One tired early morning, during my residency, I had been up all night in the ICU with a sick patient. Exhausted I sat in the cafeteria for a quick breakfast before rounds with my attending physician. I was explaining to her how I couldn’t leave my patients side I was so worried. She looked at me like Obi-Wan Kenobi: “The sign of a good doctor is when you can’t go to sleep at night worrying about one of your patients.”
I understood what she meant. Sometimes I feel like my patients are like family. I want only the best for them.
Years later, I began my first job working in a small town. One of my first few patients Ms. Joinings, came in to see me. Whenever I saw her name on my clinic schedule I got nervous. She had every disease: heart disease, diabetes, COPD, kidney failure (and on dialysis). Basically, any simple problem could be life threatening for her. That day was no exception. According to her daughter, she was more confused.
“Dr. Mashaw,” she said with an underlying tone of anxiety, “She just isn’t acting like my Mom.”
Sometimes its easy, a patient like this can get a simple infection like a urinary tract infection and that can be the gist of it. You treat the infection and your done. To the patient, you look like Dr. House. Unfortunately, I checked for everything I could think of with Ms. Joinings and all her labs and tests were normal. I suggested that we admit her, observe her and run more tests.
The look on Ms. Joinings face was pure terror.
“There is no way I’m going to a hospital,” she said, as if I were suggesting we admit her to the funeral home.
I couldn’t blame her, she had been in and out of the hospital about 10 times in the previous four months. So we discussed her goals and decided that she go home and if she got worse she’d meet me in the emergency room.
I was worried about her. In my mind, she could crash at any moment. I had given her daughter my phone number but hadn’t really gotten any calls.
Several days later, it was the 4th of July. My family and I made our way down to town to watch the fireworks. My son grasped my hand and dragged me on. Like the Energizer Bunny, he was so excited that he couldn’t contain himself. We live in a small town and everyone was there.
About every fifth person was someone I knew, and every tenth was a patient of mine. It was festive, along every house was a family picnicking in front, enjoying themselves. As I was dragged closer to where the fireworks would be, we walked by a front yard with a family relaxing. One of them was Ms. Joinings. She was sitting in her wheelchair smiling. If she was enjoying her family she must have been okay.
I didn’t have time to talk to her or her daughter. My son’s excitement was too strong. But we talked briefly.
“I guess you’re doing better,” I said with relief.
“I felt better when left the clinic,” Ms. Joinings said with a smile on her face.
To think, I stressed about her for several days after that visit. And then it hit me. Caring so much and spending so much time on my patients is a double-edged sword. You are doing the best for your patients but, for many of us, we get burned out fast. I couldn’t enjoy my time with my family because I was so occupied with my patients. I had to have resolution from a patient before I could enjoy a 4th of July celebration with my son.
Work needs to be work and home needs to be home. For me at least, there couldn’t be a grey area. So now, I don’t give out my phone number to patients and I force myself to let my colleagues cover for me when I’m not working. I’m not the “everything doctor” I had envisioned myself as, but it has made me a happier person in the end.
Arsheeya Mashaw is a geriatrician who blogs at A Doctors Guide to Healthy Aging.
