get rid of the exclamation points and ask that question for real. Why is it that people still believe all vaccines or MMR or vaccines containing thimerosol cause autism? Is it all due to that villain Dr. Wakefiled who published that now discredited study in the Lancet? Has he mesmerized these foolish parents? Or could there be a more logical explanation. Perhaps one explained by medicine?

Let’s set aside the vaccine facts for a minute here and consider some facts that are at the core of every family’s life who has a child on the autism spectrum:

1. Doctors do not know what causes autism
2. They’re pretty sure it’s a genetic predisposition that gets triggered but they don’t know what’s triggering it
3. But they’re pretty sure it must be mulptiple things because they can’t really find any one thing these kids have in common
4. Doctors have no cure for autism
5. Doctors don’t even have a very good treatment for it
6. Most PCP’s don’t know nearly as much about autism as an informed parent. As PCP’s, we’re generalists and it’s not something stressed in med school
7. The rate of autism keeps climbing and the truth of it is, scientifically speaking, we don’t really know why

Can you honestly tell me a parent in this situation would be irrational to question things that are dogma to modern medicine such as vaccines? Modern medicine has failed them. What they need from you is not a lecture or an anecdote of what can happen to unvaccinated kids. Assurance of the rarity of adverse events from vaccines (and yes, there are rare but quite serious effects at times) will not comfort them. They need their trust in medicine restored. And that begins with you, the PCP. I say begins because it is a process that can’t be rushed. You have to sit with them, sit with the uncertainty and anger and helplessness that comes with special needs parenting. You need to show them their child is your patient who you care about. That you see the challenges and the joys of their life. To show them that this isn’t about a battle for control. That you want what’s best for their child. And that you’re open to learning from them. That it really is a dialogue and not a lecture.

Only 1% of parents in Pennsylvania choose not to vaccinate their child, but the lessons we can learn from this issue will make us better doctors in a lot of ways. And better people for that matter.

Listen. Empathize. Validate. Assert. Repeat.

I often tell my kids: it’s okay to get angry. It’s not bad to feel angry. But when we get angry, we have to make good choices of what to do with that anger. I think we could all stand to hear that on a regular basis. So, my fellow physicians: it’s okay to get angry about vaccination. It’s not bad to feel angry. But you need to make good choices.

You’re a physician practicing evidence based medicine. So act like it.

I Know You Feel Like Your Doctor Doesn’t Care, But That’s Just Because He Doesn’t

27 Tuesday May 2014

Posted by elizabethspaardo in medicine

≈ Leave a comment

Tags

empathy, medical school, residency

I often get patients telling me they feel like I’m really listening, like I really care. Unlike that other doctor, Dr. So-And-So. Sometimes I’m surprised by the name they drop as so many of my colleagues genuinely care about their patients and have, as far as I’ve observed, a good bedside manner. Some patients will always complain, regardless of how physicians behave. We tend to hold our doctors to a pretty high, oftentimes impossible standard. Other times, I’m not so surprised to hear Doc So-and-So has rubbed them the wrong way. Some physicians certainly have a gruff bedside manner. And others, probably more, are nice enough to patients, but don’t really feel the kind of empathy and concern patients expect from their doctor. They follow the script, but you feel like they don’t care the way you want them to. Having spent time behind closed doors with medical students and residents, I can tell you, you’re probably not wrong.

Multiple studies on the empathy levels of medical students, residents and practicing physicians have shown we tend to have less empathy than the average person. One study in the journal Academic Medicine showed that empathy levels actually decrease as medical students move along in their training. Cynicism goes up, compassion goes down.

The widely accepted reason for this is, basically, that medical training is a real bitch. The first two years, where students are taught the science of medicine in a classroom setting, are competitive and stressful. Actually, the words competitive and stressful do not convey what we go through. I’m talking people crying in the halls after exams, weeping and gnashing of teeth. Eating disorders and binge drinking galore. Keep your grades up or get the hell out. I once asked for an extension that I thought was pretty reasonable. My son was in the ER getting IV fluids for dehydration and would possibly need admitted to the hospital and the exam was the next morning. It was the only time I’d ever asked for an extension. I knew leaving sick toddlers at home with my mom, no matter how sad and guilty it made me feel, was part of the deal when I started medical school. I thought the fact he was in the hospital and that I wasn’t one to ask for special treatment might cause them to grant the extension. The professor refused my request and went further. He said, your scores haven’t been that great lately, you’d better do very well on that exam or maybe you’re just not cut out for med school. Damn.

