April is the time of the year when the additive months of psychological toil and physical stress from first year of fellowship culminates in a palpable weight. The sleepless nights of weeks of calls on end, the familiar scenarios of ushering family through tough times, and the dedication of advocating for your patient builds up to a toll. It’s easy to get “burnt out,” so to speak. To feel by default as if you can’t care as much anymore. To feel as if you are living for the next day off. To feel as if you are on autopilot.
Today, I sat between my ICU attending and ICU resident during a mid-day memorial service the VA hospital held in the hospital chapel honoring the veterans who had passed in ICU in the last 3 months. Family of various veterans were there. In a short period of time, the chaplain covered a lot of material on grief and honoring those who have passed. He read from two very disparate yet neighboring scriptures in psalms 22&23. Psalm 22 speaking on the the extent of vacuum and sense of isolation felt in our loss. Psalm 23 as one where peace of mind and joy can come even in the midst of a tumultuous storm. He read a poem called “We are Seven” from Wordsworth, a poem about tragedy and strife experienced by a young girl who loses her siblings yet defiantly, resiliently responds to death with hope. The message being that although death is inevitable, our response to it does not have to be one of resignation and hopelessness. Then he sang “Fallen, but not Forgotten”. In my mind flashed the faces of those patients whom I had lost and our last words… “we’ll take good care of you,” “don’t worry, you won’t have pain”.
This year has been a year of firsts for me. First solo intubation, chest tube. First crazy save. First time crying during the middle of a family meeting. It has been a year full of codes, full of losses, full of saves, full of laughter, full of grief. Full of rotating through different hospitals, coming and going, and meeting a lot of people: patients, families, students, residents, nurses, respiratory therapists, pharmacists. Wonderful, great people who have taught me so much, supported me, and been pillars of strengths for me. It’s an emotional time.
In medicine, and perhaps more so in critical care, people depend on YOU, the physician, to lead the team, to stay calm under pressure, to direct the code. If you don’t, at the worst, chaos may ensue, at the best, it feeds stress and anxiety. You have to be strong, to be reliable. There is not a whole lot of opportunities to be vulnerable, no room to show your weaknesses. For doctors as a whole, we deal with our own stress by talking to each other about medicine A LOT. This aspect makes our non-medicine colleagues extremely frustrated with us in social settings. It seems as we cannot stop talking about medicine. But it’s because a large amount of our life investment has been poured out into this. Our patient are so much a part of our lives that they literally consume our dreams and our thoughts. Most of us would put our own lives on hold in a heart beat for them, willingly and lovingly, because we love what we do. This is not anything heroic, it’s simply what we agreed to do when we signed up.
This year has been a whirlwind and a barrel of emotions to sift through, and there seems to be no time to dive into it. In the memorial service today, I paused to grieve the losses of this year, in a community with others who experienced it…with my fellow colleagues, with families, and in a public place where I work. It allowed for me to be vulnerable and acknowledge my own feelings, for just a second, in a place where I am expected to be strong. I was reminded of why we do what we do, reminded of the hope in living, and the healing that comes with honoring the lost.