Another weekend gone…

Still recovering from a 30-hour shift over the weekend. The fatigue is starting to catch up with me. It is a half-sprint to the end now, just one week away. My nerves are on edge, and I come home only to dream that I am still in the hospital on call, and that my patients are dying. And so it goes. One foot in front of the next, over and over again. A zombie, you eventually reach the point where nothing can phase you. Multiple patients crashing at a time, monitors beeping, codes being called overhead. The constant rhythm of CPR compressions, epinephrine, atropine, check a pulse, and resume compressions. Shock if you can. And the beeper goes off again – another patient crashing, hovering in time and space between two worlds. And through it all you have an inner calm, an inner quiet, a sense of knowing exactly what to do, and equally a sense of knowing the degree of futility – for at the end of it all, the death rate is one hundred percent. In the end, nature will take its course. Another one bites the dust.

Nothing can phase me anymore – families falling apart, weeping over the bed of a young woman. Children rushing in, looking lost. The absence of people, a room which is empty except for the patient and his monitors, fighting for life all on his own.

How do we do it? And why do we do it? We do it because we have no other choice. We are here as soldiers, to keep on keeping on.This is our duty. This is the oath we took as physicians, to put our patients first. But at what cost? At what cost when our families are at home without us, night after night? At what cost when they themselves are sick, or need us, and we cannot be there? Maybe this is a selfish thought – too selfish, that is, for a physician. But I won’t deny myself that thought, because I know too well – after seeing all of the patients and families who come through our doors – that life does not have to be this way. This is a sacrifice we choose to make, and I would argue that we sometimes make it for our own “selfish” reasons. How could we truly perform the job well if we did not derive some benefit from it? I am far too sleep-deprived to delve into the reasons why I might need this, but I know there are many.

Today I had a window into one of the saddest moments of a husband’s life. His wife, a woman in her 60s, was diagnosed with metastatic adenocarcinoma. Although she had been ill for a period of months, she came to me in the morning alert and conversant. Her passing was a surprise – and this always makes it more difficult to accept. When I called to let her family know that she was in critical condition, the phone went to voicemail – and sure enough, her voice, young and vibrant, came through on the answering machine. I froze. I simply could not leave a message on the answering machine. And so I called again, and thankfully someone answered. But her voice on the machine made her real to me – and as I watched her husband weep at her bedside, it resonated in my head, and I began to wonder…where has her soul gone? Was her presence there at all in the room, with her family? Was her presence there at all as we ran the cardiac resuscitation? I wanted to bring her back – for her family, but also for myself. Based on the way her family was present and grieved so deeply for her loss, and based on the sound of her voice on the machine, it was clear that she had a strong spirit and a strong presence on this earth. As painful as it was to watch her husband through the glass windows, I could not help myself; I watched as he broke down at her side, holding her hand, a wave of thoughts overtaking him. And I began to wonder: what is the purpose of it all? This loss. The aging process. Going through life means losing the people we love, one by one. It means grieving, then picking ourselves up by our bootstraps, and moving on again. And so that is exactly what I did – the pager went off, another patient needed my attention, and so I walked away, the image of her room and the story of the morning etched in my mind.

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