The house is asleep, and I can’t turn off my brain. I just cried my way through an episode of SEAL Team, especially the part where two SEALs are opening up to a psychologist about feeling broken. One says he’s tired of pretending he’s OK that he has PTSD and needs help. Later, he breaks down, and his wife folds him in her arms and tells him she’s there to pick up the pieces.
I feel like that SEAL.
Maybe that’s why this show resonates with me. After all, I’m not one for gratuitous violence and warfare. I’ve often asked myself if I only watch it because I have had a crush on David Boreanaz since he headlined “Buffy” and then “Angel.” But no — now I see the hell they go through reflects the hell we go through in medicine.
These days, it’s really hard to self-reflect and allow others to read my words or feel my emotions. There’s just too much pain in our world now, and everyone is suffering. What makes my pain more important than my neighbor’s? Nothing.
But I’m going to allow myself to write about it and let others read it because maybe it will give you, the reader, license to sit with your own grief by feeling mine.
Every day I go to work, it’s a minefield. I never know what or whom I will meet and maybe destroy or be destroyed by. When I pick up a chart for an ankle sprain, that patient could be the woman whose husband pushed her down the stairs, and that’s why she sprained her ankle. Or the chest pain in a 20-year-old man could be lymphoma. Or the constipation in the 40-year-old exceedingly kind-looking man with the softly accented voice could be new rectal cancer.
After a minor car accident a few months ago, the X-ray of her ribs was normal and my patient was sent home by the physician she saw at a community hospital in Ontario. She was still in pain three months later, so she presented to the ambulatory side of our ED. I figured, when I saw her, maybe a small fracture was missed, and it’s not healing well, or perhaps it’s all just muscular pain.
My clinical assessment found tenderness along one rib in particular. Repeat X-ray showed something not quite right, so I ordered a CT. Before even reading the whole report, in my haste to keep going and see new patients, I called her into the reassessment room. She met me smiling and thanked me for the analgesia that had dramatically improved her pain. Reading the concluding statement of the report as I stood across from her expectant face, I took a sharp breath, and without the ability to self-edit I said, “Oh no, I’m so sorry.” Then, “Let’s sit down.” Her face froze. I had fucked up. I had stabbed her in the heart with my stupid words. Thankfully, her husband was there and guided her to a seat. A harbinger of doom, I read the words aloud that sealed the fate not only of herself, but of her lover and her family, forever changing their lives.
Metastases. Multiple. Unknown primary.
Her eyes wet. Her husband’s eyes met mine, knowing. The world shifting.
It was, however, as if she already knew. The gnawing bone pain waking her and keeping her from sleep could only be one thing. And she knew. She just knew. And she tried her best to be strong for her husband. Together, they accepted the words, the plan, the further CT scans that found a large lung cancer. Together, they stoically met the dangers with swords in hand.
And me — I am devastated. Crushed. Heartbroken. Not only by the diagnosis and knowing what comes next, but by my failure. My failure to keep my mouth shut, to hold, to wait. Maybe it’s burnout, exhaustion, sleep deprivation. Maybe it’s stupidity. Maybe it’s delirium. No matter what, it’s awful.
So I know how those soldiers felt in their moments of emotional agony. I feel it too.
Emergency medicine — medicine in general — hurts my soul in ways I never knew it would. Sometimes I wish I didn’t know what I know. Walking into a room after reading a triage note, and already knowing what I’ll find. Knowing the diagnosis and the denouement of my patients’ stories way before they do. Prophecy of sorts, based on training and experience. And prophets have never had it easy. Foresight is a curse, a crutch, a needle always stabbing just that right spot where the pain is always fresh.
Medicine also lifts me. Sometimes. But lately? Nope. It has drowned me.
And I feel broken too. Hoping somehow to mend the pieces, sew them together like the wounds I’ve fixed at work, stitch them or crazy glue them until it’s possible to continue. The SEALs on the show say “ignore and override” — this can be said for physicians and nurses as well. But it’s not the right thing to do.
I hope that reading my story and hearing my struggle can help you with yours. Don’t let medicine crush you. Fight back with all your strength. Talk about it. Write about it. But let it out. In the space between people, there is healing — there is space for all the hurt inside to come out. Though you may be scared to burden others, if they care for you, let them be your parachute.
Sara R. Ahronheim is an emergency physician.
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