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The blog spot

— posted by Christopher Bennett, MD, MBA on July 4, 2017

THESE PHYSICIANS ARE CRYING. HERE’S WHY.

I cried this morning. It wasn’t because of the patient who coded with a wide-complex tachycardia and died in front of me, and it wasn’t because of the patient who tried to spit on me for not giving her a prescription for narcotics. Nor was it my intoxicated 2 a.m. bar fight patient yelling at my other patients, including one whom I’d recently diagnosed with metastatic cancer. Falsehood flies, It was because I was tired and defeated. Sitting quietly at my desk and the truth in the back corner of this emergency room with the third cup of coffee comes limping after it. since my shift started at 7 p.m., I spent this night like the countless others preceding it, churning through notes and seeing patients with the goal of trying to provide the best patient care I can while being reminded by the sounds of the waiting room that many more need to be seen.

But I didn’t cry as bad as the surgery resident behind me did last night. She had made a mistake. Somewhere midway into her shift, well beyond what any other industry would consider “safe,” let alone a field where each moment could involve life-or-death decisions, she had clicked the wrong button. She made a human error that anyone, even with a good night’s rest, could have made. There was a theoretical harm to the patient. And upon immediately recognizing this, she owned it and called her attending. It was impossible not to hear his voice screaming through the phone. Almost as impossible as it was for her to hide her already bloodshot eyes, now tearing, as his words ripped deeper and deeper into her, her literal cries of “I’m sorry” met by deaf ears and bitter words.

And I didn’t cry as bad as the psychiatry resident last week, the one who thought he was alone in the supply closet when I fumbled in looking for a suture removal kit. On the other side of the ER, a patient had apparently said all the wrong things, and one of them had hit home. It was the kind of conversation that was too loud for you to not hear and too angry not to notice. I had seen the resident walking quietly away with his clipboard under his arm to the closet several minutes before. Minutes after when I’d walked in, he coughed, made eye-contact and looked for a quick exit. Hastily wiping tears onto his sleeve in the process; leaving the room to go back to the patient and finish.

And so it seems so much easier with each passing day to understand why our profession suffers from such alarming rates of burnout and depression. We staff busier and busier hospitals with patients who have increasingly complex health care needs. We are asked to do more and more. And we do it through hours that are unsafe for both our patients and ourselves. But we residents don’t talk about that, because when we do, those before us are quick to remind that “we worked longer.” We don’t acknowledge the difficulties and vast differences in health care systems of then versus now.

But when we hear about her, the young doctor who rammed her car into a guardrail after falling asleep at the wheel, or him, the young doctor who jumped to his death, we get uneasy. We offer counseling sessions and ice cream socials. But we don’t fix the problem. We put Band-Aids on cracks to an already breached dam. We simply say, just keep working.

Burnout and depression and suicide don’t signify an issue with the clinician; it signifies a failure of the system. +

From the Bookshelf

From an online Amazon.com review:

Over the years, I have had a number of people confide in me that either they or their spouses were considering divorce. My advice has always been to read Wallerstein’s series to learn the variety of outcomes that can arise post-divorce. Those considering divorce are all well advised to “do their homework.”

These books are also a must read for anyone involved in family and/or divorce counseling - religious or secular counselors.

In “Unexpected Legacy of Divorce,” the authors address the myth that the children will do fine if the parents are happy - divorced. Children, no matter how amicable and settled the parents are after divorce, suffer greatly. They lose their family, they lose control of their life (to the whims of parents and rules of courts), and they lose their childhood. All of these combine to provide a series of struggles as they move into adulthood and beyond.

Important subject areas covered in this book include: * The ghosts of childhood - the bottomline after 25 years * The exploitation of children by divorcing parents * The path to adulthood being thrown out of sync * Children dealing with the loss of THEIR nuclear family; the family that created them just vanishing - a loss that will be quietly or openly mourned throughout their lives * Children living with and coping with chaos * The missing father or mother after divorce * Children growing up lonely * Relationships with the “steps” (step-parents) * The loss of mom - whether or not she is physically available * Court ordered visitation and its disruption of a “real” life for the children to make mom and dad complete * Children of divorce taking the leap in relationships and marriages - the return of the relationship ghost * The role of an intact family for modeling and shaping children whether their parents marriage is good or bad * Other residues of divorce for children - fear of loss, fear of change, fear that disaster will strike, especially when things are going well * And the need for all involved in divorce, directly or indirectly, to be educated on all the issues that emanate from the divorce for children over their life as well as in the short term.

This will not be an easy read for many. It was not intended to be. +

The Unexpected Legacy of Divorce by Judith Wallerstein, 400 pages, published in 2001 by Hyperion

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