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on the consequences of this career change

Lakeview, 4 June 2016

I’ll be up front. It’s been a painful year. No big surprise—residency has a tendency to suck, intern year especially. No one who goes into this enterprise is unaware of this. Coping mechanisms are essential—hobbies, friends, family. Alcohol’s in there somewhere, too. Social media tends to be a double-edged sword — I would feel on some superficial level connected to the family and friends I’ve left behind, but my conclusion after checking my Facebook or Instagram feed for the twentieth time that day was that everyone is spending all their time vacationing in exotic locales and eating exquisite food. (That’s an exaggeration, of course, because no resident has time to putter around on the Internet that frequently. But the end result is the same.)

The first half of the year wasn’t too bad. Catching babies, practicing intubations, practicing ultrasounds. Getting past the hump of “I should check with my attending before I order fluids/Tylenol/that hand X-ray for a guy who clearly injured it.” A short vacation to see an old friend. The days were still long enough that there was still plenty of sunlight waiting for me when I went home. I would go back to Chicago when I could. Spend time with Mom and Dad. Making up for lost time.

Depending on where you start counting, it was anywhere from thirteen to sixteen years that I’d been gone from home. I missed out on a lot of the day-to-day with them. There were the semi-regular visits when I lived in Waukesha, but it wasn’t until moving back to Chicago for medical school that I was able to see them more often and, in comparing them now to my memories of them as a kid, see just how much time had passed. With every visit, all I would see is how much they had changed, all I would think about is how sad I was to see this. The thoughts consumed me so much that I could never be in the moment with them and really truly enjoy the time I was being gifted with them.

Medical school gave concrete goals to work toward, tasks to get lost in, distractions from the reality of parents with less spry in their step. In the end, it paid off—in a time where a common refrain from emergency medicine residents was “I’m glad I’m not applying for residency this year,” it’s no small thing to match into EM, let alone at your first choice.  It was an intense relief after spending much of fourth year worrying. Mom and Dad and my brother were there at Match Day, my parents proud at their son becoming a doctor, and Robert just overjoyed that his little brother, long separated for over 20 years, would be close by again. I moved away again, though Milwaukee had never felt too far away (according to the sign outside a pub near Wrigley Field that I spotted one day, Milwaukee is Chicago’s largest suburb) that I couldn’t visit when I wanted to.

So I did the 90-minute drive when I could. I’d also text one or two med school friends to see if they were free, knowing more often than not the answer would be no. And every once in awhile, I’d also get to see some of my other “age-appropriate” friends, the ones here in Wisconsin and also those still in Illinois. Those visits came with their own baggage, in the form of reminders of things I wasn’t doing with my life—marriage, kids, home ownership—which nurtured an intensity of emptiness within. And every visit with Mom and Dad compounded a sense of guilt—guilt at not being able to provide the kind of support they need, guilt at not being able to be the dutiful son.

What was turning out to be a severe existentialist crisis had an added dimension from grinding, grueling inpatient months kicking off 2016, with a single month in the emergency department providing the sole interruption. It promised to provide some respite, a reminder of why I chose this profession, but it failed to deliver, instead only bringing frustration, exasperation, a growing cynicism, and feelings of failure. Cap off intern year with two intensive care months that reinforced the truth of the fragility of our existences, and apply that lesson to your own life, and to the lives of those you love, and you feel exquisitely the pain of every precious moment you are missing out with them.

When you see people your parents’ ages with their life’s fortunes turned on a dime, struck suddenly with infection, with head bleeds, when every intervention only puts them through more pain and you are praying their families realize the same; when you see yourself starting to resent the people that come to the emergency department that make you ask, “Why are you even here?,” when there is no end to the people who demand more from you than you’re able to give, when you see yourself depersonalize in a desperate attempt to stave off a complete internal emotional collapse, when you fear waking up because you dread the thought of what awaits you at the hospital, when you wonder what it was that led you to abandon your first career, a career that took time to get good at, that provided a measure of security and stability–

I want to leave this all behind. Run away home and take care of Mom and Dad. With every day I waste in a role feeling less than capable, I wonder what was the point of it all.

Oh. Hi, burnout. Yeah, I saw you coming. I saw you when one of the staffers in the ED remarked to me, “You’re not as chipper as you usually are.” I know you’re there. You are what makes me resist falling asleep, because sleep brings another day on the hamster wheel. But fatigue wins, and it’s not long before I plead with my alarm clock for a few minutes more, it’ll be all better with just a few minutes more; but it never is.

Coping mechanisms are essential. Hobbies, family, friends. My photographs have been uninspired and I’ve barely had time for family and friends.

Then Orlando happened, and—okay, I think I remember why I thought this might be worthwhile. Maybe I remember the nurse who stopped me to relay a family’s thanks for the care showed to their father, who had to make the impossible decision to let go of his wife of so many years.

I suspect, I hope, that it will get better. Yes, my parents are getting old; and who knows what each day will bring for them; but for right now, if I scrutinize the picture I took of them on my last visit home, they are happy with what they have, they are happy with what their younger son is doing with his life, and they are even happier when he comes to visit, and I have to treasure the moments I do get to spend with them. I have to keep myself open to the experiences that made me choose to be an emergency physician, and let that be what motivates me to go to work in the morning.

Easier said than done. I’m working on it, though.

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