Death by a thousand clicks.
I could feel the anger start to boil over as I painstakingly built my new 80 year old patient’s chart in the electronic medical record.
*Click Past Medical History*
Type in hypertension.
*Click*
What kind of hypertension? Renovascular hypertension? Essential hypertension?
*Click essential hypertension*
Hypertensive emergency? Or just urgency? Or well controlled?
*Click hypertensive emergency*
*Click accept*
Problem #2:
Type in chest pain.
What kind of chest pain? Angina? Musculoskeletal? Unspecified?
*Click angina*
Angina of native arteries? Non-native arterial grafts? Unspecified?
Hell if I know! That’s why he’s being admitted – so we can figure that out. Just click unspecified everything, M. I’m sure the billers will love annotating the entire chart with their clinical documentation “improvement” questions.
How many more diagnoses do I have to put in here? 15 more? And just wait til we get to the medications – then I get to click 10 times for each med because typing “mg” is not enough, the frickin’ EMR needs to flash a popup so you can click again to confirm you indeed meant “mg”.
At this rate it was going to take me more time to build the patient’s chart than it took to actually interview the patient. I missed the days when I could just speak into a phone and spend 3 minutes dictating my H&P. Now I was looking at another 40 minutes of containing my rage as I slogged through all this garbage.
Couldn’t he have just gone to the hospital system he usually goes to???
The buzzing of my phone interrupted my train of thought. Welcoming a distraction, I glanced down to read the text on the screen.
“Oh hey. How’s it going?”
How’s it going? Such a loaded question, especially coming from H.
Guessing from the timing on this Wednesday afternoon, H had probably read my last blog post where I said to myself: Yes, we need good doctors. But who said it has to be me? Which probably meant he was checking in on my mental health.
And why shouldn’t he? After J, he’s the first person you openly admitted you were struggling to. H has been invested ever since your time together in residency. This is what friends do.
Pushing aside the urge to fall back on my go-to: “It’s fine”, I sighed and answered the question he was actually asking.
“Not great.”
“I can tell. You alright?”
Mulling over my response, my antiquated pager sounded off.
Not right now, M. If you open that door, you’re not going to be able to keep your shit together for the next 4 hours. Just live one click and one page at a time.
Putting my phone away, I returned to the task at hand. Dr. M was here to work and save lives by clicking through incredibly inefficient electronic medical records. With a smile and heart full of compassion. Regular M could whine and cry about things later.
I could hear my old scribe A‘s voice echo from what felt like a lifetime ago,
“I’ve never seen someone switch so quickly before! You’re so sweet in the room and as soon as you walk out, you’re completely cynical.”
Compartmentalization. Used by psychopaths and doctors alike to get the job done.
Quickly immersed again in an onslaught of pages and paperwork, an hour and a half later I reached for my phone. Missed call from H and a few texts from J.
Oops. “Not great” was probably not the best thing to leave him hanging on.
Swiping over to my texts, I received the following instructions from J:
“Just talked to H for a bit. You should call him on your way home.”
Calling in the reinforcements now, are we?
I didn’t know whether to feel loved or annoyed. Or betrayed.
Well, maybe J just thought talking to another doctor would be helpful, M. Especially one that went through residency with you. Who remembers you before you turned into… this. Besides, remember how you still enjoy his company?
Of all my friends from residency, H was the one I stayed in contact with the most. The others had faded into more of a Facebook “friend” status, not out of ill will but because of all those cliché reasons lonely people give at the end of their lives – life got in the way. Kids. Work. Overstuffed schedules. Distance. Different time zones.
But not H.
No, even after J and I moved across the country almost 4 years ago, he still checked in. “What uppp?”, “Heyy” and “Sup” were regular occurrences every 1-2 months, even with his busy fellowship schedule.
And now he was still making the time to check in on me.
Get over yourself and call him, M. It’s not like you can do anything else productive during your 35 minute commute home.
Tapping his name on the screen, I waited for what felt like an eternity as the phone rang and went to voicemail. A mix of disappointment and relief washed over me.
Did I really want to talk to someone who if the whole world was on fire, he’d be the person to say, “How did they know I wanted to make s’mores?!” Misery does not make friends with eternal optimists. Now I could say I tried but not have to open all this up.
