The angst and guilt of an older physician

I am writing this a bit selfishly as part of personal catharsis, and it has been helpful serving that purpose and helping me better understand what I am experiencing. If, however, some of it strikes a meaningful chord or you have some critique or suggestions, then, of course, I am delighted to hear from you.

While we all are under stress, I have been feeling angst I could not pinpoint until today. Finally, it came to me: I have a certain guilt from working at home on top of the loss of human contact both with colleagues and patients, and the lessening of the sense that I am making a difference. As an old clinician, I am going to be the last put into face to face patient contact due to the increase in my risk due to age.  The increased risk still doesn’t lessen the irrationality of the guilt. Or is it irrational? Dr. Spock of Star Trek fame often said, “Logic clearly dictates that the needs of the many outweigh the needs of the few.” While I am more at risk, I am, in many ways, more expendable. My family is grown and independent. When compared to a younger physician, I will have much less to offer patients, society, the practice, and the University over time since I will retire soon.  So while younger clinicians face less risk, there is more potential loss with them than me. What is the balance?

Our young residents are asking themselves questions about the balance between risks to themselves and their families as opposed to their need to care for patients. We have all asked this question at times over our career. Some now, however, have asked this in a way that I and some others of our colleagues who also have young families found quite upsetting, calling it a “moral” question. Have we gone too far in trying to correct work-life/family imbalance? Is this just an excuse for the appropriate fear we all have? Or am I the one who is wrong in his sense of duty? While in the face of the unknown (at the time) epidemics of HIV and Legionnaires, we were often terrified, but we never questioned that we, like earlier physicians over the ages of the much worse and much more dangerous epidemics of Spanish Flu, smallpox, and plague, had our duty as part of our job, part of our calling.

Physicians, nurses, first responders are courageous people with a strong sense of duty in the sense FDR described, “Courage is not the absence of fear, but rather the assessment that something else is more important than fear.” But then again, what right do I sitting on the sidelines, have to criticize others? I rationalize that it is not my decision to not be there physically, that I put in my time and faced my risks, that I am at higher risk, and that my family is not running away from risk given that my daughter is practicing general internal medicine on the front lines at Bellevue with young children and a husband who is immunosuppressed with treatment for inflammatory bowel disease. Were I able, I would take her place, not that she would let me or any of her colleagues. Nevertheless, this critique of some of our residents is another source of guilt, perhaps analogous to that which leaders feel, or at least should feel, when they send the young off to war rather than fighting themselves.

Not that I want to, but I find myself unafraid of dying and really am primarily afraid of suffering, loss of function, and being unimportant and irrelevant. I came to grips with what I am really afraid of or not when I was first diagnosed with prostate cancer four years ago, and my feelings are only even more crystalized in the present crisis. I am fighting most hard to overcome the sense of being helpless, being worthless, and making less of a difference than I should. Consequently, more than even I at my obnoxiously best typically do, I am now constantly interposing myself into processes to correct errors I discover and to suggest improvements. I have been gratified when I have improved and corrected things during this crisis. But I also realize that my personal need to be useful has, at times, resulted in what can be a bit too overzealous of an attempt at constructive critique. At times I know I come across as an insensitive pain in the ass.

If you got this far, I thank you for being there and listening. I appreciate your patience with my self-indulgence, my unpolitic critiques, my outspokenness. I value your friendship, honesty, and wisdom.

Eliot Nierman is an internal medicine physician.

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