On Burnout:

This will sound more morose than I intend it to- or perhaps exactly as morose as I intend, but there are times when I’m in the back of the truck and I’m watching the cardiac monitor and it feels like I’m watching my life slip away with the patient’s. Just one beat at a time. It’s worse when there’s no chance at improvement for the patient. When I’m serving my time as a goat herder- ushering a demented little-old-lady who’s blind and deaf and requires artificial nutrition to stay alive. In those times it’s hard to feel like there’s a real purpose behind the job- that this is really a calling. Sometimes it feels more like a prison sentence. “You are hereby ordered to witness the slow death of 300 individuals per year. You will maintain what is cynically referred to as comfort measures, and extend these lives despite many good reasons not to. May God have mercy on your soul.”

I’m watching this lady’s husband tell her to stay calm, and that all of this is to help, and it just feels like a lie. Rather- it is a lie. This isn’t to help her. There is no helping her. Her brain has atrophied past the point where any meaningful interaction is possible. She’s receiving treatment for a raging UTI (her third in as many months), and we’re about to cut off her leg since her peripheral vascular disease has reached the point of no return and the skin around her foot has begun to spontaneously die. His words of assurance and calming are for himself. Convincing himself that his desire to hold on for just a bit longer is only due to love and not fear. That her case is different, and she’s about to turn the corner. That letting a surgeon cut off the lower portion of her legs is completely justified because he’ll have one more day. I know the truth: I know that this lady will in all likelihood never come off the ventilator she’ll be placed on for surgery. If she survives the procedure at all she’ll live out her few remaining days in the ICU with an endotracheal tube shoved into her airway.

We’ve arrived at the new hospital. The place (in all likelihood) that this lady will die. Far from home. Missing part of her legs. Hooked to machines, and tubes, and completely unaware of the decisions being made on her behalf. With my willing participation.

She's agitated now from the movement of transport, so I give her a little bit of Ativan. This is the life this lady gets to live in her final days. A nameless stranger who you won't remember- sedating you as you scream in the back of a vehicle taking you to a place you can't name. I don't mean to suggest that it's never worth it. I know what it is to truly save a life- to bring someone back from the very brink or even just beyond. It's just that it's so rare, and it so often feels like we're doing more harm than good. We set out to heal the world and end up just letting wounds fester into gangrene.

Tomorrow I'll go back. And I'll be in the back of the truck again, and maybe this time I'll make something positive happen. Maybe my hands will heal and revive, rather than maintain and sustain- but I truly have little faith.