Hard Conversations: That’s Why You’re Here

“FYI, 643 refusing am meds and all cares.  BP 178/70.  Please advise.”

It’s not even 7:30 am yet and this is the 5th page.  I guess this is just the day we’re going to have, M.

Picking up my travel coffee mug, I searched for even just a few last drops of black coffee but there were none to be found.  Just enough left to taste the bitterness.

Maybe it’s actually the aftertaste of you not leaving the hospital til 9 last night.  You’re only a little bitter about that. 

Sighing, I set the mug down.  No amount of coffee in the world was going to refuel me after the week I was having.  I recalled the 30 minute conversation I had with 643’s daughter – the last thing on my to do list before leaving yesterday.

“Your father is stable today, but I would like to really encourage you to come to the hospital as soon as you can.”

“Ugh… can’t he just stay until the weekend?  I can’t get down there this week.”

“Ma’am, I understand there are logistical things you need to work out since you’re coming from out of state, but I also want to be up front about the seriousness of his condition – I can’t promise that he’s going to make it to the weekend.  And I know he really wants to go home, possibly on hospice, but he’s waiting until you get here to make that decision.”

“I thought you said he was doing alright.”

How many times had we gone in circles for 30 minutes?  Pushing closer and closer to my edge at the 14th hour of my heavy work day, it took all my willpower to stop myself from saying:

Stable does not mean alright.  You know, you can be stable AND dead.  Please stop hanging on to the word I probably shouldn’t have used, but lunch was 8 hours ago, this is the 4th hospice spiel I’ve had to give today and I’m really just not at the top of my word game right now. 

YOUR DAD IS DYING. 

Do you want to be here when that happens?  Yes or no?  It really is a simple question.  And quite frankly, this is a courtesy to you so you don’t live with the regret of your father dying alone.  Because for me it doesn’t matter – they’ll just fill his empty room with another person that I’ll probably have to have this same exact conversation with, and I’m going to purge the emotion from all this because that’s the only way to keep doing my job.

So, are you coming or not?

Sitting back in my seat, I watched the minutes count down on my computer screen.

For a disorienting moment, it felt like I hadn’t even left my cubicle last night.  Had I even driven home?  I vaguely remembered my husband reheating the stew he had made because yet again, he’d hoped I would be out at a reasonable time so we could have dinner together.  But even as I tried to push out the day while J handed me a cup of tea with a shot of whiskey, my mind was still here.

In this chair.

Ruminating about the conversation I had last night.

Get your shit together, M.  You can do this.  Just like you kept it together last night.  Because you’re not going to be that dick that adds trauma to someone else’s grief.  She’s doing the best she can with what she has available to her… which apparently is not much, but that’s ok.  That’s not your mess to fix.  

It’s fine… everything’s fine.  And also, the sooner you actually work, the sooner this day can be over.

643

“Don’t sit down until you feel the chair behind your legs.  Don’t sit down yet.  Don’t sit!  You’re not there yet!”

Arriving to the room, I watched R’s emaciated arms tremble as he struggled to hold himself up on the walker.  I couldn’t contain my grimace as his right shoulder buckled, then his elbow, and finally the left side of his body until he collapsed like a deck of cards into his chair, narrowly missing the armrest.

“R!  You could have seriously hurt yourself!  You need to wait until you feel the chair behind your legs.”

“Gah!  Just leave me alone!  Leave me be in peace!  I was totally fine in bed, but you come in here and make me move to the chair and now you’re yelling at me!  Good riddance to you.”

The physical therapist’s grey eyes connected with mine as we all soaked in the frustration.  How do you encourage someone who’s already committed to dying, just not til Saturday?  What is the right balance to strike when you know you’re just going through the motions?

Maybe if you had done your job better yesterday, M, we wouldn’t be standing here awkwardly.

Side stepping the physical therapist as she scurried out of the room, I readied myself for a verbal onslaught.

“Good morning, R.  How are you doing today?”

“… did you talk to my daughter last night?”

“I did.  I gave her the update.  She told me she won’t be able to come for another 2 days.”

R slumped in his chair, unwilling to look at me.  For a brief second, I was tempted to listen to his heart and lungs, run out of the room and check this patient off my to-see list.  But that would be too easy.

This is why you’re here, M.  To have the hard conversations other people don’t want to have.  Just because you didn’t have enough coffee this morning doesn’t mean you don’t have to do your job.

“You seemed frustrated with the physical therapist just now and the nurse told me you declined to take your meds this morning, including the diuretic that’s helping your heart failure.  I know yesterday we talked about waiting for your daughter before committing to hospice, but if you want to restart that conversation, I’m happy to do that now…”

As R contemplated his response, a bright knock at the door broke the silence.

“Hello!  Oh, hi doctor!  Is this a bad time?  I can come back.”

For the first time in 4 days, I watched R come to life as he beckoned to his friend hovering by the doorway.

“No, please come in!  Dr. M, this is Y, an old friend from the university I used to teach at.”

“I didn’t know you were a professor!  What did you teach?”

“Oh, R was a nationally renowned geologist in his heyday.  Back then, he was known for his adventurous white water rafting trips that he’d somehow label ‘field research’ and get grants for!  Boy, do you remember all the students who’d apply to be on your team?  We’d get into a fair bit of trouble – safety wasn’t really our biggest concern in those days!”

