Saturday, December 31, 2011

The Dual ER Doc Couple

I read a blog the other day that was written about being the wife of an ER doctor.  Multiple people commented regaling stories of absentee husbands, husbands devoid of empathy, husbands constantly stressed and on edge.  I am also the wife of an ER doctor, so I could relate on some level, but my perspective is slightly different in that I am also an ER doctor myself.  I honestly don’t know if this makes things easier or harder.  There is, of course, the benefit of having your partner know your pain and all of the ins and outs of what you deal with every day.  Well...  sometimes it’s a benefit.  You would think it would be easier to get sympathy from someone who knows your pain, but it can be hard to suffer through something all day at work and then come home and suffer it all over again through your partner’s stories of his or her day.  Sometimes you just can’t stand to hear about a single other patient or another asshole consultant after you have finally escaped from the ER.  
I’m also not sure if it is better or worse that we are both on erratic shift work schedules.  It’s nice to get weekdays off with some frequency to get “business hour” type things done.  We probably do get to “sleep in” more often than other people- although not that often with each other.  The biggest problem is just being completely out of sync with your partner.  I’m on days, he’s on nights...  We get a day off together, but he’s post overnight and needs to sleep all day when I’m up.  I need to go to bed early to get up for my 7am shift and he doesn’t get home and into bed until 2am...  I’m eating dinner at 6pm, he’s eating dinner at midnight...  And the schedule that we had last week is likely to be completely different next week, so forget planning around it or getting used to it.  I could go on.
There is an analogy that I like about how there needs to be a flower and a gardner in a relationship, and the same partner doesn’t need to be the flower all the time, but I’m afraid that too often in my dual ER doctor relationship- we’re both flowers.  We spend all day at work taking care of other people’s needs and being empathetic and tend to not have much left to take care of anything else once we’re home.  So not only does that leave us both without a gardner for ourselves, but who gardens the house?  Who gardens the relationships with friends and family?  And what scares me the most- even though we don’t have kids yet, who’s going to garden the kids??  
If being the spouse of an ER doctor is hard, what must it be like to be the child of a dual ER doctor couple?  I’d love to read a blog about that (if you fit that description, comment please!)  Beyond two stressed and exhausted parents, because let’s face it, that is not at all unique to ER doctor couples- kids need routine, and there is absolutely no routine in the home of a dual ER doctor couple.  It would be bad enough if only one parent was an ER doctor- when do I get to see Daddy today?  Is he going to be home for breakfast?  Or maybe he’s going to be leaving for work right after I get home from school?  Is today a day that I have to be extra quiet because Daddy is sleeping?  Daddy’s shift is over at 3, but who knows when he’ll actually be home.  Imagine if there was no certainty about Mommy or Daddy!  How about holidays?  My husband and I get one holiday off among Thanksgiving, Christmas and New Years- and each year it’s likely to change which one you get.  To only get to spend one of those holidays per year with both of your parents??  Or possibly even none of them if Mommy and Daddy don’t get the same holiday off?  It just makes me sad to think about. 
 I know that people must somehow make this work.  There must be plenty of couples who both do shift work and raise children.  My question is how.  Live in help?  Super-human powers?  Benevolent grandparents?  Confused children?  Seriously, if you are out there or have any insight- I need to hear it!

