Monday, May 23, 2011

Triggers

The first time it happened I was an intern. I was starting the first day of a week of vacation after a 6 month straight spell of no vacation and few full weekends. I had just finished one of our more demanding services and had been up until 1am finishing up notes. I woke up late Monday morning - after the sun was up - and got in the shower. It was a bright, beautiful sunny day! Then, about 5 minutes into this glorious long shower I started BAWLING!!!! Just the day before I heard about a patient that I’d taken care of off and on all year - she had died in hospice earlier that week. She was a patient who I got to know well. I got to know her family. I was devastated but never really felt it because I was just way to busy. Well, five minutes into my vacation shower I started to feel it. I started to think of all the patients who had died - oncology patients who fought hard to the end, sick kids in the PICU, bad trauma patients, EVERYTHING!!! I cried for like an hour! Then I got myself together, and went out for breakfast.

Well, this morning, I was driving to work. I had just dropped my super cute daughter off at daycare and I was having a good morning. Then, on npr there was a story about poet Dean Young who had just received a heart transplant. In the interview he talks about what it means to receive a heart from someone - in his case a 22 year old college student - and suddenly I start crying. A patient I took care of died over a year ago suddenly and very dramatically after being totally stable from his heart transplant. It was a heart I helped procure. He was one of the kindest patients I had ever had. He was young and so happy about the new life he was about to begin. I had a hard time with his death last year but I thought it was behind me. However, here I was, in my car, crying for this patient. I knew I needed to write about this, the thought of writing it out is part of what got me to stop crying so that I could get out of my car and go to work. How do we deal with the crushing losses we are a part of? How do we stay human and also stay sane?

7 comments:

  1. By doing exactly what you're doing :) Let it out! Cry, write, talk to someone about it. Being in healthcare, we see the worst of the worst at times, but remember you're human-the day it doesn't effect you, it's time to throw in the towel. Hang in there!

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  2. @Cutter-You are doing exactly what you are supposed to do. I would worry if you did not have to vent every once in a while. These events do not seem to signal that you cannot deal--just that you have had a bad run.

    I do med/onc so sometimes the bad events pile up. Vacation is vital because it gives me the time to process away from the stresses of work. Honestly, the day it stops bothering me or the year when the deaths or bad outcomes seem blase is the signal for me to retire.

    I have repeatedly said I love my work and I mean even the bad days, but being human means finding an outlet for the emotion you cannot release at work or even during the day to day. Yoga,religion,running, writing, whatever floats your boat. Sometimes a hug from my 2 year old will do....

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  3. Part of the wonderful thing about being a pathologist is being so removed from seeing the actual patient that you are giving a cancer diagnosis to.

    Having said that, I still break down from time to time. It's natural. Especially when I look at a nasty breast cancer and see lactating ducts right next door. Nursing moms should NOT get breast cancer.

    You sound like you are handling things beautifully.

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  4. I've thought you sounded like a wonderful mother all along. This has confirmed you're an awesome dr too.
    I hope I never end up in the care of a doctor who doesn't have these same feelings you're describing. And I sure hope I never become one.

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  5. I work in psychiatry, where I treat people with PTSD from horrible events, take social histories that involve unbelievably rates of childhood abuse and neglect, and lose patients to suicide.

    It is a real struggle for me to retain a positive view of the world, sometimes. I begin to feel like despite all the goodness I also see, the world is filled with so much evil that no amount of good could actually overcome it.

    I take my daughter to the playground, and sometimes when I look around at the happy children and parents, I think of my patients and the suffering they've been through, and the statistics that suggest that some real fraction of those children right in front of me will be seriously abused before they are grown.

    I heavily censor the things I tell my husband and other family members about my day to day work, so that they don't start to dread hearing me talk about work, figuring it will just be another sad sad story they didn't really want to know.

    This isn't always true, and I work hard to build a "wall" that will allow me to continue to feel for my patients when I am with them but not to let the sadness of it all creep to far into the rest of my life. But it's a real struggle, and it's one of my very biggest fears about how my profession will affect my life and my family.

    Finally, I think that my susceptibility to this is in a real way higher for being a mother at this point in my training. Other people at my stage in my training are not yet parents, and I think it leads to a subtle but real change in how this issue affects me vs them, sometimes.

    I would love to hear more about how others handle this.

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  6. I think medicine is one of those places where those losses also make us appreciate joys more - both in our own lives and in our patients' lives. I see mostly older patients and the fact that i have seen some of them through the heartbreaking loss of a child makes other, more simple, everyday stories, more joyful. one of my elderly patients today wanted all new scripts to take with her to out of state to see her great-granddaughter graduate from high school. she was so proud and happy she was glowing. It doesn't make the losses any easier at the time though.

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  7. I'm so glad to have seen this. I'm a soon to be 4th year, coming back from a leave of absence. This year really did allow me to reflect. I find myself crying and sobbing for no apparent reason sometimes. Sometimes, I start feeling down and than it just snowballs because I start thinking of the sadness that I've seen. Today I cried three times. Once in the morning. Then twice in the afternoon, once triggered by the ambulance.

    I'm struggling to understand my emotions and to use them effectively too. But if this lead sto more compassion...you know, I'm okay with it. It's just a bit unnerving is all...

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