Having utterly abandoned this blog for quite some time (10 months), I’m pretty certain I can post without anyone actually reading.
So, no recipe today, just soul baring.
Since starting this medical journey, I’ve had a lot of curiosity expressed by acquaintances about what it’s like to be a doctor. Generally it’s of the “eeeww, how can you deal with blood, I hate blood” variety.
In answer to that, blood isn’t actually a big deal. You can genuinely accustom yourself to just about anything unless it’s a true phobia. I like to use the analogy of a life drawing class with nude models – if you’ve ever taken one, for the first bit of time you’re hyper-aware that there’s a naked person in the room, but then they just become an object you’re sketching. Medicine isn’t quite the same as the “models” are more interactive, but you train your brain (or at least I do; I can’t speak for everyone) to make yourself perceive people as just meat when you must, for example when their care requires hurting them. There are limits to this, for example I can outwardly pretend to be okay when watching people put an IV in an infant or toddler, but inside it hurts really, really badly to watch them stick a screaming child with needles. I know from personal experience though that I can push past this and drill into their bone to place an IO (bone IV) if I must.
Many shifts, honestly, my job is basically like waiting tables. There’s a lot of customer service, and a mixture of satisfaction with a job well done and frustration with trouble customers. With any luck I walk away from the shift with a small sense of accomplishment, but it isn’t even necessarily with my connection with patients, or with my medical knowledge. It can be about good teamwork with other staff members, or seeing more patients than usual, or rocking a procedure.
One of the happiest and then most depressing moments of my second year of residency involved a lost dog. I found a friendly pitbull skulking around the house. I lured it onto our porch with treats, and spent a long time deciphering its worn-out collar to determine its owners number. The end result was the dog reunited with its owner who was tearful and grateful. I felt like I’d genuinely made a difference and brought someone joy without any expectations or ulterior motives. This was exhilarating, until I realized that medicine never made me feel this way. Even when I did a great job, when patients sung my praises, it was still a job, and there was always the pressure to make the next person happy, to see more patients, to please my next attending, and this disconnect had grown the longer I spent in training.
Fact is, there always is and will always be a degree of dissociation in medicine, perhaps especially in Emergency Medicine, that is fundamentally unhealthy. Unless you have an anomalous job or past history (for example, Sudanese child soldier), I can virtually guarantee I’ve seen more people die in front of my eyes than you, and most of them died in a brutal and hideous manner. Next time you hear someone bemoan how emotionally cold doctors can seem, or even be, please remember this. We are human, and watching people die and suffer is initially about as hard for us as it is for you. The ways we cope with it change us and I can’t really think of the way for that not to be the case.
Lord only knows how I will deal with the things I see long term, but my short-term coping mechanism involves pop music. The downside is that it is ruining my ability to wholeheartedly enjoy top 100 songs. Every time I have a shift that involves something so painful even I, with all my years of desensitization, can’t shove it down deep immediately, I get in my car at the end of the shift, cruise through the stations until I find something with a danceable beat, turn the volume to eleven, and drive waaaaay too fast while crying until I can deal with my shit.
This ritual started pre-medical school, when I was a tech, with the first death that actually hit me. It wasn’t the first death I’d seen – I was working a facility that was half hospice, so death was not uncommon and I’d cleaned and arranged more than a handful of bodies at that time. This wasn’t even a patient I knew well, unlike the deaths before him. He’d been my patient the night before, and he was obviously on his way out. He was known to be terminal, he was nonverbal, and his only signs of life were the pained moans he emitted every time we turned him to change his diaper or to prevent bedsores. When I went in to check him and he was waxy and cooling, it frankly seemed like a mercy. However, when I saw the face of his daughter, whom we’d been unable to reach on the phone, who had walked into the facility through a side door and discovered his body with no advance warning, who was doing chest compressions on him despite his DNR/DNI status, it changed things. Not immediately, but when I was driving home and it hit me that, while in my eyes, he was a husk of a man who could feel nothing but pain and for whom death was likely welcome, in her eyes he was her father, who was once a giant, who held her, who meant so much. I had to pull over because I was crying so hard I couldn’t see the road.
Most deaths frankly don’t hit me so hard anymore. I’m worn down and numb to so very much. However, occasionally something sneaks through the armor I’ve built. The problem is, every time it does, and I have to deal with it, I destroy a pop song forever, because it will forever be someone’s death song. Here are two:
Young woman in her 20s, car accident after overdose. Arrived in cardiac arrest. I placed a chest tube as we tried unsuccessfully to bring her back. This song will forever, for me, be associated with the feeling of her flesh, so young and healthy but so slack, as I sliced her open and shoved a tube into her chest to drain blood and fluid, and then listened to air whistle in and out of it as chest compressions were performed. She was declared dead after about 40 minutes.
Man in his 70s, found down by his wife. Unresponsive on arrival and arrested multiple times. Head CT showed a massive bleed. We worked his body, barely sustained by a brain too damaged to do anything besides intermittently tell his heart to pump, until his wife was able to accept the catastrophic change to her world and let him go. I walked out of his room immediately into that of a patient from a psychiatric facility, brought in with a hand fracture after punching a wall, who was livid after waiting an hour for his xray read. For once, exhausted and raw, I didn’t just apologize but told him the wait was because someone else was dying, and he told me he didn’t care and that I was a fucking bitch for not putting a splint on him sooner. I was not the biggest fan of humankind in that moment.
There are so many other songs, for the woman whose brains oozed out of her head as I intubated her after a gunshot while her pregnant coworker’s belly was sliced open across the way to save the baby, for the young man who drank so much he stopped breathing and for his 13 year old son I had to tell that his daddy was gone on Christmas Eve.
This job can be so, so hard. It’s still the one for me, but the world better keep cranking out songs with strong beats, or people have to stop getting hurt.