This post is inspired by the recent devastating hurricanes that have affected millions and tested the perseverance of many healthcare professionals in the areas.
I started writing this blog post over a month ago, after spending a few minutes out on my sunny stoop with a cup of coffee and a cooing baby. Like so many privileges, this was one many people could not enjoy that day. I specifically thought of our colleagues in Texas, Florida and Puerto Rico, many of whom no doubt were entering day two, three, or even four of a shift with no end in sight.
As a second year resident I did my trauma rotation at Cook County in the dead of winter. Not the time of year for a lot of chest tubes or thoracotomies, but that’s a blessing on it’s own. On one of my 30-hour calls, snow fell in earnest as the day progressed. The hospital instituted emergency procedures and nurses and staff starting calling off for the next day. Early on February 2nd, after some 20 inches of snow had fallen, the doctors and nurses were informed their shifts would continue until relief showed up. The 30-hour call could now stretch indefinitely. Like so much in residency, we knew to take things as they came, having figured out that the capacity to cope with difficulty increases out of necessity. And with a seemingly-unlimited supply of Cool Ranch® Doritos® in the cafeteria, we shrugged and figured we’d do what we had to.
The next morning one single resident was 45 minutes late. It took her longer to dig out her city alley than she’d anticipated. The residents coming to relieve the on-call staff knew that they were expected to be there, even if they had to risk driving in the hazardous conditions. Rounds started just about on time, went quickly given the paucity of patients, and we were thankfully, if surprisingly, soon making our way home.
This snow was, of course, in no way analogous to Harvey, Irma, or Maria. Recent events are reminiscent only of Hurricane Katrina and the levels of human tragedy that it wrought for years to come. But these three back-to-back storms, that led to a surge in patients, were certainly accompanied by a resigned acknowledgment by the physicians that they would stay until relief arrived, until there was someone else to care for the patients.
And that is the point: there will always be one more patient. There will always be something else to do, someone else to see, another day and another shift. It may be business as usual or it may be catastrophe, but the expectation of a physician is that they will meet the need as long as it is humanly possible (and, in these extreme cases, longer still). You will have to keep showing up for work and the patients will keep showing up to see you. Making room in your day for one more is what you are being trained and socialized to do, and the expectation that you will both show up and keep up is ingrained deeply within the physician culture.
You will have the privilege to save lives, to kindly guide lives toward a peaceful end, and to be there for countless people on the worst days of their lives. That sets you apart from people with “normal” jobs. When other people call in sick, or aren’t able to go to work because of weather, natural, or personal disaster, you will be slogging it out until the work is done and relief arrives. It doesn’t matter what is going on in the outside world or in your own personal world, you are expected to show up, be on, and give 100%. The expectation, of course, is unreasonable: it cannot be done. It should not be expected.
But systematic change, however welcome, takes time. The culture of medicine is not rapidly changing, even as the number of patients you are expected to see rapidly increases. Perhaps, based on the above story, you think I am advocating for the culture of expecting perfection and constant, unceasing work on the part of the physician. I certainly am not. I only make the observation and the following recommendation: take care of yourself.
There will always be patients to see, residents to mentor, committees to join and just more work to do. The system will expect you to do it and generally will not take care of you. You must start to learn now where your limits are and how to generally adhere to them to keep yourself happy and healthy. Medical training teaches us to keep on trucking, but it’s important to sometimes hit the brakes and leave work behind. There will be moments where this is flat out impossible, but on the day-to-day grind, it is important to cultivate the habit of self-care, setting limits to protect yourself in the future.