During a particularly long stretch of being on call, of spending my days caring for patients, documenting in the EMR, and sleeping – I was spent. I felt like a horrible doctor. The blooper reel of my medical misadventures ran through my mind – the patient who decompensated before I got to the room, the emergent decision I made, and later regretted, the moments where my patience and compassion waned amidst an endless circuit of clinical demands and family meetings. I recalled all of these moments, and so many more, with a sense of failure. A sense of incompetence. A sinking reality that, perhaps, I should hang up my white coat for good. I would be frankly lying if I told you there were not any emotional outbursts, or even some big ugly tears, for the devastating reality of the outcomes my blood, sweat, and literal tears, resulted in. I was defined by all the ways I just wasn’t enough. At a particularly low moment, I was talking to a more senior colleague about a near-miss scenario. In the ICU, many moments are near-misses – it’s the name of the game. But still, I felt like I should have been able to anticipate it. I should have known. But I didn’t. I admitted I felt like a pathetic version of a physician. His response – that’s how I felt yesterday. That was the moment. The moment that I realized two critical concepts: 1) I was not alone, even if we do not talk about these low moments enough; and, 2) I defined my days in the worst possible way. My days were defined by the things I perceived that were so very wrong. By all of the ways I erred as a physician, because I am, like all of us, an imperfect person. Since then, I have considered how I define my days. I can choose to wade in the white coat-abandoning waters of my perceived failures and imperfections, or I could reflect on the successes of the day. I could recall the patient who survived the prolonged code and the family who commented on our incredible teamwork. Or the patient who was extubated when no one else believed it was possible. I could recall the patient who chose to withdraw life support, and then asked for me to come back just to be there. I stayed late, instead of returning to my own family, and held his hand as he drifted into his final moments. I hugged his family, who thanked me for giving him the best care, for both quantity and quality, of life. I could recall all of these defining moments of excellent care. Compassionate care. Care I am proud of. But, so rarely do I intentionally recall these moments. Too often, I passively allow the negative to greatly outweigh the positive. And it wears me down. After a particularly long stretch of being on call, of spending my days caring for patients, documenting in the EMR, and sleeping, that was all. I was spent. I felt like a horrible doctor. Then, I spent time reflecting on all the positive moments. The saves. The moments of compassion, connectedness, and clinical care; and I am less spent. There is rejuvenation in that reflection. Enough so, to get up and do it all again tomorrow. How do you define your days? Kelly Cawcutt is an internal medicine physician. Source
