soul

I sometimes feel that I have, if not lost, at least misplaced my soul.

I will deny someone painkiller without blinking nowadays.

It's not heartless - I nearly overdosed a patient of mine whom I wanted to take away suffering.

It's not safe.

I hate the choices I have to make - to determine who is telling their truth about pain and who is drug-seeking, how to balance a patient's future well-being and potential for addiction against the need for relief of pain in the moment.

I hate, hate, hate my job sometimes.  I sometimes feel the pointlessness of what I do, because no matter whom you help, someone will be back with the exact same medical problem.  We are on a treadmill of suffering, where every day is deja vu.

I know it matters to each individual patient, and I always worry when my patients ask me how I am doing.  Or they wonder why I am still there on the weekends or holidays.  Do I look that bad?   It's not really about me, but I appreciate it - I do tell them that being sick is not limited to business hours, and it is my job to be there for them. 

But I hate that it leaves my well dry for myself, for the people around me.  Sometimes I find myself muttering under my breath, hour after hour: "I hate my life, I hate my life, I hate my life." 

I don't really hate my life.  I don't even hate my job.  I just feel kind of overwhelmed by sadness sometimes in hearing people's stories, and I feel helpless when I offer someone an anticongestant when their problem is poverty, or their childhood, or whatever.  I am not a normal person any more - your pain is not necessarily a medical emergency to me, even though it is to you.  I'm trying to triage your needs against those of my other patients, and staying to counsel you 20 minutes takes 20 minutes out of my life, out of my well-being.  I hate this so very much, but every day I try to show up and do the best I can, and it often feels completely inadequate.  I can be there for you.  I won't judge you or abandon you. 

And I will take a paranoid, schizophrenic, feces- and urine-throwing patient in prison any day over an entitled, rich, mean patient from the free world.  I do not mind taking care of the prisoners, although some of them are genuinely scary, two-officer patients.  I really do not want to know what you did or did not do.  That's not my job.  My job is to take care of your medical conditions and treat you like a human for the space of the day you are here in prison, because watching you being treated like an animal in handcuffs hurts my soul.  Some of you probably deserve to be here, and some of you were imprisoned for driving under the influence.  Some of you I genuinely like, and some of you, I feel sorry for.  And sometimes I am the one who is too tired and angry and stressed to be kind, and some of you were kind to me too.

* * *
In medical school, I sat down and cried nearly every weekend for my patients and myself.  In residency, I don't have time for that nonsense.  I put it on the shelf for later, because yes I just declared my first patient dead, but my other patients have needs, and I don't have time to cry over the oncology patient I liked a lot and cared about, whose pain meds took me days to get right because I was so fearful about titrating opioids.  I don't have time anymore to be angry about the neutropenic, underinsured patient who is getting ineffective chemotherapy to buy time till his new insurance kicks in and he can go to the fancy shiny first-rate cancer hospital for rich people, most likely too late to get the definitive treatment, a stem cell transplant.  Don't know if he will make it, but he didn't make it home for the holidays so our nurses threw a holiday party for his kids in his hospital room.  I can't stand to go back and look at his chart.

And then there was that patient that eventually bled to death from a gastrointestinal bleed, in 2019, because we could never find the source, and there was nothing to do surgery on.  And he was kind and did everything we asked, innumerable colonoscopies and endoscopies and even swallowing a pill-cam, and I just found out he died recently.

There was the first patient who I accompanied through to death, and I was the one who said, No bipap, let her die in peace, and she died in 10 minutes after her sole remaining relative made peace with her, and they donated her body to science.  She just... snuffed out, so quickly, and then the monitors flatlined.

There was that young guy with history of alcoholism who died of pancreatitis, no more second chances for him to clean up and get (more) sober.  Could we have managed his care better, helped him pull through?

I don't really want to cry through every day of my vacation, but I have a lot of tears and sadness inside that comes out at weird times. My friend at another residency said he got the hospital discount even though he wasn't wearing his badge because the cashier just looked at his eyes and knew he was a resident.  (Was it the bags underneath, or the sadness?)

I sat there and looked at labs and nothing happened in my head.  It's not that I actually hate my life or hate my job.  I just feel really sad about everything I have seen, and I wonder if I will ever find or recover the happy-go-lucky me from pre-medicine.  Probably not.  I guess I chose to eat from the tree of the knowledge of good and evil, and my eyes have been opened.  This is the cost of knowledge, bought with witnessing suffering.

I put on my white coat every day - which hasn't been washed recently and is probably a vector for nosocomial infection, sorry former me who worked in infectious disease. It almost feels like a super-hero costume, but it isn't even liquid-proof, won't even protect me against a body fluid exposure.  But I put it on, and someone people call me doctor (except when they don't and call me "girlfriend" or "sweetie" or "honey" or ask how old I am) and expect me to know what is going on and to help them.  I introduce myself as "Doctor" and try not to look absolutely terrified when my patient's hemoglobin is four-point-something and I can't give a transfusion because all the blood is being hemolyzed, and sorry about your baby in there ma'am, oh and those clever blood-bank fellows have just let me know that it's a delayed transfusion reaction and I just need to sit here and stare at your labs and do nothing because there is nothing to do, but maybe now hematology tells me I could have given steroids, and why didn't you say this two days ago?

I try not to disappoint the fresh-faced medical students with my utter ignorance and that blank look because the alarm clock rang under my ear for an hour and my sleeping brain just ignored it, so I'm reading on the go as I pre-round.  I try not to sound too much the same to my friends when I smile and joke about "escaping the hospital" - but running with you all in the sunshine is the greatest thing to happen to me in about ten days, and I will go back into the twilight, into the Land of Sick People where I'm no superhero, and this white coat doesn't protect me from sorrow, doesn't make me omnipotent and omniscient, and where every day, if this was a test, I'm not sure I'm passing.

So yeah, I'm here on vacation, and it's really tempting to spend all day crying, but you know, I'm on vacation and gotta take advantage?

And next time I'm out for dinner with you all and my patient just died beforehand, and oh, shouldn't I be more sympathetic when hearing about the first near-miss that a lifeguard had in saving a life and feeling kind of traumatized afterwards - well, it's what we do every day.  I don't feel like a hero, I feel like a chump.  I am glad to be a doctor, but dear God, what happened to my soul?