It’s 1:15 am as I write this.
I’m tired. I’ve worked just under 17 hours today, but I can’t sleep.
Too bad. I will start at 8 am again tomorrow for another 8 to 9 hour day.
I can’t sleep because I’m thinking about my patient with the declining oxygen saturation. I worry that I may have missed something in the history, in the investigations… did the on call physician and I make the right decision?
I think about her. The quiet manner. Not wanting to be a bother, to make a fuss. I think about the family. Thank you, doctor. That’s what they had said.
They had trusted us. They had trusted me.
The popular Human’s of New York Facebook page posted a quote from a famous paediatric surgeon. He spoke of the handful of times a child had died on his operating table. He spoke of the profound sense of failure; of being suicidal and unable to sleep for days after each of these tragedies, sincerely wishing that he had died instead.
I’ve certainly never experienced such a traumatic event in my short career, but I can understand the emotions all the same. I didn’t before becoming a doctor.
It’s moments like these that you don’t give a shit about your license, your name, your reputation.
It’s all about her. Is she going to be okay? Will she be there when I come in tomorrow morning?
These are the moments patients don’t see. They see us as the doctor, the larger-than-life superheroes with knowledge and expertise that save lives and work miracles. Maybe they need us to be.
They don’t see the stress. We have some of the highest rates of suicide and substance abuse; more than any other profession.
They don’t see the sacrifice. It’s less than glamorous. The hours of training. The weekends and weeknights of our twenties, voluntarily offered for this career.
They don’t see the vulnerability. The loss and disappointment we too feel when patients don’t have the outcomes we had also hoped for. The nagging doubts, the moments of insecurity, the fear of failure; the sense of failure we all feel from time to time, but are afraid to confess…
The nights we go home and can’t sleep.
I went into medicine because I wanted to help people. It is the simplistic, cliché answer we are told never to give during our many rounds of interviews to reach our professional goals. The reason, of course, is because most of us did. We doctors, of all people, are the romantics, the endless optimists. We truly believe that knowledge, skill, dedication, and randomized control trials can heal the world.
Maybe we need the superhero paradigm too. Not because we want to be larger-than-life, but because we want to believe the world can be saved; because it is too painful to see the fallibility of not only ourselves, but of our profession as well.
So I write. I hesitate to share this. I fear it will hurt my career. Will my colleagues see my humanity as inferiority and weakness? Will the public, my potential future patients, interpret it as incompetence? Do we all just prefer the illusion of doctors as superhuman?
But my humble confession remains.
It’s not the first time this has happened, and it most certainly will not be the last.
Relax. No-one will think badly of you. We have all had nights of self-doubt. Worse after a few years because you remember the mistakes you have been working long enough to accumulate and you then filter the current worry through those memories. But after a few more years, hopefully you realize that no system designed by man/woman can possibly be totally perfect. Some mistakes are avoidable, many are systems failure rather than individual failure but it is simply impossible to achieve zero mistakes.
I sleep fairly well these nights, having learned to file away all the mistakes I made over the years and at the age of 62, it doesn’t bother me at all to leave the ER to younger colleagues.
Thank you so much for this.
I do not personally have the distinction of serving in your field. But I know I am only alive at the present time because of some outstanding work that your predecessors have done. I have more than once been on the other side of that sleepless night, and I would like to thank you on behalf of all those whom I am sure you will eventually save.
I hear my fathers voice in your writing. He too was a man of words ; and for some reason he thought that I, from about the age of 13 or so,would be an appropriate receptacle for his own doubts and confessions.
One point he made, was that the better you get at what you do, the more colleagues will search you out with their problems ; the consults will get more numerous and more difficult, so that in the end, you will hardly have time for any “normal” cases at all. And naturally, the “failures” increase in proportion. Such is the price of success and renown.
Above all, he was haunted with the question of whether, on balance, he had done more good than bad for his patients. That might sound strange to today’s doctors, but eighty years ago, when my dad was in training, things were different. All doctors at that time were taught to have a healthy respect for nature as the most effective healing agent.
The first time he had a chance to speak with a world famous “authority” he couldn’t resist asking this question, and the great man answered with perfect simplicity : that he was quite sure that he had NOT done any more good than harm, but that he DID hope with some confidence that my father’s generation would finally be the first to do better ; and so, I believe it has been. Radiology and surgery and antibiotics and blood gas monitoring certainly saved MY life.
Moving forward half a century, I have often been in social situations with my eldest brother, who is almost always to be found with his nose in a book or gazing absently into space. People think he is just absent minded. Family members reproach him for not tending to his guests. But the fact is, he is rehearsing the 1:15 episodes of which you speak, and the ones to which he will return within hours, or at most a day. And if he really has nothing going on at the moment, he will still be studying constantly to arm himself against the ones to come.
So if you can forgive me the presumption of saying this : When I read your text I was immediately struck with the recognition that you are the real article. The sort of doctor my life has given me the privilege to know.
My second daughter is now taking her first steps in science at the college level and hopes to be one of the chosen few. I took this blog entry as a random sign that it was time to begin lifting the curtain a little on the harder aspects of her path ahead. I sat her down and read her the entire post out loud, as I would hear her deceased grandfather read it to me.
Thank you for giving me the opportunity and the means to carry out this small operation of pedagogical initiation.
Feel the Love,
Gordon Friesen, Montreal
Thank you for this brave, honest, and insightful piece.
Your comment, “I went into medicine because I wanted to help people. … We truly believe that knowledge, skill, dedication, and randomized control trials can heal the world.” Please understand that I agree with everything you said, except the part about RCT. RCTs are an invaluable tool/resource for medicine, and do sometimes provide the basis/results required to practice evidence-based medicine. However, RCTs are not the be all and end all of medicine; some RCTs are poorly designed, biased, funded by agencies with vested interests (and therefore conflicts of interest), and can have huge differences in the interpretation of their statistical analyses and conclusions.
I hope that as you move through your career you will hold true to your passion, compassion, education, skill, dedication, and the Art of Medicine, together with a skilled and sometimes sceptical approach when reading RCTs (always ask the necessary questions – don’t just accept something because of something you were told or something that you read – check it out, from both sides, and it will serve you, and your patients, well).
Again, thank you for sharing a part of yourself in this piece.