Just as I was about to take my earbuds out, I saw his name pop up.
That would’ve been too easy…
“Hello?”
“Heyy… how are things?”
“They’re going.”
“Yeah? What’s going on?”
“… What did J tell you?”
“Oh, he just told me the job wasn’t working out the way you’d hoped. But now YOU can tell me. I mean, I know how much you love talking about your feelings and what you really think…”
Smirking, I thought back to the conversation he was referencing from 3 years ago.
“I don’t even know what you really think of me.”
“What?!”
“You’re so guarded, M… you don’t let anyone in. You just say, ‘Interesting’ and don’t commit to an opinion. I don’t even know if you really like me or just want me to think you like me as a person. And we’ve been friends for 3 years! I mean, I’m visiting you guys across the country and I still don’t know.”
“Inter– mmhmm… what would you like me to say?”
H threw his hands up as J laughed and shrugged as if to say, Welcome to my life.
I was never a wear-my-heart-on-my-sleeve kind of girl. But if I spent time, my most precious commodity, with or for someone, I just assumed they knew I cared.
And we had already spent so much time together beyond the confines of residency.
During multiple home-cooked dinners at our place after he admitted to eating Starburst and gatorade as a legit meal during an inpatient month. Spending hours upon hours down Youtube rabbit holes, including red hot nickel ball steaming through velveeta cheese and the world’s largest gummy bear. Impromptu sleepovers on each other’s couches because dozing off to sleep was preferable to saying goodbye.
After residency, he visited J and I on the other side of the country more frequently than even my own family, bringing us face to face for this awkward confrontation where he was pushing me beyond my comfort zone.
He wanted words of affirmation.
Words.
They hold so much power but I can’t control what meaning people assign to them. People hear through the lens of their own lives, not mine. How could I speak, knowing the value of these words might resonate differently in his heart than what mine is trying to say?
3 years later, again he was asking me to speak.
But this time I recognized the lie I once told myself.
That my silence would keep me safe. Safe from judgement, safe from harm.
That being vulnerable was a sign of weakness.
That living life with an open heart would only lead to disappointment.
No.
A funny thing happens when you decide to shed the layers of protection – you attract your people a lot faster than if you were to try to pick them out of a crowd yourself.
The ones who feel your wins as their own.
The friends who want to hug the broken pieces of you back together.
The people who will drop everything at a moment’s notice to call and demand you talk to them, even if you can’t find the words you want to say.
Even as I struggled against the urge to shut down the conversation with each question asked, I was secure in the rightness of this.
When the career fades, accomplishments become mere footnotes in my history and years quicken over the passage of time, what will be left but family?
Friends are the family you choose. And I’ve been fortunate enough to have been chosen by H, time and time again.
“So we’re still on for our trip this fall, right? That’ll at least give you something to look forward to! B and I are excited about it.”
“Of course! H… thanks for calling.”
As I pulled into the garage and watched J come out with the dogs to greet me, I saw him yet again shutter down the worry he always tried to conceal from me. Taking my bag, J asked deceptively nonchalantly,
“So? You called H?”
Encircling my arms around his waist and resting my ear next to J’s steady, beating heart, I decided – loved, not betrayed.
Who else would see my stubbornness and unwillingness to talk and raise me a trusted friend with a sledgehammer to break down my carefully constructed walls, even if that meant risking my wrath at the end of the day? He was going to pull me out of this, even if that meant enduring my kicking and screaming the entire way.
Sure, you probably could get through this by yourself, but why? You don’t need to go through this alone, M.
Sometimes the bravest thing you can do is accept a helping hand.
Somehow we’ve come to equate success with not needing anyone. Many of us are willing to extend a helping hand, but we’re very reluctant to reach out for help when we need it ourselves. It’s as if we’ve divided the world into “those who offer help” and “those who need help.”
The truth is that we are both.
-Brené Brown
***
Thank you to everyone who sent me messages/emails/DMs after last week’s post.
I intentionally stepped back from the blog and social media so I could spend time with the people in my life, but please know I appreciated all the words of encouragement/commiseration and am slowly working on catching back up on your comments!
There won’t be a post for next week since I’ll be spending some quality time with friends but in the meantime, CLICK HERE to get a behind the scenes peek at the blog (and me!) as I undergo the X-ray beam and answer some really thoughtful questions from Xrayvsn!
