Thursday, December 12, 2013

Guest post: How Medicine’s Changed Me – the Good and the Bad

After 11 years of training and going on five years of practice, there is no question that medicine has changed me in numerous ways. Some definitely for the good. Some for the not-so-good. On good days, I’m more optimistic and have a deeper faith in humanity as a result of my practice.  As a pediatrician, I see patients who are often funny, are so incredibly resilient and have lives full of possibility ahead of them. I have seen and participated in miracles. I have witnessed deep compassion and graciousness, in both my coworkers and the families we serve. I have seen others make sacrifices to do their best for our patients and their families. My practice is frequently deeply rewarding.

But my practice can also be incredibly difficult. As a pediatric emergency medicine physician, I bear frequent witness to the senselessness of tragedy. I have struggled to save a life and failed. More than once. I deliver news of devastating new diagnoses - the brain tumor, leukemia, intracranial bleeds. I have been yelled at, cursed at. It is a rare shift that I don’t see a child for suspected or known abuse. I care for families who are at the end of their rope, trapped in generational cycles of poverty and violence.  I see children whose physical symptoms are the result of anxiety, fear and toxic stress. At times, I feel my patients are trapped, that their lives are not filled with possibility. Currently, it is the changes brought about by this aspect of my practice that I struggle with.

I know that I’m not the same person now that I was when I slipped into my first white coat. I’m not even the same person I was when I finished my fellowship not quite five years ago. There are days when I struggle to be compassionate and gracious to my patients, their families, my coworkers and myself.  Days when I feel unable to tolerate complexity. Days when I don’t tolerate the chaos of my home as well, when I feel unable to be fully present with my husband and children. There are cases that haunt me, that I feel will always haunt me. This problem goes by many names - compassion fatigue, vicarious trauma, secondary traumatic stress.  Some say it is burnout; some say it contributes to burnout. Define it how you will, it is real and it is common.

There is a growing movement in the medical community to combat this dark side of our vocation. The hospital at which I work recently started a program for staff well-being that includes mindfulness seminars and meditation sessions. Even though I am in the beginning stages of a practice of mindfulness, it’s already helping me deal with this dark side of medicine. This new awareness, this mindfulness, is another way that medicine is changing me.  Out of necessity, yes, to enable me to deal with some not-so-good ways that I have been changed by carrying out this calling to bear witness and to enable healing. But ultimately, learning ways in which to combat these not-so-good changes that often accompany a life in medicine will result in another good change - the ability to be more present at work and home, to live more fully and to care more compassionately. And to retain my sense of gratefulness for this vocation that I am, when it comes down to it, oh-so-thankful to be pursuing.


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