Tuesday, November 29, 2011

Wow, I'm an asshole

We have all had our moments in life where we surprise ourselves with our own behavior and say, “Wow, I’m an asshole!”  I dare say that doctors may have more of these moments than other people.  Most of us get into this line of work to help people.  We all wrote application essays about our deep empathetic sentiments and benevolent ways.  We probably even honored a class related to “Humanism in Medicine” in medical school (because, yes- in medical school you receive a grade for everything from how much you know about the Krebs cycle to how good of a human you are.)  So appropriately, it comes as quite a surprise to us when we realize that, despite our best efforts and that “honors” on our transcripts, we have become total assholes.  
And there is nothing quite like working in the ER to bring out the asshole in you.  
It was 5 minutes before the end of my incredibly busy shift and things were actually just starting to look good.  I had survived, and my list of patients was shaping up so that I might leave within the next 30 minutes as long as no one else walked in over the next 5 minutes.  With two minutes remaining before the finish line, the new patient popped up on my list.  Chief complaint: SIX MONTHS of weight loss and intermittent abdominal pain- currently pain free.  My train of thought went something like this: “Expletive!  Expletive me! Expletive these expletive-ing patients! Seriously?  At 11:28 at night in the EMERGENCY room with your SIX MONTHS of symptoms that are now resolved?   Seriously.”  But alas, this is the job, and I haven’t left earlier than 2 hours late in over a month anyway so why start now?
  I dragged myself to the patient’s room dying under the weight of this large chip on my shoulder and started getting the patient’s story.  While he explained the intermittent belly pain that he had for six months, that he hadn’t felt in the past three days- all I could do was wait for him to get to the part that would explain why he had chosen tonight, of all nights, 2 minutes before I would have been home free, to finally get this checked out.  He never got there.   So when he was done speaking, I asked, with all of the tact I could muster in my current state of rage, “So...  Did something get worse today that made you decide to come to the ED?”  (Read: why are you doing this to me?)  It turns out that he had actually already seen a doctor for this very issue that morning.  The doctor had appropriately ordered some blood tests to be done and would see the patient later in the week to go over the results.  Turns out, a family member, who had not seen him in several months, visited and became very concerned with his symptoms and insisted that he seek medical attention.  When the primary care doctor did not provide immediate answers, they presented to the emergency department for a more “expedited” workup.  You can imagine my delight.  As much as I wanted to launch into a tyrade about how the emergency room is for emergencies and how anything that has been going on for six months without killing you yet is highly unlikely to be an emergency- this would be bad for PR and I honestly didn’t have the energy.  I figured I would throw him a bone and order some basic blood tests so that I could then discharge him when they inevitably came back normal and have him see his primary care doctor for the rest of this workup. I could be leaving within an hour.  I start to examine the patient as I explain the labs that we will order and the limitations of the emergency department to provide a complete diagnosis in many situations.  As I placed my hands on his abdomen for a cursory exam... “Oh shit.  I am a complete asshole.”  There was a huge, firm, irregular mass under my fingers right in the middle of his abdomen.  I knew immediately- this guy has cancer, and I’m an asshole.   
This is how life works.  As soon as I became too wrapped up in how hard MY night had been, here was this guy’s cancerous belly mass under my fingers to remind me that most of my patients were still having a worse night than I was.  I might be going home 3 hours late, but he was going home with a new cancer diagnosis.  Maybe this is why I think doctors have more of these shameful moments.  We do have a hard job and sacrifice a lot to do what we do like many people do, but we are also constantly surrounded by people that have it far worse than we do; pain, terminal illness, disabilities...  Even the most unsavory of our patients, the drug seekers, the borderline personalities, the needy and anxious, the drunks- I still wouldn’t want to be in their shoes. So all of those inevitable and simply human moments of frustration, exhaustion and self preservation that we experience tend to make us feel like...   well...  assholes.

(please note that details relating to this patient's story have been changed to preserve privacy)