***
Photo taken of a J and H walking off the edge of a cliff AKA the trail to Mount Fremont Lookout point.
From my own burnout adventure, documented elsewhere ad nauseum, I found that the more I revealed, not only did I feel better, but others around me seemed to benefit, too. It’s like the exact opposite of doctorthink, where you expect everyone to think you are nuts and flee you as if you were Chernobyl on 4/26/86.
Here’s how it needs to go…
H: M, howya doing?
M: Actually, I am really struggling now, to be honest. (And then you tell him what’s going in your head, just like you tell us every week.)
When you can do that, you will be on the road way to recovery. I promise.
I’m definitely a lot more open to those who are willing to listen than I was 3 years ago… this last interaction with H really highlighted that for me.
I think the difficulty is trying to surmise who is asking, “How are you?”, for the sake of asking vs who is wanting to know the actual answer. Two very different answers for two very different scenarios. It’s a fine line to walk between becoming an over-sharer who will gripe to anyone who listens and a person who is just trying to keep it real.
It’s still something I’m trying to figure out, so I put things on the blog and my real life people can come and go as they please on here and text me when they want to engage. It’s been… interesting, to say the least. It’s kind of a bizarre social experiment, but it seems to be working out.
I am so happy you have a confident/friend in H who seems to sincerely care about your well being. Good friends like that are hard to find. Your husband also is a great asset as he too is promoting these important relationships.
Well I hope your career path takes you to a place where you can finally find some peace. Enjoy your trip, it’s a much deserved break.
I was reading something the other day about the epidemic of loneliness and just felt so grateful that I somehow keep finding and collecting these great people along the way. Even if my career goes to crap, at least I’m assured I’ll still have what matters most to me in my life.
I’m going to offer you a program called self authoring https://www.selfauthoring.com/ It’s by Jordan B Peterson and his crew designed to brainstorm your way out of this morass. You don’t have to do it perfectly, in fact you can’t do it perfectly but it will give you direction. It’s cheap and follows solid psychological principals. Why not exercise a little freedom and author your own life instead of having circumstance author it for you? I practiced for a decade as fee for service private practice, yes I’m that old, before the hospital forced us to form a group. After the group formed I owned the group which became a challenge in itself. You can create a situation where you do something you like without being stuck under someone else’s thumb. You may not get rich but one thing leads to another.
Thanks for the tips! I will have to check this and cenegenics out. I’m realizing maybe I wasn’t ever meant to be in an employed position and this whole situation is perhaps pushing me to create something of my own making.
We’ll see. There’s a certain comfort in not going your own way and taking those risks…
I had a H, only mine was S. Sandy and I had been through medical school, and then residency together. That was 30 years ago. Like you, I moved hundreds of miles away after residency. However, my family and I returned many, many, times and would frequently meet her and her family at medical conventions over the years. Two years ago this week, her friend went to check on her because she had mentioned she wasn’t feeling well and was going to lay down for a bit. She was found in bed ……gone. Myocardial Infarction at 56 years old. I miss her. Make sure you hug H when you can, and break through that wall you describe just enough so H knows how you feel. Sandy knew.
I am just devastated for you. Thank you for sharing Sandy and your story.
I have definitely been making it a priority in the last 2 years to make sure my friends know how I feel about them. I would never want these unsaid things to be the thing I’d regret the most.
I liken armor to packing for travel, it encumbers and constrains far more than it protects or prepares for contingencies.
The most seasoned travelers rely only on carry on luggage. Agility is more useful than excess.
My most valued friendships have, over time, become those who express their vulnerability and weirdness without reservation.
Life is too brief to spend potential connection time with those you love in emotional foreplay.
You have good emotional fishermen in your life. Stop nibbling and bite already 😉
OMG.. emotional foreplay.
That is brilliant, but I’m not sure I’ll be able to work that one into my usual lexicon.
Having moved cities after residency with no known contacts, J and I had to do quite a bit of friend dating as adults which is always weird. I will say, I was always the first one to ripcord because I have no patience in making things click, especially when I already have great friendships by which to measure them by.
Makes for a small sample size, but seems to be working well so far!