June 6, 2010 Leave a comment
Just as there are the comical drunks, the depressed drunks, the loud drunks, the quiet, mumbling drunks, and the hermit-bursting-out-of-its-shell drunks, so it is with post-call delirium. Everyone has their own characteristic response to 30 hours without sleep. The brutality of a 30-hour shift with incessant pages (don’t broach the question of why we aren’t given phones…I would not be able to give you a sensible answers) is quite unparalled, in my mind. Endurance, intellect, patience, and genuine compassion are all required to get through it – not to mention competence and clear thinking, which are less simple to control. I hit the bed at 4:02AM today to the sound of beeping monitors, and continued to be woken up every 3 to 5 minutes by a nurse with questions. Sleep is shallow and constantly interrupted. You dream with the sound of beeping monitors as a constant intrusion, and you’re never sure if they’re intruding from the outside or if they’re in your dream. Not worth exploring, they continue on incessantly. And then you wake to the sound of beeping monitors. And then you round with the sound of beeping monitors in the background. They become the soft, irritating rhythm of the day and your body falls in step. You leave the hospital and hear them on the drive home, and they even seem to squeeze their way beneath the comforters of your very own bed. How audacious they are.
Now I recall one of the reasons I chose emergency medicine: time flies there. Maybe it’s because there are no clocks, or you never have time to check your watch. But the main thing is you’re so busy, flying, riding the wave of sick incomers, one after another after another…and so 5 hours fly in the blink of an eye and 12 hours pass in a matter of moments. You’re so overwhelmed that you don’t have time to think: here I am, in this windowless basement, a haven for the sickest of the sick. And even if you do, it is only a fleeting thought before the next critically ill patient rolls through the doorway. This is why I like it: because I don’t have time to remember how much I dislike being in a hospital, day in day out, 365 days a year, 1460 days in total.
On the floors, you have time to think about being in the hospital. Even have time to reflect on what a hospital really is. It is supposed to be a place to heal the sick. In practice, it is a place to treat the sick – but how we treat them and whether or not they get better are questions which I will not address here. The politics of medicine are rampant, just as in any large organization, and so patients sit around at $10,000 awaiting an expert consult from an expert who is out of the country.
But at least most of the patients in the ICU are sick, and so it is much easier to develop some form of empathy for them and their families. To survive, of course, I develop this then proceed to shove it into the deepest, darkest spot of myself, where I let it harbor and fester and grow. It is only after time, day in, day out, that these troubles begin to fill all the crevices in my body to the point where they can no longer find any space to live. And thus we enter the point of breakdown. Thus far, I have been successful at avoiding the breakdown; but it happens predictably during week 4, when I can no longer take any more, when I begin dragging my feet, and when the only thing that keeps me going is the light at the end of the tunnel.