M3

Often this role feels like any other job. The daily lists of things to do, the labs that need checking and electrolytes that need repleting, the note writing and the documenting, the relentless rounding, the endless clatter and beeping, the sound and fury of the machines and alarms and notifications that keep our patients alive, but also serves to slowly drive us all insane. We wake our patients before dawn and inspect them, interrogate them with questions asked too loudly, prick their already bruised arms and take their blood, discuss their numbers, assess and plan, as if all reduced to a series of checkboxes for completion. The level of objective measurement and objective action in the day to day surprised me. The rigidity of medicine often feels stifling. But it is also comforting, that there is after all a rhyme and a reason to how we heal, treat and cure horrible and not so horrible ailments. It is remarkable how we have evolved such a system to catalog and logically organize a response to physical deterioration and human suffering. It is remarkable how much DOES work, even though we often fixate on the many parts of this system that do not. 

There are also moments that make you lose your breath. People that walk into the hospital one day with a cough can die the next. Their names in the electronic medical record greyed out, and italicized after they have been “discharged as deceased.“ People who are healthy one day have pancreatic cancer the next day. The line in between is more tenuous than I had imagined. It is difficult not to feel guilty when we suspect the worst but wait until we are certain to tell the patient. Sometimes they already know, sometimes they are completely blindsided. 

I have questioned this path, in the moments when I am walking down a dark Madison avenue, the only people on the sidewalks a steady stream of teal and blue scrubs moving toward the glowing hospital doors. There is little glamour in the conference rooms of mismatching chairs and peeling paint and a dozen cups of cold coffee littered around the computers jammed into every spare corner of the room. The bathrooms that smell intensely of antiseptic, unsuccessfully masking the odors that permeate everywhere I turn. Is it too early in this career to have doubts? Is it too late to turn back?    

But then, when I am least expecting it, the algorithm fatigue and the evidence based medicine and fear of doing something terribly wrong intersect with something that I can’t properly describe. Sometimes it is a little old lady who gets better, and goes home. Sometimes it is a simple piece of pathophysiology that I had learned long ago that suddenly makes sense. Even if this giant mountain of knowledge is overwhelming in its weight and expansiveness, every so often I feel myself inching toward some kind of understanding, ever elusive, but perhaps just enough to motivate and guide the path forward.