Thursday, August 28, 2008

What If?

In Eat, Pray, Love Elizabeth Gilbert introduces us to her goons, Depression and Loneliness. They follow her through Rome and Italy as she begins her journey back to herself. I have thugs, too – the What Ifs? They’re a nebulous group of wanderers that pop up as uninvited guests to my thought party.

As a physician they appear as I’m trying to decide how to treat a febrile infant with no source for the fever. “What if,” they poke, “this baby is septic? Will the parents call for more advice, treatment?” “Will this child die in the night?”

“What if the eight-year old that hit his head on the basketball court has a subdural hematoma? What if I miss this serious diagnosis? What if I get sued?” They love to spin tornado-like into larger and larger scenarios of doom. Rarely, they bring news of good. There’s no “What if you catch this hip click before it becomes avascular necrosis of the femoral head and needs a hip replacement when this patient is 25 years old?" There’s no “What if you’ve caught this MRSA before it’s an admission to the hospital?”

They bleed into life as a mother, too, where they take advantage of my sympathy and relative novice state as the parent of a grade- schooler and tween. Never having charted this particular course in parenthood – and it’s very different being a parent and having experience and being a physician and having book-knowledge – is perfect fodder for these thugs.

“What if being too tired to read to Harry tonight makes him feel unloved, unintelligent, uninteresting – take your pick? What if my slightly overweight sons don't hit that growth spurt just right to put their body mass indexes into a normal range? What if someone takes my social and easy-going seven-year old? Who will I call? Where do I look first? What would he do?”

Neurosis is part of my hard drive. I was born to worry about something and these goons know that. A good day for them is when they spin me so tightly that I spook when someone drops a pencil or my husband sticks his head into my office to say hello. Sometimes the What Ifs bring their cousins the What’s Next and Whys. Newspaper trivia about lame lawsuits and pediatric listservs feed their hungry mouths, but they’re always starving for more. Sleep deprivation is a neon open sign to my goons, and if they can catch me just right, What Ifs can keep me up all night with their myriad possibilities.

Lexapro is weak garlic to the What If bloodsuckers that leach my energy. Gilbert’s kept her vampires at bay with Wellbutrin. Breathing exercises and meditation return me to now from La La Future Land where these ding-a-lings prefer to inhabit. Running, walking and exercise also repel the monsters that dwell in my head. Maybe they hate body odor and running shoes. Experience locks the door on the What Ifs cage using reason and common sense as arsenal for the grenades they lob at my head.

Do you know the What ifs?


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  2. MWAS, I TOTALLY know those thugs. They lurk around my neighborhood too.

    "Sleep deprivation is a neon open sign to my goons, and if they can catch me just right, What Ifs can keep me up...Lexapro is weak garlic to the What-If bloodsuckers..." BRILLIANTLY PUT!

    Sometimes I can fight them off by arm-wrestling them with a few "then's" and "so-what's." What if I can't get the spinal for this C-section and the OB/gyn thinks I'm an idiot? Well, then I'll go to epidural. What if the surgeon huffs and puffs about the delay? Then she needs to understand patient safety comes first. And if she thinks I'm a moron - so what? Does it REALLY matter?

    Sometimes it backfires, though, when I think of some really dreadful "then's." Then what? Well, then my husband by now has been brought into the loop and reminds me, "And worrying about it - is that really going to prevent that final dreadful thing?" No, honey, I know that, but what if...

    Those goons are hard if they happen to haunt you - I know! So I totally sympathize...:)


  3. I absolutely know these goons both inside and outside of Medicine. Their grip is mighty. Their power, I think, it what makes me get out of bed in the morning and put one foot ahead of the next.

    Right on.

  4. It sounds like I have a serious anxiety issue from this post, but most of the time I keep these guys at a very long distance. Every once and a while, though...especially if I am tired, hormonal, have had a string of tough diagnoses, or just burnt out; they know how to get to me.

  5. This post reminded me of my wife. She is attempting to enter Medical School next fall. We have three kids - who will be 8, 5, and 2 when she starts. She constantly battles those What Ifs - even though she is so amazing and brilliant and competent. She keeps hers at bay with Luvox, since many of them come from her OCD. But still there are many nights when I try (sometimes unsuccessfully) to help her fight the Doubts and What Ifs. I know that reading this post really blessed her - and me. The more she sees people succeeding where she desires to, the more she is able and willing to become the woman and doctor I know she can be. Thanks for sharing.

  6. This post had perfect timing. I've spent all day drowning in what ifs after a 15 year old severely disabled patient of mine died after getting a tracheostomy. What if I had shipped her out sooner? What if we had been able to intubate her the first time and she hadn't aspirated? What if I had been a more experienced physician? Would she still be alive today? The What Ifs nip at my heels daily as a busy family physician and a mother of 5, but today they took a big bite out of me.

  7. Personally, I think having the what ifs (as long as in check) is part and parcel of being a mother or being a physician. In a lot of ways they are good - I think probably a evolutionary component as they pertain to the well-being of our children. There is something maternal about caring for patients (thinking of FreshMD's Tucked In post), and perhaps they bleed in together -these neuroses.

    I've worked with residents before who have no What Ifs whatsoever (the ones I can think of happen to all be male) and it scares me.

  8. Ack! Get out of my head!

    Oh, yes, the what ifs...they haunt my sleeping and waking hours. Especially with work and the kids. Maybe I should look into some medical help so I can get more sleep and put the what ifs to rest, once and for all. Great post!

  9. Oh, yes the 'what ifs" and the "why can't I do it all's" those families are very closely related in my world. Maybe I need a switch in medications, because I seem to be getting worse not better.

  10. Pathology what-ifs have a way of startling you out of sleep at 3 am desperate and hyperventilating about whether you made the wrong call on something (usually a frozen section). Then you go into work, frantic and anginal, making a bee-line to the permanent slides, wherein lie the incontrovertible proof of the possible error in judgement from the previous day. So far, so good, but one day...

    So add one more to the list.

  11. My name is Todd Thomas and i would like to show you my personal experience with Wellbutrin.

    I am 29 years old. Have been on Wellbutrin for 2 weeks now. The positives do not outweigh the negatives in any way.I strongly recommend trying natural dopamine supplements that are out there including Gaba.Look into it.All that I was getting with anti-depressants was frustration which led to helplessness which led to hopelessnes and suicidal feelings.Its really sad to know that drugs whether legal or not,can become a dependency factor,and when they fail to live up to the standards,and after all the $$$ has been handed over,we all end up right back where we started.I am always interested in talking to people about this subject..

    I have experienced some of these side effects -
    Insomnia,extreme energy surges and stomach aches.I also had appetite decrease.

    I hope this information will be useful to others,
    Todd Thomas


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