the middle space

June 5 2017

A brief reprieve last night; no new patients needing the intensive care unit. Initially I did not know what to do with myself as the past three weeks have been like racing the Indy 500; unrelenting laps around the unit at high speeds tending to the critical needs of desperately ill patients. In the midst of the chaos I found comfort in the chime of the monitors and the whir of the ventilators.

As the sleepy sun rose behind saturated clouds dropping ribbons of rain to the well-trodden earth, the quite morning was sliced through with the sharp screech of the pager directing my next steps to a patient’s room where he had stopped breathing and was without a pulse. Despite a well-run code, he ultimately passed away; my third death in 48 hours.

I then signed out my pager, walked to my car, and drove to my apartment. Away from the monitors, IV infusions, and vents I become surrounded by the mundane of a broken dishwasher, piles of laundry, and clogged drains. Despite my 30+ years on this earth, I know nothing about an automatic dishwasher except when I turn it on it cleans my dishes. This particular morning I am unsure how to navigate the space between telling a father his son is dead and fixing a dishwasher. How am I supposed to walk these incongruent worlds of managing disease and managing a home?

I recently experienced a challenging day in clinic at the end of which I questioned whether or not I was good enough for this career at which I have been practicing. As I looked back over that chaotic afternoon, drained of any hint of energy, I realized there is not enough of me to meet the needs of patients and nurses and techs and nursing assistants and co residents and attendings and admin staff. I do not know how to button up that 30 minute visit in a nice package with a billing code and follow up directions. I do not know how to put human suffering in a tidy electronic note, signed and cleared from my in box. I do not know how to comprehend my daily experience is not unique, rather is multiplied over thousands of residency programs and other hospitals across the country and hundreds of thousands of medical centers around the world.

There is this hot topic up for debate in the world of medicine regarding wellness and burnout. Some have suggested it can be tempered with a week-long recognition during which there is free ice cream and soda. Others think it can be solved by restricting work hours, and still others hope it can be mitigated by winning points for certain activities followed by bagels and a pat on the back. I would argue these solutions not only fail to improve wellness, they also are counter-productive. How can suffering be licked away with mint chip on an ice cream cone? Points, in my view, only serve to remind me of the long list of things I fail to achieve.  

Perhaps then, “wellness” is found not in free food on a certain day, rather in attention paid to mundane things. Perhaps wellness has more to do with cultivating experiences that provide meaning rather than having it dictated to us. Perhaps wellness is found in that awkward space between disease and the dishwasher.