Efficiency

There is a cloud that comes for me. I cannot name it exactly. It’s like smoke—the kind that seeps rather than billows, curling at the edges of the conversation the moment I step into a patient’s room. It starts as a feeling. Then a sound. A clock, ticking somewhere behind my sternum, low and insistent, counting down something I cannot afford to lose.

Ten minutes until rounds. Eight. Five.

The urgency doesn’t announce itself. It simply arrives, the way dread does: quietly, then totally. And suddenly I’m no longer listening. I’m cataloguing. I’m calculating. I’m thinking about what my attending will ask, what I should have asked, what this patient isn’t telling me fast enough, efficiently enough, in the right order. They begin to describe their daughter, their dog, the way they couldn’t sleep for three nights, and somewhere inside me a door closes. Not out of cruelty. Out of something I was taught to call necessity.

Brutal efficiency. That was the phrase she used. A slippery little word, efficiency. It sounds clean. It sounds like a virtue. And yet it wrings the meaning out of the encounter, removes the person from the room, until what is left is a list of symptoms, a problem set, a “case” to discharge.

The urgency owns me in ways I’m ashamed of. I know it’s there, I can feel it gathering before I’ve even knocked, yet I don’t know what to do with it. It’s strange how you can see a thing happening to you, name it, even mourn it, and still stand there and let it happen.

Some mornings I pause outside a room and think that this time I’ll muffle it, press it down beneath something quieter, more deliberate. Then I walk in, and the dull hum of a clock that exists only in my chest begins. I start to disappear from myself. Still nodding. Still asking. Still performing the motions of presence while somewhere, underneath it all, I’m already gone, in the hallway, on to the next encounter.

I wonder if they can tell. I wonder if the woman who told me about her daughter, the man who mentioned he hadn’t slept in three days, could tell I was only partly there. Presence, I’m learning, is not something that happens automatically just because you’re standing in a room. It’s a choice you have to keep making, over and over, against everything pulling you out the door.

I’m still learning how to make it. I don’t always succeed. But I think the fact that it still bothers me means I haven’t lost the thing I came here to protect.

Natalie Malluru
Austin, Texas

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