Empathy levels drop even further after the third year of medical school. That’s when you finally start seeing patients so you’d think the battle weary medical students would become more compassionate, not less. That thinking ignores what third year of medical school is really about: pimping. I recall the confused look on my husband’s face the first time I mentioned getting pimped on rotation that day. I’d forgotten the term has another meaning altogether outside the medical bubble. Pimping here refers to a style of teaching employed by attendings with medical students and residents. Oh, how civilized that sounds! The attending, generally an intimidating person who makes no effort to make you feel comfortable in the least, asks you a series of questions about medical facts. A surgeon might ask you to list off the blood vessels and nerves that run through the area he’s currently operating on (as you stand in an awkward, turned and bent over position holding a retractor with each hand). He then might move on to having you trace the blood vessels back to their origins. You’ve just spent two years drinking from the proverbial fire hydrant of medical knowledge, so you search your cluttered, fact-saturated mine desperately looking for the answer. If you fail to produce (which every one of us does at some point), you’re made to feel very small.

As you progress, your wrong answers or, worse yet, no answer at all, move from eliciting comments and looks that merely make you feel like a moron, to comments like, “You’re going to be a resident next year. What if a nurse calls you in the middle of the night with a patient in such-and-such a condition and you don’t know the answer? People’s lives are going to be in your hands. Haven’t you thought about that?”

This is part of the explanation used to defend pimping. If we’re going to be in high presure situations with patients’ lives hanging in the balance, then hadn’t we better learn to deal with pressure? I’ve yet to see the research showing that idea is valid and I doubt I ever will. Because it’s not. What I do see is the culture of physician training where change is resisted and the hierarchy fiercely protected. New doctors really ought to show appreciation for their suffering. It’s how mere humans become physicians.

I have to admit, I’m guilty of it myself. My residency recently moved from 24 hour call shifts to 12 hour ones. It really bothered me. I mean, really bothered me. And I couldn’t figure out why. We know from the research that sleep deprived residents make more mistakes in patient care and also get in more car accidents on their way home. The work hours of residents have decreased in recent years as new guidelines were instituted. We cap out at 24 hours of direct patient care now (no more 30 or 36 hour shifts). First year residents aren’t even allowed to work 24 hour shifts anymore. There’s also a minimum number of hours you must be given off between shifts and a weekly cap on total hours. (An average of 80 hours per week over a four week period). We’re also supposed to have at least one 24 hour period off of work each month. Are these guidelines followed to the tee across the board at all residencies? Oh hell no. But, the point is, the times they are a-changing. Now, back to me and my own old fashioned ways. I was really bothered by the end of 24 hour shifts at my residency and I couldn’t figure out why.

After much soul searching, and many discussions with my fellow residents (none of whom minded the change at all) that ended with “You’re seriously not upset? Really?!”, I came to realize I was so upset because it took away some of what makes being a physican special. There aren’t too many professions out there who work 24 hours shifts on a regular basis for several years straight. Residency is grueling (and mine is one of the kindest ones out there) and people know it. For me, we endure this because medicine is a calling. Not just a job or career or profession. I wouldn’t give up so much time with my husband and children for a mere career. I wouldn’t ask them to make the sacrifices they do for my profession. I do these things because I have been called.

There is no clocking out when you’re a doctor, especially not during residency. I remember the time intern year when I needed to talk to the family member of a patient about placing the patient on hospice for her terminal condition. I’d been there since 6am when I placed the call to the patient’s son at 4pm that afternoon. I’d already spoken to her older son and he felt hospice was the best thing for her, but he wanted me to talk to his brother and him together before making the decision. Her younger son was audibly upset as I told him what I needed to discuss with him. His mother hadn’t been doing well for a while, but who’s ever ready for their mother to die? He told me he was at work, but he would be getting off at five and could come over right after. I was supposed to be done at five o’clock, barring any disasters (always a possibility when you’re working inpatient service), but I told him I would wait. He said he worked about twenty minutes away, maybe half an hour with traffic. I was missing my babies, ages 8, 6, and six months and I knew they were missing me (not to mention how my mom, the one who’d been watching them for twelve hours, felt). But I also knew this family needed me to stay. This was not something I could sign out to the intern coming in to begin night shift. This was something I needed to do for my patient.

