Turning to T, I said, "I'm going to examine you, but did you have any questions you wanted to write out for me?" Reaching out for my lapel to presumably find my name embroidered on my white coat, his hand landed, palm open over my left breast. He was just a squeeze away from a full on grope. "Is this really happening right now??"
"I love my doctor! She's the best." "Aww.. thank you! You're going to set some unrealistic expectations for him from the get-go... see you next time!" Turning to A, my new scribe, I pondered out loud after exiting the room, "I don't know what it is about having you here, but all of a sudden people are coming out of the woodwork saying nice things. It's to fill the awkward silence of having someone new in the room, I think. This is not typical. AT ALL. You can't ever let this stuff get to your head, because it just makes the bad days worse." Watching A nod his head, probably in an effort to patronize me, I couldn't silence the inner monologue. You're just teaching him foreboding joy*, M. Don't pass on your maladaptive coping skills way before his time.
"M, what do you think about a scribe? You said you'd be open to that in the past, and I have just the guy for you. He's the son of a friend, and he wants to get more clinical experience before he applies to med school next year." My partner looked expectantly at me, waiting for my response. "What's his background? Pre-med?" "No.. an engineering background. So you'll have to train him, but he's a smart kid and I'm sure he'll pick up quickly!" 3 weeks later and I was shaking said kid's hand in my office manager's office. So earnest, so excited. So... pure. This was a mistake, M.
I've been expecting this day for a long time. I'm even surprised it took so long. When you open yourself up in any arena, whether that be in real life or on the internet, you invite commentary. Your inner thoughts are no longer sacred and safe from harm. As someone who has spent my entire career in STEM where facts and data rule the day, transitioning to this new creative role of story teller has been a thoroughly foreign experience. I started off telling the stories of my patients, but as I have become braver and willing to be more vulnerable, I've allowed myself to bleed on the page along with them. I knew at some point, someone was going to take issue with that and it would feel very personal.
What happened? Sitting back in my chair, I studied her. The buoyant, excitable 9 year old I had met when H's family first started coming to see me had been replaced by this sullen teenager in bedazzled Converses who now had the telltale signs of cutting on her non-dominant forearm. "How are you sleeping?" "Fine." "Tell me about the things you're eating." "All junk food." H stuck her chin out defiantly as she declared this, almost as if to say, I dare you to tell me I'm fat.
We have allowed work to become this all consuming part of our lives, and not just in medicine. It's too easy to become married to our jobs, forgetting there are people at home who are more deserving of our time and attention. When will I allow myself to say doctoring needs to be just a job and not my life - and when will I actually believe it? What is life when it's no longer defined by work?
Why do I check in on my vacation days? Because these are MY patients. That is MY 18 year old, that is MY 2 month old. I will take care of them as if they are my own family, because we should expect no less from our physicians. And when they suffer, I do too.
"I'll see you in 6 months, ok?" I said as I exited the patient room. Flashing a smile, I waved goodbye and turned to see my 4 medical assistants huddled around the closest workstation. All staring at me. Imagery of hunters circling their felled prey before they delivered the final death blow flashed in my mind. Sympathy intermixed with indecision as to when exactly was the right moment to strike. "What.... ?" I asked, a little disconcerted. After what felt like an eternity, one of them spoke up. "C just called to let us know his wife, R, just died from a stroke. He wanted to thank you for everything, but he doesn't need her appointment now." "Oh. Okay." Silence punctuated with shocked faces by my curt reply. "Are you ok, Dr. M?" Was I OK?
Now as I am looking forward to what the next step in my journey will be and the guilt that ensues with the thought of leaving my current practice, I have to remember - there will be patients who will remember our relationship fondly. There will be patients who would be willing to follow me. There is far more gratitude and grace that I've somehow forgotten along the way.
Doctors, PA's, nurses and medical assistants only exist to help people in their time of need. This is what we signed up for. This is what I signed up for, and I did this knowingly with my eyes wide open. I just didn't anticipate the toll that this would take on me now in my 7th year since graduating from medical school.