Being a doctor takes a toll

It takes its toll on me, being a doctor.

I think as I wait in the Indian restaurant buffet. My son is curled on my lap. Uncharacteristically tired.  Later he will develop a fever and I will realize why he is so warn out.

It takes it toll on me. I wouldn’t say I am a stressed out person but I certainly live with stress. Most of it is self inflicted.

It’s just that I can’t help feeling responsible. For those few thousand people who have placed their lives in my hands. I know I am not God. I know that doctors can only do so much. But that doesn’t stop me from worrying.

It doesn’t stop my mind from racing at night as I pour over the problems of the day. And it doesn’t stop the guilt. Every time someone gets sicker then expected. Every time someone dies. And boy do they die. All the time.

I guess that’s what happens when you take care of people in their eighties … and nineties … and hundreds. And when you spend a lot of time in nursing homes.

I always ask myself what could I have done different. How could I have been better. Was I enough?

Mostly the answer is yes. Occasionally the answer is no. But I always ask the question.

It takes a toll on me — the stress. The sadness. And sometimes I wonder what this is doing to my mind. My body. Am I causing in myself that which I spend so much time fighting in others. Will the stress raise my blood pressure. Clog my coronaries. Herald in a major depressive episode or uncontrollable anxiety.

But how can I complain? My life has meaning. I struggle daily with the essence of life. And I get paid a comfortable salary to do so. I get to help people, at least when things are working at their best. I get to reach out to my fellow man.

And I get to do it on my own terms. I work when I want to work and rest when I want to rest. Sure, I spend my share of weekends and nights working. But I am usually home by 4pm and no later then 5.

I can count the number of times I have missed dinner with my children on one maybe two hands … ever. I am present. I put them to sleep at night. I see them on the weekends. They know me. They love me.

And maybe that’s worth it. The stress, the worry. The physical and emotional burdens of this lifestyle. Maybe its worth it because it has afforded the ability to be there. For my children. For my wife. Such that my son will walk over to me when he is hurting.

He will climb up on my lap. And place his head on my chest. And he will feel safe.

Because I am always here.

Of all the things this profession has allowed, it allowed me to be present in my family’s life.

Jordan Grumet is an internal medicine physician who blogs at In My Humble Opinion.

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  • http://twitter.com/techguy John Lynn

    Thanks for the great personal story.  My gratitude for you as a physician and the stress you incur on your patients behalf.  Even more thanks for reminding us of the importance of what’s really important: family.

  • Pamela Curtis

    You know what I hear in here? Loneliness. Disconnectedness…. except, as you summarize, with your family.

    I *love* this post. Have you ever thought of perhaps sharing your sadness with your patients? Maybe then it wouldn’t be such a burden.

    I don’t mind that you’re a human being. I don’t mind that there are limitations of medicine. I know there’s no way to get out of this life alive. I’m a big girl… I can handle it. Everything has risks attached. Everything has consequences, seen and unseen.

    If you were to express your sadness to me about these limitations, as you have done so wonderfully here… if you were to take that into the patient visits… Then I would know that what I’m seeing and what I’m feeling about my situation is valid. Then I would know to how match my expectations to reality as a patient.

    I’ve never understood this professional stoicism that’s been taught to y’all. All it does is make a wall. And it places that wall exactly where it’s least useful… between you and your patients. 

    If you knew the joys of our life… if you could enjoy us as *people* and not just “cases” that were “won” or “lost”… if you could reframe it in your mind so that no matter the outcome of the “case” you still saw the benefit of time won or quality of life gained or suffering averted… perhaps then the weight wouldn’t be so heavy.

    Perhaps then, the ties that bind you could be sweet…

    Dare to dream ;)

  • http://twitter.com/KathyAMorelli Kathy Morelli, LPC

    hi there – I worked in a cancer center as a professional counselor for a few years. I thought I was a mature, compassionate person before I started my job in the cancer center. However, that job changed me forever. Yes of course, cancer is treatable and many people get cancer get treatment and go on to live long full lives. But then again, there was always death. and there were, as you say, many people in their 70s 80s 90s whom I met, and who passed away, as that is the natural order of things.
    And I really loved my job. Really, really loved my job and the patients as well. and I was happy in my job, and I thought I was handling the sadness, the depression, the illness…after all, I did get on-site,  professional supervision to help me handle my my own stuff.  But, you know, my husband kept mentioning to me,, you seem sad. You seem withdrawn. And I just said I’m fine, I’m fine.
    And then, I moved on and began my own business in private practice. And you know, I felt better. I didn’t realize what it toll seeing all that death and illness had taken on me. So, it was an interesting lesson. I thought I felt okay, but, you know, I really wasn’t okay. I learned that for me personally there were things I couldn’t do long-term.
    Take care, Kathy

