That Which I Miss Most

Empathy

My eyes glare across the table.  I can feel his shoulders hunch forward as he subconsciously recoils in preparation for my response.  The room becomes thick.  Nurses, social workers, a chaplain.  Everyone waiting for the doctor.

Not just the doctor, but me.  Sixteen years out of residency.  Battle scarred and warn by PTSD.  The images from residency still so clear.  A gasp, a gurgle, flat line.  Wailing family members, angry nurses, and an uncompromising chief.  

They died so much more easily back then.  The young, the old, the unwanted, and the uncared for.  The academic medical center with it's social mission.  The Veterans Administration with it's untethered and unloved.  

Practice.  We practiced for lack of a better word.  We  stumbled into situations too big and too great for our burgeoning grip on competence.  We learned as we taught.  We taught as we mastered.  We mastered in the single digits. 

Battle Worn

Emerging from training was like a breath of air.  But not clean air.  Smog.  The same thickness.  Life's murkiness banished to that protected oasis long hidden in the recesses.  Just out of reach.  

Schedules fill.  Patients to squeeze in.  The morass of physical and emotional trauma.  Ducking from the base insults hurled at our backs, and delivering the same into the next examining room when patience grows thin.  

Dragging such toxicity home on the belabored backs of our families.  Of our children.  The raspy voice declares death over the phone with cold and surgical certainty while the kids watch cartoons on a Sunday morning.  Clear eyed retribution turns to tears when the story line on the big screen goes awry.  

That Which I Miss Most.  

In this beloved room full of colleagues battling to make the last gasps of life bearable.  Is the softness.  The weakness of heart and the quietness of spirit.  The empathy that lifted those around me instead of made them cower.  

The absence of fear, and anger, and helplessness.

Not of battling life or death.  Not of winning or losing.  But of learning to feel unhindered.  To feel again.

I defang my claws.  Drop my shoulders and consciously restrain the edge in my voice.

And I do my best to fake it.

     

Something Different

And the dam breaks  

Because it always does.  As the rebellious seas churn and the indelible cracks breach at the base, a web of infirmity spreads it's lacey tendrils unloosening the mooring of a once sturdy structure.  The cackling of unhinged cement, the prepubescent rejoinder to the whoosh as the frothy waters churn past what once was solid, absolving the absurdity of insincere firmness.  That which was an obstacle, now a conduit.  

The mark of the trainee.  The years of suffering, and sweating, and staring down disaster with a stiff upper lip and trembling twenty-four hour knees.  The abuse.  Rampant abuse.  From patients.  From colleagues. From the dumb luck of being on the opposite side of death.  A familiar foe with unbearable strength and agility.

The self effacement.  The drowning of ones own needs.  The rumpled collar, greasy hair, and lazy eyes of a night on call.  Sleep abandoned.  Needs betrayed.  Humanity unraveled into a dream laden schedule.  Every few days.

A calling.  A calling to duty.  A call to sacrifice.

And the dam breaks

Because it had to.  Patients replaced by computers.  Insurance forms and boxes to check, and minutia upon minutia.  Upon minutia.  Until the little becomes so big that you become little too.  With tiny pitiable goals and aspirations.

Far from a healer.  You are a generator of paper.  A signer of forms.  A whipping boy for an ungodly mechanical voice heard disjointedly from somewhere up above.

That drug is not formulary!
That admission is an observation!
That is not a C3, it's a C2!  Run to the fax machine.

Suggestions become commands.  Commands become dictates.  Dictates become laws.

Laws we abide while sneering.  Pitiful sneers that make us hide from the reflection in the mirror.  The reflection in the eyes of those we had sworn to serve.

I'm sorry you're having the most shitty day of your life.  But I can't seem to remember how to order that  coffin in my electronic medical record.  What's the ICD-10 for death?

And the dam breaks

Because the words stop coming.  There is simply nothing more to be said.  There are only so many eloquent ways to talk about something that is broken.  Smashed to pieces.  The whole no longer exists.