My alarm goes off at 3:30 a.m. for some early charting. I love these pre-work hours, even though it’s my own unpaid time. I went into debt for hundreds of thousands of dollars to have the need for sleep trained out of me. A neat side effect of this is that it also wiped away my will to resist inane admin tasks.
While I’m pre-charting, my family wakes up, or at least I think they do. But I can’t look away from my screen. I’m completely absorbed in the electronic health record (EHR). I don’t want to miss a single message that pops into my in-basket. It’s like a legendary hydra; two more messages magically appear for every task I complete. It’s mesmerizing. My spouse, whom I haven’t seen during daylight hours for eleven years, feeds the children and takes them to school, or at least I think they do. But I can’t check on my family because I exist solely to serve the EHR. And strangely, I’m content with that.
My clinic day officially starts at 8:00 a.m., but I arrive by 7:00 a.m. I can’t wait to see what paperwork awaits me. On my way in, I pass our department admin leader and sign up for every available call shift this month, since our newest physician partner is still on some sort of imposed leave, which we are assured is voluntary. I inhale the scent of freshly faxed insurance denials on my desk.
After fifteen minutes of seeing patients, I’m called away to make my first appeal call for a prior authorization denial. I don’t mind because, as a physician, keeping people waiting is part of my job. My patients aren’t aware of the intricate complexities of dealing with insurance companies. But I’m content to be the verbal punching bag for their frustration. It’s something they taught us in medical school, and I remember to smile.
At noon, I log into the mandatory physician wellness lunch hour webinar. The hospital administrator has arranged for free pizza delivery to our clinic. Apparently, doctors can endure anything as long as we’re supplied with free pizza! I listen to the webinar, practice the mindfulness mantras, and answer in-basket messages on the other monitor. And I’m quite mindful of how good that pizza tastes. Those wellness gurus are certainly clever.
With my newfound mindfulness, the afternoon flies by. I keep many patients waiting while I make three more prior authorization denial appeal calls. I’m fully aware of how far behind I am, and it’s oddly wonderful. It helps me pretend that I don’t notice how unhappy my patients are. I make good eye contact, smile, and offer validating statements.
When a new patient expresses worry over their insurance company denying their globally agreed-upon standard-of-care treatment for their disease, I reassure them not to fret. I promise to mindfully appeal the denial with a thirty-minute phone call squeezed into the five minutes I’m given.
After clinic, there’s a department meeting. We learn that the understaffing issue is worsening. But that’s okay because we’re resilient. Res-eel-ee-ent. Together, we mindfully chant the word until it loses all meaning. It’s okay because our leaders have a surprise for us—more free pizza!
During the meeting, the administrator mentions our Press Ganey scores. Thanks to the pizza-induced coma, my mind is dulled, and all I can manage is a nod when we’re told we must improve the scores. Otherwise, no more pizza!
After the department meeting, I head home. My spouse apologizes that the family already ate dinner. Surprise! It was pizza!
The dog barks at me as if I’m a stranger. Come to think of it; I don’t recognize the dog. It’s possible that the old dog died, and my family got a new one without telling me. I give the dog a piece of pizza. Good dog.
I sit at the kitchen table with my laptop and log into the EHR. I must have forgotten to be mindful because when I look up, the house is quiet, and all the lights are out. I don’t want to wake my spouse, so I crash on the couch. I can’t wait to wake up in three hours and do it all again. This life is exactly what I dreamed of when I sacrificed my twenties and thirties for medical training.
As I fall into a deep sleep, I chant “res-eel-ee-ent” to myself over and over. I dream of pizza.
Jennifer Lycette is a novelist, award-winning essayist, rural hematology-oncology physician, wife, and mom. Mid-career, Dr. Lycette discovered the power of narrative medicine on her path back from physician burnout and has been writing ever since. Her essays can be found in The Intima, NEJM, JAMA, and other journals. She can be reached on Instagram, LinkedIn, Facebook, and Mastodon.
Her books explore the overarching theme of humanism in medicine. Her first novel, The Algorithm Will See You Now (Black Rose Writing Press), a near-future medical thriller, is available now. Her second novel, The Committee Will Kill You Now, a prequel in the form of a near-historical medical suspense, is out 11/9/23 and available for preorder now in paperback and on Kindle.