  • http://www.facebook.com/profile.php?id=1418631459 Lynne G Siegel

    Ah..these are all good questions to ask yourself. Your health DOES matter, take care, because one day, you too, might become the patient. And it might come sooner than you think! That stress elevates your cortisol levels. You should know that, better than anyone. And if you don’t get enough sleep, or eat right? If you eat the wrong foods? Or gain weight..Do you really want to know?
    Your child who sleeps feverishly on your lap will one day be an adult, with a job somewhere across the country, busy, and with a life of his or her own..will he or she be there for you? Will you have parents or sibs, or even a spouse by your side, after all these working years? Think about it.
    That Doctor standing over you with the catheter, ready to thread it into your groin..he wants to find our how bad your blockages are, and you have worked so hard all these years..do you want to tell him something, that you know, now?

  • Chrysalis Angel

    That’s why it’s so very important to find that balance of work, and  time with friends and family.  The caregivers of the world need care, too.  You need to be supported, and to have that safe place to come home to at the end of the day.
    The relationships you share with others, outside of medicine, will sustain, nurture and replenish you.  Guard those relationships, they are a vital part in helping you to do what you do every day. 

  • Anonymous

    Dr Grumet,
    I too work in the medical field as an RN, and I too see a lot of pain and suffering, a lot of which I can ease, and make my patients more comfortable.  I have worked in a wide variety of areas and have shared the joy of birth and the sadness of death with numerous families.  But in regards to my own family, I can’t count the number of dinners, holidays ,bedtimes, family outings I have missed as they are too numerous to count.  For the vast majority of nurses, we can’t pick and choose our schedules.  The institutions we work for don’t care that our children are little and scared at night and mommy (or daddy)  is at work.  There are many physicians that are in the same boat, long hours spent away from their families because of emergencies with their patients. 
    You are so right in saying that the time we have with our families should be valuable time and we need to be present 100% as I have learned our children grow very quickly and there is no going back!
    My chosen field is one of hard work and sacrifice, but it is one of personal satisfaction and rewards for knowing that we have made a significant difference in the lives of those we touch

  • http://pulse.yahoo.com/_UQ52N63EO5UL7JQE7RLBOG3YRU kumud

    I too have a very similar practice setup.  And in the first 3-4 years I definitely had gone thru these stages of self-doubt and anxiety about all the illness and death (occasionally still do). But please regularly remind yourself of all the good you can do in this setting: keeping the sick elderly out of the hospital where they get passed from one specialist to another to do procedure after procedure, almost always without benefit; to develop excellent long-term relationships with patients and families (after a while it’s clear these outweigh the “diffiult” families even though it’s easy to get caught up focusing on the latter); and the lifestyle of limited after-hours exposure, as opposed to a regular outpatient office practice.

    To me, working with the nursing home population is a clear winner over office-based practice for so many reasons, and I think this will catch on in the coming years. 

  • Anonymous

    Internally a doctor needs to be as analytical and objective
    as a professional can be.  A wall needs
    to be established between the patient and the doctor’s emotions.  If not, every time a patient succumbs to
    nature’s destiny, the overload of emotion will drag down the physician.  There is no time for that, there is always
    another patient coming.  Yes I love
    people (ok, not all people) and I definitely love my family and guess which
    ones will always win in the final analysis. 
    I only have so much emotional reserve and that is directed mainly to my
    family.  I do the absolute best job a
    physician can do and luckily I do have a great bedside matter, it’s just my
    disposition.  I know, however, that to
    maintain ones mental and physical integrity, one has to take care of themselves
    first and then pour 100% into the rigorous profession of medicine with daily,
    study, discipline and confidence. 
    Patients do not want to hear about my problems. Patients want a
    physician who is confident, sure and competent. 
    I know it is a complicated subject and there are nuances and artistic
    methods to reach this end, but in a nutshell this is how I manage.

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