The Healing of an Emergency Doctor

(I had written this post actually a long time ago, when my emotions were still raw, and far from having came through on the other end. I've always wanted to post this, however, as a reminder to myself, and to others in similar position, of the mental struggle and recovery we go through sometimes with what we do. This has been well over a year now, and I have been working diligently on my regular shift routine. But still not a day goes by that this does not weight on my mind, if anything, simply as a gentle reminder of how expectedly sometimes things could go. It has changed me, no doubt. How could anyone not. I'd like to think for the better, but that would be suggesting that I wasn't at my best before. I think, the better perspective, is that we always grow, we always learn, and we always keep trying. That is what we do.) 




I cried for 3 days straight. By the third day, my tears have started to dry up. But it was still hard to get out of bed in the morning.

All I could do was sit and stare. Sometimes with my head down on my elbow at the table. Sometimes my head buried into a pillow. Thankfully, I had sports highlights or hockey games playing the background. I couldn’t bring myself to care. But it was a good diversion to the vast emptiness that surrounded my home, so full of quiet sadness.

I lost a patient. It was highly unexpected which makes it even more traumatic to hear. The scary thing is that even upon reviewing, I don’t think I would have done anything particularly differently. All of the colleagues who reviewed the case with me reassured me that they would have managed everything the same way. But that doesn’t make it any less painful of a reality to deal with. And when you dissect everything down, there are always areas where a slight tweak in thinking might have altered my plans. But in the bigger picture, it was unclear if any adjustments would have made a difference in the terrible outcome.

I started by sharing with a few close friends who had asked. One offered me a shoulder to cry on, and I let it all go over her poor sweater. I found the best consolation via emailing back and forth my small team of colleagues, all of whom I felt comfortable sharing with and some of whom have so much more life experiences than I have and offered me their kind perspectives. Those emails got me through the first several days.

Two colleagues also helped me pick up two of my upcoming shifts. Crucial, as I was in no shape to work in this mess. This gave me about a week to get myself together before I have to perform at my best again.

By day 3, I shared the news with my family. I wanted them to know my sadness, and why I plan to not do much celebrating this Christmas. They offered their unconditional love and support, as always. They understand the risks that I take each day in my job and that these things could happen.

I also called a work-place counsellor, someone who offers counselling and crisis management for physicians. She was compassionate, understanding, but I found lack the true clinical real life experience to offer me much comfort beyond some generic grieving approaches and advices. But it was still good to talk things over.

By day 4, I was able to be a little more productive with my mind, and I started to use it a little more by studying and reviewing some latest updates in my field. There is a lot of web-based continued medical learning these days, something called FOAM, or Free Open Access Med-ucation. It was perhaps the most productive way to get my mind off the sadness, and served the dual purpose of also trying to better myself as a physician. In fact, learning something new got me a little more eager to work again. To apply those new knowledge into use. To make use of my training again for some good.

I also hit the gym. My mind and body was still sluggish as hell, but I knew it would be good to get my blood flowing. I still didn’t care much for my own health, to be honest. I still feel like I deserve to sink in this sadness, as I’m sure the family is doing, even if it means, irrationally, as an attempt to share a little bit of their pain to help lighten the load.

In the depth of sadness, there were many slow, passive, circulating thoughts. Most of them were to do with how the family can ever cope with this, and how something like this tears so many people apart. The sadness is all encompassing. Overwhelming. Suffocating. But I embraced it. I felt like it’s part of the process. One cannot start to recover if he hasn’t hit the rock bottom of his emotional turmoil.

I thought about quitting, although it’s not really a realistic option for I’m scheduled all the way into June and I have obligations to keep. But can I really keep doing this job. Can I ever stand to face such a tragic outcome again. People in our line of work face such drastic consequences every day. Most of us are numbed by it. Most of up wake up each day and go to bed each night without ever thinking about it. We go to work. Do our best to put in a good job. And usually go home feeling that we’ve done right. But it’s when something like this hits us, then it really sinks in the unreasonable pressure that we actually face each day. That sometimes when we thought we did our best, something terrible like this could still happen.

My brother pointed out, correctly, that most things we see isn’t black and white. There are always so many factors, so many considerations, that go into our decision making and made us commit to one path or another in our clinical approaches. Critical analysis happen in a dynamic ever-changing fashion in a fast paced uncontrolled environment and often all we can do is make our most sound judgement in the presence of all the available information that we are possessing at the time.

But that does not matter. We are the gate keepers. Between good outcome, and terrible ones.

By the fifth day, drips of normal human emotions starts to passively creep back into my head. Desires, hopes, even the occasional brief smile when I see a funny commercial on TV. Like faint flickers of a tiny candle light, my mind quickly smothers it. Go away, as if to say. I’m not ready to welcome you back. I’m still feeling sad.

On the 6th day, with 2 days to go before I have to work again (I gave myself a week to recover from this), I started to force myself to live somewhat of a normal routine. I hit the gym again, did a bit more self study, and even tried a little bit of Christmas shopping and then had dinner with a friend. If I were to perform at my best again, which is what every shift requires, I needed to gradually pull myself back together.

On day 7, with one more day before going back to work, I told myself, it’s time to put this away in my mind. No it’s not the same as forgetting about it. There are lessons to be learned. But I can’t be wearing this on my conscience and still expect myself to perform admirably.

I have to be able to face the consequences of whatever happens as long as I try my best. I have to be okay with the risk of another bad outcome, even though I dearly hope nothing like this ever happens again. A close friend and a colleague reminded me, that as much as we like to play the role of the determinant in our patient’s outcome, very often all we can be is the best possible facilitator. There are things beyond our control. We do our best with what we can control, and try to learn to let go of the rest.

One of the more productive thing was returning to work (I couldn’t have done it any earlier, but a week was about the right time to get myself back into functional mode). Going in, and just simply focusing on the medicine, doing what I’ve always done, applying my same reasoning and decision making that I trust, helped filtered away some lingering doubts and uncertainty. Seeing new faces, and just focusing on solving their problems, helped refocused my attention onto others and not what’s been going on. There are still moments of vulnerability, but with each shift the patterns become more regular, and my trade-mark quick shuffle started to pick up its pace again as my mind warp back into turbo mode, releasing the surge of serotonin that not only lifts my productivity, but my mood.