A Lonely Calling
July 12, 2010 2 Comments
There is a place
where the village meets the sky.
To walk along the water’s edge and be away from the hospital, even for a day, is relaxing. My breathing here is slower, deeper. When I look back on medical residency, I can hardly imagine how much I have changed since the beginning. The process of growing from an intern to a physician happened without my noticing. Central lines slide into the internal jugular with ease. I slip breathing tubes just below the epiglottis and curve them upwards between the vocal chords almost as often as I place a straw into a cold glass of iced tea. Puncturing the lumbar spine for dripping fluid, threading a long line into the narrow radial artery, suturing a through and through lip laceration with perfect alignment – all of these have become second nature. I can remember a time, not too long ago, when they were terrifying.
More and more, I feel like the RocketMan in Elton John’s song, a lone astronaut wandering in space, gear and all, forcibly removed from the rest of the world. Medicine is a lonely calling. As a physician, I spend so much of my time caring for patients. I am a listener, observer, sympathizer. If I were to let my own emotions intrude during the day, the results would be disastrous. As a physician, I am not expected to share. I observe. Tragedies, healing, grief, gratitude, survival. I am an onlooker in people’s lives. As such, I walk this road alone much of the time.
I often find that I am the only stranger in a room full of family members – not only that, I am a central presence in that room because I have knowledge which affects their lives. I still remember the first time that I declared one of my patients dead. In my four years of medical school, no one had ever taught me how to do this. It was close to Christmas. Heavy snow was falling outside. The coronary care unit was decorated with white lights and candy baskets. A nurse came up to me at 2AM and said, “You need to come to the room. I think Mrs. S has passed away.” It was one of the many times in medicine that my heart skipped a beat. I turned to her with what must have been a look of pale disbelief – it inspired the first warm smile I had ever seen from her. I asked her what I needed to do. She told me. And then I asked her if she would come into the room with me. She said she would.
It was one of the longest minutes of my life – 60 seconds with my stethoscope on her silent heart. I watched the clock. I watched her face, eyes closed, motionless. I watched the expressions of all of the family members who were circled around me. I watched the clock again, wondering if she might miraculously take a breath, wanting time to move quickly but simultaneously not wanting it to move at all. When the 60 seconds had passed, I announced her time of death in a shaky, uncertain voice. Her sons shook my hand, patted me on the back, thanked me – more for me than for them, I realize now.
Since then, so much has changed. The last time a patient died, I looked at my watch and wondered if I had time to get a sandwich at the cafeteria which was closing before going upstairs to meet with the family. It may sound cruel, but that is how the volume of death I have seen and my extreme fatigue have affected me. I walked quietly into the room with a clear task – to listen for 60 seconds, express my condolences to the family, request a chaplain to take over for me, and leave the room to complete the pages and pages of paperwork.
Being a physician has required building up walls upon walls in the hospital. And no matter how many colleagues surround me, I so often find myself in situations where I am the “doctor,” where I am the outsider in the midst of an entire family – trying to figure out how exactly I belong, knowing all along that I never will.