As Y painted the picture of an energetic professor with a contagious passion for his work, the tension in R’s face released as they traded memories collected from 40+ years of friendship.  Backpacking trips on the Pacific Crest Trail, research outings in torrential rainfall, literally being pushed out of their houses by their wives when they got too antsy from being cooped up indoors for too long.  The highlight reel they pieced together started to push the boundaries of what I’d expect for a little embellishment, making me wonder how many details had been inadvertently added with each retelling.

It was quite the story, their lives told through each other’s eyes. 

The power of the mutual love and respect they shared was mesmerizing – how many people get to have that kind of steadfast loyalty in their lives?  Over those 4 decades, did they recognize the bond they were building?  Or were they just realizing the depth of their friendship now? 

And did they ever stop to think that in 40 years, they’d be reminiscing the best days of their lives with someone who’d only be present during this late, dark hour?

It felt like an intrusion, to share in their world.  To take part of likely their last lucid conversation.  Yet I couldn’t step away. 

Not from the privilege of seeing a 40 year friendship make its last victory lap.

“We really are old friends, aren’t we?  You know, when your wife died last year…”

“You knew I wasn’t too far behind.

… It’s ok, Y.  I’m ready.”

Looking up and holding my gaze through tearful, cloudy eyes, R nodded his assent.

“I’m ready for hospice, Dr. M.”

---

“Hey, M, is that you?”

Peeking through the little sliver between our cubicles, I spied the metal framed glasses of my colleague I’d handed off my patients to the week prior.

“Yeah, what’s up?”

“Oh, I just wanted to thank you for prepping that patient… I think his name was R.”

“He’s still alive??”

“No, definitely not.  He passed the next day after you signed him out to me, but fortunately his daughter was able to make it in time.  She wanted me to thank you for pushing her to come earlier.”

“Oh… well, glad that worked out.  Thanks for letting me know.”

Glad that worked out, M?  You’re not glad.  In fact, you’re not anything.  Are you ok with this nothingness?  Do you still feel right about the emotional purging you’ve been doing?

Shrugging it off, I returned to the chart of the new patient I was admitting and spotted the triage hospitalist’s notes from talking to the emergency physician:

Stage IV colon cancer, considering hospice.

Sighing, I popped my earbuds back in.

Back to work

Admit, discharge, admit, discharge – just moving the meat.

In this assembly line, patients get in the way of the ruthless efficiency at which I’m expected to perform.

No, not the body that supplies the blood for all the labs that get drawn every morning, ready for me to review so I can plan out the day’s course of action – I need that.

The actual patient – the one who paddled over white rapids and waterfalls, introduced thousands of students to their love of geology and was a loyal fixture in his friend’s life through thick and thin – the one who’s trapped in a failing body, I have no time for.

I have no time for the thousand instances of daily self-cajoling to be kind because there’s still a person in there.  There’s still a family who loves that person.  A friend who’ll mourn that person.

It takes too much time and effort to maintain my compassion at an appropriate emotional distance while I wade in and out of other people’s humanity.

All of this, I know.

And yet I refuse to let this part of me go, even as it comes at a great personal cost. 

Even as I recognize the extra time I spend is stolen from my husband, friends and family. 

The guilt begins to mound as I continue to build upon my script of apologies for broken commitments that end up in dinner for one or sit blankly at get togethers where I simply nod and smile in a state of detachment because all of my emotional capital has been depleted.

I watch as I rob myself of the little margin I keep in reserve, the part that used to love sitting down and writing every week, or revisiting memories of happy times in the outdoors as I edited my pictures for Instagram.  Now I hover my fingers at the keyboard, unable to find the words to adequately express how utterly exhausted I am.

Because for all the changes that happened in the last year, I’m actually deeper than ever in my burnout struggle.  All the fears I pushed to the back of my mind when I moved from primary care to the hospital 9 months ago were realized.  All the hope I had exploded in a devastating plume of smoke when I reached out to grab it.

But I refuse to let this last part of me go.

Some days it’s the only thing I have left.

It’s the thing that’ll keep me moving forward.

 

***

Photo taken of a broken glacier fragment in Alaska.

***

Thank you for all the check-ins the last 2 months – yes, I’m still around and yes, I still plan on writing.  I’ve started, stopped and restarted so many posts as I’ve tried to regroup these last several months, but could never work up the nerve to finish them. 

I read once that we should “write from the well healed scar, not from the wound.”  So I kept waiting for the wound that inspired this post to heal fully, but then I realized that’s not why people have continued to read my ramblings over the last 2 years.  It’s not what you tell me when you reach out to say something really resonated with you.

You could be on someone else’s site, reading their condensed story of victory over burnout.  I’m sure they’d have a little snippet of how to work with them so they can life coach you on your way to happiness as well, for a nominal fee. 

But you’re not there, you’re here.

Because while other people gloss over the middle with phrases like, “It was the hardest time of my life and I know exactly how you feel,” I write about what that looks like in real time.  The middle is messy, raw and confusing.  And sometimes things in real time happen a lot slower than I want them to.

So thank you for your patience and continued attention.  

P.S. I’ve got nothing against life coaches – I’m just not going to pretend to be one of them… otherwise this would be playing a very long game.