Traffic was heavy and then there was an accident. He didn’t make it in until 6:30. I sat at the computer in the ICU, going through emails, finishing up notes from the day’s admissions, waiting. He eventually got there and apologized for being late. I told him he didn’t need to. And I meant it. We talked about his mom’s condition, about their options. Her sons talked about what they thought she would have wanted. The younger son cried on his wife’s shoulder. And then they made the decision to make her hospice. They thanked me. I told them how much I’d loved taking care of her and assured them of how loving and brave their decision was.

I left then, headed home to my family. Soon after, the upper year on night shift called to let me know my patient had passed. She lived less than an hour after the uncomfortable BiPap machine was removed and the morphine drip started to make her comfortable. She passed peacefully with her sons at her side. I cried a little, but there was dinner to be cooked and homework to be done. The baby needed a bottle. I needed some sleep.

I look at the changes being made in medicine these days and I worry it is losing its identity as a calling. Family doctors once saw their hospitalized patients in the morning before going to the office. If their hospitalized patients needed something in the middle of the night, they fielded the call. Now, family medicine is being divided into hospitalists and outpatient docs. Small practices expand bigger and bigger, cutting down on the frequency of call for each doc. Graduating medical students look at the lifestyle a particular specialty will provide as much as the kind of relationship they will have with their patients. Will medicine soon be little more than a job? A paycheck you put your hours in for? Clock in, see patients, clock out.

Perhaps this is what the older physicians worry about when they think about giving up things like pimping and 100 hour weeks. And perhaps, in order to hold onto our humanity,we must remember that not only are our patients feeling human beings, but so are the young doctors we train. We are human beings with limits. Limits to what we can do physically and to how much we can take emotionally.

In the end, it is not 24 hour shifts that makes medicine a calling. It’s certainly not the battle scars of impossible exams and pimping. It is the compassion we feel for our patients. What determines if it is a calling is the motivation that brings us to this job with its blurred borders of where it ends and the rest of us begins. You can go without sleep and endure overhwhelming stress with a hardened heart. You can bring this sacrifice and an abundance of medical knowledge and procedural skill to your patients, but if you don’t really give a damn about who they are, you aren’t really a physician. All the technology and constant outpouring of new medical knowledge and developing of drugs doesn’t change what is most important about us. We are healers, much more powerless than we like to admit. If we can serve with a humble heart and keep from doing too much harm along the way, I’d count that a worthwhile medical career. And I bet my patients would too.

Subscribe

  • Entries (RSS)
  • Comments (RSS)

Archives

  • May 2022
  • April 2022
  • March 2022
  • November 2021
  • September 2021
  • August 2021
  • July 2021
  • June 2021
  • May 2021
  • April 2021
  • March 2021
  • February 2021
  • January 2021
  • July 2020
  • May 2020
  • April 2020
  • March 2020
  • January 2020
  • August 2019
  • June 2018
  • May 2018
  • March 2018
  • February 2018
  • January 2018
  • December 2017
  • May 2017
  • March 2017
  • February 2017
  • December 2016
  • November 2016
  • October 2016
  • February 2016
  • April 2015
  • February 2015
  • January 2015
  • December 2014
  • November 2014
  • October 2014
  • September 2014
  • June 2014
  • May 2014

Categories

  • addiction
  • autism
  • Catholicism
  • christianity
  • COVID 19
  • doctors
  • empathy
  • Evil
  • kids
  • love
  • marriage
  • medicine
  • movies
  • my awesome husband
  • narcissism
  • New York City
  • outrage
  • parenting
  • Politics
  • PTSD
  • Rape
  • residency
  • romance
  • Sin
  • special needs
  • Uncategorized

Meta

  • Register
  • Log in

Blog at WordPress.com.

  • Follow Following
    • I'll Sleep When I'm Dead
    • Join 787 other followers
    • Already have a WordPress.com account? Log in now.
    • I'll Sleep When I'm Dead
    • Customize
    • Follow Following
    • Sign up
    • Log in
    • Report this content
    • View site in Reader
    • Manage subscriptions
    • Collapse this bar