Tuesday, November 15, 2011


As anyone who works a rotating schedule with night shifts will understand, today I am in purgatory.  I hate purgatory.  I’m scheduled to work the first of a string of night shifts tonight.  The shift begins at 11:30pm and ends at 8am.  The last string of shifts that I worked (the last of which was the day before yesterday) were day shifts starting at 7am and ending at 4pm.  So two days ago I was going to bed precisely when I would (ideally) be waking up to go to work tonight.  That is what makes today purgatory- neither a day off nor a work day.  A day when my dutiful body naturally woke up at 5:00am (like I asked it to for the past several days) with all the energy to attack this “day” that does not require me to be at work, but a day that I will spend desperately trying to force my body out of it’s natural rhythm to save some shred of energy and wakefulness for the night shift.  
My body, much like my personality, does not take well to force.  In fact, just to spite me, my body will probably have more energy and motivation today than on most other days.  Just when I lay my body down to preemptively rest will be precisely when it starts itching to clean the kitchen or when my stomach will start gnawing away with hunger.  I will lie awake looking at the ceiling, looking at the clock, counting down the wasted minutes as they fly by as neither rest nor productive activity. 
 I could just say “screw it”, get up, enjoy this “day off,” and get shit done while I have this precious and fleeting motivation.  The price that I will pay, however, for living today like a normal human being is that at approximately 10pm I will still be a normal human being and will become sleepy eyed and exhausted, as normal humans do, just in time to go from 0-60mph at work in the ER.  Not ideal.  
On the other hand, there is always medication, right?  I am a doctor after all.  And if my patients are right, medication should be able to fix EVERYTHING. I can just medicate myself into superhuman feats of wakefulness!  Benadryl rotating with palpitation-inducing doses of caffeine!  Take that, body- you stubborn bitch!  Unfortunately, I’ve tried this too, and found that not only is my body stubborn, but it is vengeful when wronged.  And the only thing worse than working bleary-eyed with sleep deprivation is working bleary-eyed, hung over and tweeked out on stimulants.  
So here I sit in purgatory in my pajamas at 10:33am with my laptop, blogging, which -as luck would have it- is a nice little expenditure of mental without physical energy, since all of my energy expenditures are being painstakingly budgeted over the next 24 hours.  So as I conclude this post- let me apologize in advance to tonight’s patients for whatever lack of fortitude may be caused if I am unable to balance today’s voyage to Target with mind-numbing daytime television.  I hate purgatory.

Friday, November 11, 2011

So What's This All About?

So, “Physician, heal thyself” is a phrase that we have all heard.  It originated from the Bible (notice: the first and last time I will ever quote the bible) and refers to being able to do for yourself and your own people what you are able to do for others.  Seems simple enough.  My hairdresser always seems to have a killer do, and I bet a chef’s wife or husband eats pretty well at home.  But despite the fact that the phrase directly refers to physicians (although applies to everyone), this seems to be a completely alien concept to physicians.  We all know how challenging it is to take care of patients that don’t take care of themselves- well doctors make shitty patients- and that is only one reason why.
Becoming a physician has always meant sacrifice- probably more than many of us realized when we got ourselves into this- sacrifice of sleep, nutrition, relationships, exercise, bathroom breaks... and too often, by the end of training our last shreds of compassion.  We sacrifice all of these things for years to be in a position to take care of other people.  The profession was somehow built with the understanding that, in order to be good physicians, we must sacrifice our right to take care of ourselves to take care of other people. In the doctor/patient relationship- ONLY the patient is allowed to have needs.  It’s funny how medical schools have such a big push toward teaching “Humanism in Medicine” these days but in every other way expect you to be completely inhuman.
I recently finished my long and painful journey through the trenches of medical training- the years that we all claw our way through trying to keep a glimpse of the light at the end of the tunnel in view- that warm light that will magically transform us back into real humans.  Well, I’m out of the tunnel, and I still can’t seem to find this light.  (Jaded young doctor- oh, how cliche... stick with me though) I’ve done plenty of moping and commiserating with other young colleagues (which is how I know I’m not alone in this) about false expectations and regrets and feelings of being trapped.  Frankly, I feel like I have gotten myself into a huge mess that I can’t get myself out of and fear that I may never be happy again (ouch, heavy, I know).  
My dad passed away in 2005, but whenever I feel like I’m in a mess, it helps to imagine myself talking to him about it.  His response to any of my problems was always pretty much the same anyway, “So what are you doing about it?”  Simple, but it would always make me embarrassed to realize that the answer was too often “nothing, just complaining.”  So I guess in this situation, dad would have said “Physician, heal thyself” (albeit in a manner slightly less biblical), so that is what I’m doing here- attempting to heal myself through writing and whatever else it takes. To find my way back to happiness whether that be in medicine or not.  It was a long journey to get me to this point, and it may be a long journey to get me out- but I’m going to find that light, dammit!  Wherever it may be.  I hope that my blog entries will be therapeutic for me but maybe for other people too.  After all, that is what this physician thing is all about, right?