The Depths Of The Ocean

I could taste the frustration and anger.  I walked out of the room instead of saying something I would regret.  My patient was dying.  She had cancer riddled throughout her body.  Her kidneys and liver were failing.  Every ounce of medical knowledge told me that she would be gone in days.  But she refused to hear it.  She didn't care if it was futile, she wanted to go to the hospital. She wanted IV's and cat scans, chemotherapy, and radiation.  It mattered little the physical and emotional toll it would take on her.

My anger quickly transformed into shame and guilt.  Could I blame her for hoping to prolong the inevitable?  Just as I couldn't see the world through her eyes, she couldn't step into my shoes.  She had no idea the horrors that awaited her.  She had not watched helplessly by the bedside as torture upon torture was practiced on a beloved patient.  But I had, and it scarred me.

***

We talk of burnout as if it is a single event.  One day the doctor was happily rounding at the hospital and the next day boom...he turned bitter.  But those of us who have trudged through medical education know the fallacy of such arguments.  Our profession struggles not with the ebb and flow of the current but rather with the depths of the ocean.

The process of becoming a physician is marked by the diminution of the stress response.  We become so overwhelmed by intense, prolonged stimulation that the signals our patients send are no longer recognized as abnormal.  We are habituated to pain, dulled to suffering, and downright unsympathetic at times.  We have lost the ability to walk a moment in someonelse's shoes.

And in some ways, I truly believe that this is the pound of flesh that is extracted for the privilege of wearing the stethoscope.  But this loss comes at a price.  Physicians become depressed, leave the profession, or continue to practice on auto pilot.

***

One day, I woke up and realized that my brains are full of knowledge, my hands full of skill, and yet a small part of my soul is gone.

And sadly, it was that part that drove me to medicine,

that part that used to make me feel so special in the first place.