“I can’t sleep,” I repeatedly told my PCP. I told him I would lie in bed at night, my mind racing from one topic to another: work, errands, kids, pets, yardwork. I would turn the light back on and play solitaire until my eyes were blurry, then give sleeping another try. Getting up at 4:00 a.m. was usual for me, which meant getting to sleep between 8:00 p.m. and 9:00 p.m. was essential.
I must disguise the truth.
Because of HIPAA.
I must hold these heavy truths within my small-framed body. Because of HIPAA, I can’t tell you the real reasons I’m so upset–the death tolls, the suicides, the real-life people who are my patients and the real tragedies that they suffer. I have to change the identifying facts about this person or these people to the point that they are unrecognizable. They are my secret, my deep, dark secret that can fester inside of me and cause me to feel terrible. Incapable of saving. Inadequate at what I do, because what I am expected to do is everything.
“What do you think?”
“How long does she have?”
…”We need you here.”
At least 3 people arriving. The ED is bustling, preparing for their arrival. Blade and Prolene stitch in my scrub pocket, I am ready. We are ready.
For a moment the ED almost seems silent.
It’s 8:00 pm. You check your work inbox and prepare for the following day: reply to emails, fill prescriptions, prep your notes.
You wake at 5:00 am. You exercise, eat, rush your daughter to school. You arrive to work at 7:30 and review the schedule with your team. You see a man with shortness of breath and a new arrhythmia, a walk-in patient with a severe headache, a teenager there for a sports physical who admits she’s binging and purging. You’re already running behind.
Again we talked about options: cut out carbohydrates, increase exercise, add medicines. She admitted a predilection for bread, and I talked about mood eating: how stress can drive us to eat. She smiled back at me, shaking her head. I mentioned our counselors and the option of coming just to talk. She shook her head again, but her smile broke and her eyes closed.
Her one son, whom she brought here as a six-year old, had been deported back to a country he doesn’t know, where he has no one, where life is dangerous.
I have always been too enthusiastic. Out of all my classmates, I sang the loudest at birthdays, I laughed the longest at jokes and I asked more questions than anyone else. In fifth grade, a firefighter visited my class; after I’d asked my third question about how fire suits actually work, I remember hearing some classmates groan and seeing my friend Thom lift his arms up and, in mock agony, flop down on his desk. I tried to be shy, really. I would go for a few days sitting on my hands during lessons, but, inevitably exhausted by my inauthenticity, I would soon find my excitement uncontainable once more.
How many times have I tried to begin writing about my experience of stress and burnout?
I’ve lost count.
Each time I begin to write, detachment renders me into pieces like a jigsaw puzzle. Where are the straight edges? Where is the frame? What is supposed to be where all of these empty spaces are? Where is the box lid with a picture to guide me?
A few years ago the medical library where I had worked for six years relocated from a building outside the hospital to a space inside the busiest area of a busy hospital. Prior to the relocation, I rarely entered the hospital or did so only when my energy felt sufficient to handle whatever I might see, hear or smell. It helped that I worked an evening schedule. After 5:00 p.m. the hospital was almost unpopulated.
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