The brutal emotional challenge of medical training


I can vividly remember the day the phone call came. My cousin screaming over the phone, trying to make out words but unable to speak, disbelief, horror, the fear in her voice palpable even though she was thousands of miles away. It was barely 5:30 a.m., I was frantically rushing out to beat traffic, hoping to get a head start on pre rounding since I was on call. Confused, I hung onto every word, trying to keep my voice steady, even though I knew what was coming.

In my confusion, in my anguish, I steadied my voice, willing myself to sound as reassuring as possible as they ran the code on my Aunt; after a week-long stay in uncontrolled atrial fibrillation, I knew the odds of surviving a third cardiac arrest were negligible. Knowing the course of her ICU stay over the past 3 weeks, with fulminant amiodarone-induced liver failure, severe laryngospasm following endotracheal intubation, esophageal ulceration resulting from a transesophageal endoscope, culminating in persistent somnolence, the prognosis was glaringly dire.

As I drove, my mind flashed back to all the moments we had shared. Growing up, she was the amazing independent strong woman who carried herself gracefully and inspired me as I watched. She was so full of life, always dancing, always lighting up the dance floor with her moves, always the first to comment on any social media post. In a sadly twisted stroke of fate, we spent our last moments together at my medical school graduation just a few months before she passed. We reminisced about my high school days, how she watched me grow from a seemingly shy, reserved, headstrong bookworm, into a young blossoming physician. As she mingled with other guests at my graduation party, one could barely tell her ejection fraction had fallen critically below-normal, close to 10 percent. Watching her waltz and eat and sing all at the same time without missing a beat, one would have never guessed. Little did I know the next time I would see her she would be laying peacefully in a daintily embellished white casket.

On that call day, as my senior barked one order after another, seemingly nonchalant about my family’s demise; it was all I could do to make it to the end of the day. Reassuring a patient his mild dyspnea would resolve with optimal medication, discussing pending discharges with case managers, sifting through patient’s charts for thorough medical histories, while the thoughts of my aunt hanging for dear life rang in my ears, my resilience was truly stretched to its core.

I missed my flight to Portland that night; my senior refused to let me leave work early since we were on call. As I stood at the Delta airlines station, begging for a spot on the next flight, I received the dreaded call: She had finally expired after all the fraught efforts.

Sitting in the airport lobby, I questioned my love for medicine; I wondered why my hopes of “helping people” had drawn me so far from helping my own. As I reflect on my intern year; the excitement of match day, the anticipation leading up to the first day of intern year, arriving early on July 1st, the optimism quickly dissipated by long call days, this day stands out as the biggest test of my commitment to medicine. One I’ll forever relive painfully. Missing out on special family events has been a constant reality throughout my medical training, but nothing could have ever prepared me for such a brutal emotional challenge.

Nyembezi L. Dhliwayo is an internal medicine resident.

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