What occurred to me this week was that, underlying the fulfillment, and often barricaded back by the gratitude, is the fact that this is also very challenging and exhausting work. It means carrying the grief of others and seeing their pain, sadness, and frustration and trying to guide them through the underbrush and dim light to the other side of the forest. I make the trip several times a day, know the way to bring them through some of their fear. I find patients on a dark path, knowing what lies ahead of them won't be easy, and I try to say, "You are not the first to go here, and there is a way through. I will keep you from feeling the thorns and fearing the strange noises and rumbling around us. I will do my best to keep you from suffering on this journey."
The problem is, when you walk that path so many times a day, you can't avoid every thorn yourself. The sense of what is lurking in the darkness can't be avoided. First there are a few tattered bits of cloth caught by a bramble, easy enough to look beyond as you keep leading others through the woods. Then a sleeve gets caught and torn, and as more and more of the outer layers between you and the reality of this dark world become more shredded, eventually you feel a scrape on your skin. At first nothing more than a scratch, but each journey comes closer and closer to drawing blood. Until, eventually, you have wounds as fresh and tender as the wounds on the people you are trying to protect.
So here I am, after eight weeks of trips through the forest, finding myself tattered and exposed, trickles of blood appearing. Raw.
The first blood was drawn Sunday night when, after spending the entire weekend working, standing by families and patients, attending to death, I came home, tired, anxious to cuddle my child and have an evening to recuperate. On my way home I got a call that a new patient had arrived, and the family was very upset that there was no longer a doctor in the facility. Having already kept the babysitter almost 2 hours later than she'd planned, the thought of turning around and going back made me want to cry. I was told the staff there would try and handle the situation, explain that, being a Sunday evening, there was not generally a physician in house. I had left orders for the patient's care, spoken with the nurses about the plan, and me being there was, truly, not necessary. Several phone calls and a couple of hours later, I heard that the family was still livid but had calmed down to a low simmer. They had, though, stated that "whichever doctor didn't care enough to stay here or come back and see our mother has no business taking care of her and we want someone else to see her."
Hearing that, my temper boiled. Me, not caring enough? Hadn't I stayed hours longer than expected that day because I wanted to sit with a family whose mother had died? Hadn't I stayed longer that day to make sure the patient with worsening pain was doing better after I made changes to her medications? Hadn't I sacrificed time with my son to make sure people who are relative strangers to me have the best care possible? And after that, be accused, by someone who has never met me, of NOT caring?
This isn't a career I chose in order to be recognized for my personal sacrifices or be seen as some kind of saint, but eventually, after putting every bit of my heart and mind into what I do I become sensitive to being accused of anything short of that. I tried to work through my anger. Tried to remember this is a grieving family, and grief has many faces. They don't know what they are saying. They misunderstood the information and now had to adjust their view of the situation. Still, I woke up several times overnight and immediately felt my heart begin to race, anger well up. My drive to work that morning was dreadful, knowing I would have to face these people, but maintain my calm and rational demeanor, maintain professionalism.
I didn't have to, though. The patient had died overnight, her family at her bedside. She was not in pain or distress. With some measure of guilt, I thought to myself, "thank God." It meant one less challenge to face that day.
This week has worn on, under the shadow of that rough start. My son and husband, and then eventually me, were all struck by a stomach bug. I was up nearly an entire night caring for my vomiting toddler while my husband retreated to the bathroom not to escape until the morning. I had to go to work the next morning, and since H looked better and his daddy was still a mess, and there wasn't really another option, I took the poor little guy to preschool. I cried when I left- knowing I had chosen work over my child.
The night before everyone got sick, I got news that a dear friend had miscarried her twin babies. What can I do for her? Offer her for comfort or peace? Nothing. Yet all day long I comfort strangers. Those close to me, though, I feel worthless to even try and help.
My grandmother is on a nursing home. Her health is failing, I see her heading down a path that I have watched so many of my patients head down. She is 200 miles away, though, and I can't take care of her or make sure her doctors are doing the best for her. I talk to my mom once or twice a day, hear the strain and grief of seeing her own mother slipping away.
All around me, people I love dearly are caught up in the thorn bushes, crouching away from the sounds in the darkness, searching for a direction on a path. I'm not with them, though. I'm with people I hardly know. People who, while I know they need me and appreciate what I do for them, have never done anything for me. All the while, some of those who have been there for me my entire life and helped me get to this point, are suffering. And I feel powerless to take their hands and show them through the dark path.
So, with my body physically exhausted, my heart emotionally tattered, my spirit powerfully drained, I felt myself collapsing. It started with a tearful display at a meeting Wednesday morning. Continued as I drove home to my sick boys that afternoon. Thursday morning I went back to work, hoping to get in as much as possible before the stomach bug took full hold, but also breaking into tears again when another doctor showed me some kindness and told me I should go home.
So, I did come home. H and I curled up in my bed for a three hour nap. I slept through the night last night, and woke up to a day that I already had off (the benefit of working through the prior weekend). I've spent the morning relaxing with my still-not-100%-toddler. And now I have given voice to my own grief, revealed some of the emotional cuts and bruises that come along with my job.