The civilian casualties of being a doctor

As an ER doctor, I often meet people on the worst day of their lives. I’m the guy who gets to tell you your mom is dead. I’m the one who works the futile code on your four-year-old, while your screams cut right through everyone in the room. I find your cancer. I tell you your husband overdosed in the McDonald’s parking lot. When you decide you want to shoot yourself (but chicken out at the last second, so the gun just blows off your face), I’m the guy picking the tooth fragments aside so I can intubate what’s left of you.

Sometimes, I get to witness the worst things people can do to each other. Assaults, rapes, child abuse cases, human trafficking — guess where they all end up day or night?

I suspect many of you reading this witness equally horrific things. You inevitably developed some defense mechanisms, otherwise, you would have quit long ago. You compartmentalize. You flip the detachment switch on and do your job as effectively as possible.

Every once in a while, you may be tempted to give your non-medical friends and family (civilians) a glimpse into what it is you do.

This is a double-edged sword: It may be cathartic to let them in on what you’ve seen, but they’re not equipped to handle it. You’ll either leave them traumatized or even worse — they’ll think you’re heartless for being able to speak about such depressing things without flinching.

Even if you don’t fully expose the civilians in your life to the things you’ve witnessed, these tragedies still take their toll. If you’re not careful, you’ll leave a trail of civilian casualties in your wake. Here are a few of the civilian casualties in my life.

My spouse

Some days my wife gets the very best of me. Other days she gets what’s left of me. She knows me better than I know myself and she can usually tell when I’ve had a particularly bad day at work. I feel very lucky to have married the right person.

Decision fatigue. Do you ever have a shift whereby the time you get home you have lost the ability to make even the simplest of decisions? At first, my wife liked that I always let her have her way, but it quickly got old. A grown man really should be able to pick a pizza topping in under 30 minutes.

Zoning out. Some days I get home, but my mind is still replaying the shift. I’ve mastered the art of the husband conversation. Eye contact. Nod. Repeat a few keywords. Interject with just enough questions to indicate I’ve heard what was said.

Unfortunately, it all falls apart two weeks later when it becomes abundantly clear that I have no memory of agreeing to host a dinner party for 20 people.

A doc in the streets, wide awake in the sheets. I don’t even have to tell my wife if I’ve seen something that got to me. My tossing and turning is a dead give away. One time I had a bad pediatric code and didn’t tell my wife about it for two weeks. When I finally told her, she said, “I know. I’ve been waiting for you to be ready to talk about it.” That was her polite way of saying: “If you keep me up one more night, I’m going to smother you with this pillow.”

My kids

If you think I tell my kids about the things I see at work? You’re nuts. My kids are one, two and eight. My eight-year-old daughter is interested in hearing about people needing stitches, but that’s about as graphic as it gets. Just because I keep my kids in the dark doesn’t mean it doesn’t impact them too. These kids need you whether you had a bad day or not.

Too many patients, not enough patience. Parenting is the hardest job on earth. It takes patience, understanding and the ability to withstand a cacophony of crying, whining, and nonsense. There is no doubt I am a better parent on my days off.

Where’s the gratitude? Kids are kids. It is their nature to be self-centered. Somedays I get frustrated with my kids for not knowing how good they’ve got it. It’s not my two-year-old’s job to know that some kids live in cars with addict parents. He’s too busy making fake fart noises and laughing hysterically.

My friends

Most of my friends aren’t doctors. They’re teachers, social workers, graphic designers, and scientists. One of my best friends has had a string of corporate jobs that boil down to getting paid six-figures to play Candy Crush in a cubicle. He recently got a promotion, and now he gets to play Candy Crush remotely from home.

All humans are the same. We all like to complain about our jobs. I have a pretty high tolerance for my friends whining, but every once in a while I give them perspective.

After listening to a friend complain for the fifth time about how boring a work teleconference is, I might interject with: “Nothing like a dead six-week-old to pep up a slow work day.” It never goes over well, and I regret it every time. When your friends vent to you, they just want someone to listen. They’re not trying to engage in a “whose job sucks more” competition.

Protect the innocent

It’s not your friends’ and family’s fault you became a doctor. Everyone needs a way to decompress, but dragging civilians into something they’re not equipped to handle is never the answer. Here are some alternatives to adding to the civilian casualty body count.

Find your tribe. Somewhere out there is a group of people just like you. For me, it’s my coworkers. We can talk bluntly about rough cases without judgment. We cheer each other up with the darkest gallows humor you can imagine. The physician bloggers I interact with have also given me a new sense of community. Whether it’s face-to-face or online, there are people out there who understand what you’ve seen.

Write it down. You’d be surprised how much better you’ll feel just simply organizing and writing down your thoughts. I’ve never been a journal-diary kind of guy, but this blog has really helped me process a lot of my views on life and medicine.

Know your audience. When you’re with a group of civilians, and they want to hear some war stories, make sure you read the room. They may think they want to hear about the grossest thing you’ve seen, but they don’t really mean it. Stick to the classics. I have a catalog of rectal foreign body stories that are always a hit at parties.

Your medical career is a privilege. We work hard, but we also get the chance to save lives and make a real positive impact on a daily basis. You are going to see some truly messed up stuff doing this job and you need to find some healthy ways to process it. Just make sure you don’t drag any civilians into the battlefield. If you haven’t found your tribe yet, you can contact me. I promise not to turn it into a whose job sucks more competition.

“Side Hustle Scrubs” is an emergency physician who blogs at the self-title site, Side Hustle Scrubs.

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