Another workday comes to an end. 11 a.m. rolls around and freedom from the hospital beckons after another 24-hour call is finished. In the span of the preceding day, it is likely that numerous important decisions had to be made with the expectation that all of your mental faculties would be used, irrespective of what time of day it was or how much sleep was obtained. It is a day full of adrenaline, full of fielding questions from concerned patients and family members, and full of presenting patients on rounds with the expectation that each detail of a patient will be known inside and out.
In the midst of all this, there is a feeling that you have to be invincible and superhuman, and that there is little room to just be human and to cry out for a moment of rest. Perhaps you want a moment to yourself or to lie down for a moment, and maybe you can get away from the medical world for a split second. However, that time is not completely peaceful, since you’re anticipating that your pager may go off at any second, and that there is a chance that attached to the end of the page is a seriously ill patient that will require all your mental and physical strength to see them through the night.
As the day goes on, more pages come through, and more patients show up that require your attention. In the midst of this, your body is crying out for sleep, even if it is only temporary. However, the second the eyes are closed, the pager shakes you awake and you slowly gain your bearings as you reach for you pager to see who is calling you. The expectation to be superhuman comes up again, and you try to be, but it does become tiring after a while. It gets to a point that 11 a.m. becomes your most favorite time of day, and by the time it comes, you’re exhausted. You sign out, you walk out of the hospital seeing what feels like an unnatural sun, and you head home, wanting to unwind from the prior day.
It is likely that if you’re a physician who has gone through or still is going through medical training, you have probably had these particular feelings. I write the previous paragraphs based on personal experience, and I can tell you that the exhaustion that is felt after shifts like this is intense, and it can add up over time during a long month on the floors or in the units. The fatigue that develops over time can become a hindrance to taking care of patients in the best way possible and could potentially expose patients to harm, as certain studies have shown. It behooves us to find ways to take care of ourselves.
For me, what I have found to be helpful is finding other activities to distract myself from thinking about the hospital after I complete my clinical duties for the day. When it gets to that time, my mind is already tired from thinking so much about patients for the full day, and I need my mind to rest so that it can be ready for the next day at the hospital. Whether it be music, reading, or spending time with friends, such activities do not require as much mental energy at the moment.
At times, I also find that I need to recharge by temporarily being away from other people. Being in the hospital, a physician is required to interface with numerous people, whether it be a physician, a patient, or a family member. Many times, the content of the discussions tends to be very intense given that they focus on a patient’s health, and these conversations require a certain amount of energy. Combine that with the energy expended in running around seeing patients and it makes for an exhausting experience. That exhaustion temporarily makes regular conversations with other people difficult, and in order for that difficulty to be overcome, recharging has to occur in the setting of solitude.
In the midst of all of the fatigue, it is important to remind ourselves that there is life outside of medicine, and we should search for ways to be reminded of this reality. It is so easy to spend so much time in the hospital that we fall into the trap of believing that medicine is all there is and all that should define us. The reality is that outside of this world, we have friends and family members who can remind us of who we are outside of the white coats that we wear. This becomes all the more important during our times away from the hospital. It is a momentary respite where we can enjoy other aspects of ourselves and be renewed for another day.
At the end of the day, in training like this, we need to heal ourselves. Putting the weight of the world on our shoulders when we step into the hospital and carrying it with us on our way out does nothing to help the healing process. We have to learn to let go and accept that we are human at the end of the day. Yes, we are looked up to by others in the hospital. Yes, we have respect given to us when we don the white coats. But in the midst of all this, there is still a tired human being who is trying to rest and ultimately needs to rest. May we strive to search for our own healing so that we can serve others in a better way.
Chiduzie Madubata is a cardiology fellow.
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