Rain Reflections: Into the fall…

There is a darkness outside. An icy wind cuts through the windows, on a mission to an unknown destination. A lone dog howls, mixing melancholy and anger into discordant moans. Two boys pedal their tricycles – the squeaking of their wheels a hollow echo along a stretch of abandoned sidewalk. A young woman stares hard at herself in the mirror as she slides a knife along her inner arm, red blossoming from a thin crooked line. A man holds a gun at his hip, screaming at the top of his lungs, observing with contentment as three girls tremble.

I am drained. Too drained, in fact, to comment on any of the new and interesting articles out there in the medical world. Most notable, perhaps, being Abigail Zuger’s piece on isolation in the hospital, Isolation, an Ancient and Lonely Practice, Endures. Tonight I feel more like the patient in her story than the physician. Today I cared for a young woman who chose to drink several cleaning fluids in an attempt to hurt herself – or more as a an outcry for help – after a fight with her mother which sent her into a spiral of stress and frustration. Although I have never reached a point in my life where the cleaning fluids beneath the sink seemed like the best option, today more than ever I could see where she was coming from. The moon was orange last night – a harvest moon. The color of the moon changes depending on the time of year and on refraction of sunlight – which, in turn, changes based on the amount of dust and clouds in the Earth’s atmosphere. The color can vary from gray to blue to yellow to orange, even red. Tonight it was orange, shrouded in clouds. The emergency department was filled with sicker patients than usual. There is something foreboding in the air, but I cannot put my finger on it. Maybe it is the approaching storm, or maybe it is something else.

A total lunar eclipse, photographed on Oct. 27, 2004, from Palm Beach Gardens, Florida.

Intuition is something Dr. Judith Orloff – a psychiatrist, patient, and writer – discusses quite elegantly in her book entitled Emotional Freedom. She strongly believes the idea that certain people have intuition – beyond logic or reason – and are capable of using it to sense things that are not outwardly apparent. It is difficult to find scientists or physicians – or anyone with scientific or medical training – who believe in intuition. But our inability to explain it through research does not serve as adequate proof that it does not exist.

And so, drained, I leave tonight with uneasy thoughts and reluctant anticipation. Perhaps this storm will pass uneventfully, or perhaps there is another storm on its way – something deeper and more internal than the thrashing winds and pouring sheets of rain – that will only be revealed in the days to come.

Maybe this intuition is only a reflection of my own senses. Maybe residency is a storm, wearing me down and taking its toll, day in, day out, hour after hour – as I am flooded with a room full of suffering patients, and as I encounter moment upon moment of difficult intubations, suicide attempts, sexual assaults. The rain never stops, the flood never subsides, the doors never close – and I never leave, through it all.

The cruel irony is that even when I leave for 12 to 24 hours, I never really leave. My spirit remains there. This flood creeps in through the windows to invade my dreams, interrupt my sleep, and remind me that my patients are still – always – present, waiting, coming, dying. If this is drowning, then I know now that I have never felt drowning before – never in all the trials and tribulations that were required for me to reach this point in my training. I have been strong, stalwart. I have endured. But now my sense of time is breaking down.

I can only infer the passage of time from everyone else around me. This patient will eventually roll upstairs to the intensive care unit, and then will no longer be mine. My attending will eventually finish his shift, and so I will go home just before he does. My colleague is driving in to work now – and this means I will eventually be relieved. I can no longer measure time by my internal clock – it is frozen, shattered. Just like the clock, my days too are shattered – chopped carelessly into hospital shifts all strung together into one long, wavering tight rope line. Never ending – or so it seems. For now, I hold my breath and wait for this all to sink in, or subside.

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