Sleep

For as long as I can remember, sleep has always been my greatest stress reliever. I know that a lot of people relieve stress with exercise or partying or drinking. On some level, exercise always seemed to add to my stress… primarily because it seemed to always remind me of how out of shape I was. Partying and drinking never really worked for me, because in the quiet moments in between the action, I could physically feel the weight of the stress that I was avoiding.

But sleep… sleep always has taken me to a place where things just seemed to work themselves out… or at the very least… sleep takes the edge off of whatever raw emotions I am dealing with… and when I wake up… I am somehow able to think a lot clearer.

I think a lot of this has to do with the fact that I am such an introvert. I know a lot of people have a hard time accepting that I am introverted, but I really am. I enjoy interacting with people and I enjoy knowing lots of people. But being out and about in public exhausts me… and at the end of the day, I absolutely need time along or with just a few people to recharge myself. When things are stressful… I think the ultimate “alone” time really ends up being sleep.

I’ve also always felt that sleep was when God provided me the most comfort. It sounds silly, but in the way that God talks to us in our dreams… sometimes I feel that in my sleep, God is just there with me… knowing I don’t need to hear Him… I just need to feel comforted by him.

So, I am giving this extended dissertation on my relationship with sleep, because I think that’s what makes my job so tough sometimes. Sleep just doesn’t come easily. It’s a lament that I have made often over the past 6 years or so… often in jest. However, the past few weeks have made this fact especially noteworthy. As I struggled with trying to recover from my patient’s death (see previous blog post), I found that the one thing that has helped me the most was exceptionally hard to attain. And it made it much harder to get myself back to being who I am.

Until… I got sick. Predictably, after everything that has happened the past few weeks, I finally got overwhelmed by one of the many upper respiratory infections I treat 100 times a week. It started last weekend. I started to feel fevers and chills and kind of achey. Then I found myself on call and though my call was mercifully mild, I woke up post-call feeling like I had been hit by a tractor and had no voice. I came home post-call and went to sleep. I did not wake up until the next morning. I then slept through most of that day as well. By Thursday, I was starting to feel significantly better. And I started to try to catch up with my work. That’s when I realized… that sleeping had not only helped me get better from being sick… it had also taken the edge off of a lot of the pain I was feeling. And I also awoke with a lot of clarity.

In the middle of one of these sleep filled days, I somehow woke up to check on lab results that I had ordered on a patient. This patient had had some very odd and troubling symptoms for almost 6 weeks. I originally was very worried that she had a cancer. I checked a ton of stuff initially… which all came back normal. I sent her for studies… all of which confirmed that there were some weird things going on, but none of which gave a definite answer or clue as to what that was. I sent her to some specialists… none of whom really seemed as puzzled or concerned as me. Yet, something nagged me about her. I couldn’t put my diagnostic finger on it, but something was not quite right. So I had ordered another battery of tests… and added a Lyme Test as almost a last minute-why-not-check-this-while-we’re-at-it kind of test. In the middle of my delirious sick state, I somehow remembered that her labs still hadn’t come back yet and I needed to check on them.

When I did… lo and behold… her Lyme test came back positive. I had to read the result multiple times to believe it. It was such an odd presentation of Lyme Disease. She had none of the typical… and all of the atypical symptoms of Lyme Disease. It just was not something that was on my radar as a possible diagnosis. But the most important part of this… is that it was still treatable. So I called her and got her started on treatment right away.

I guess that’s the reality of my job. Medicine is imperfect. I am imperfect. I am going to miss diagnoses. There is no way around it. I could be the smartest doctor in the universe… but it wouldn’t change the fact that there are just some illnesses that simply don’t show themselves in a diagnosable way. Not necessarily rare once in a million illnesses… but even simple, common diagnoses… just because there is a natural variance to things. But in reality… I will probably correctly diagnose a lot more conditions than I will miss.

This all came to me as part of a greater epiphany. I need to get my act together. I think on some level, the fact that I’m a doctor still has been a shock to me. I think about my past and how I got here and it is still hard to believe that I am actually at this point. But it needs to get real for me. I don’t mean in the way I approach my job when I’m at work. I mean in the way I approach my job outside of work. It’s a lot like professional athletes who suddenly realize how much work they need to put into their craft outside of the time they spend on the field or on the court. I realized that the only way I am going to truly do right by my patients is to really put work into my craft. I need to get smarter. I need to get my life in better order. I need to get myself in a better place physically.

This has been a really hard few weeks. I haven't taken an emotional hit like this in a very long time. I’ve gotten a lot of support. I have certainly felt that there were places I could turn. I've had a chance to talk things through more times than I care to count. I've done more soul searching than I ever have before in my life. Finally... I feel that I am coming out of this stretch. But I'm not coming out of it with a sense of relief... I'm coming out of it with a sense of focuse.  I see now the way my life needs to unfold a little more clearly. I see the things that I need to do to take the next step. It took some incredible misery and pain to see all that. But I am excited about the changes I see coming.

And with that… I’m off to sleep.

The Darkness

I’ve had a rough 2 weeks.


It started with just being incredibly busy. I was working in the hospital taking care of our patients that were admitted. Our list of patients at Fairfax is usually 5-7 patients. Our week, it was 12-14. This is a significant difference. And it seemed like every day I was there, a new patient would need to be admitted the same morning I was there. Our patients were also very sick. It was an extremely stressful week.

Then about midway through the week… one of my patients died. It happened very suddenly. It happened very unexpectedly. It happened while I was there. And no matter what we did, we couldn’t bring him back.

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That’s all I want to say about that day.

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But, it’s been a pretty steep descent into darkness since then.

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As a physician, I think none of us is deluded enough to think that we are going to save everyone. Death is a reality of life. And I’m no stranger to it. I’ve seen my share of it. But this was different. It was different in many ways. I didn’t see it coming… on multiple levels… I really didn’t see this coming. I think it was also tough that I was directly involved in his care from beginning to end and that includes being involved in the attempts to bring him back.

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When something like this happens, I think you start mentally and emotionally killing yourself over and over again. Intellectually, you pore over everything trying to figure out what you missed. Even when you clearly didn’t miss anything and when you clearly didn’t do anything wrong, you feel this burden of unbelievable guilt. It’s not a logical thing. And no matter how much you pore over it and see how things unfolded and know in your head you did nothing wrong… you still feel sick. Everyone involved in the case and everyone who has heard about the case all walked away shocked because they couldn’t see this coming either. And I’ve heard multiple times that this wasn’t my fault. But still… it makes you sick.

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We all carry insecurities about ourselves… personally… and professionally. Something like this brings all of those out to the forefront… and begins an onslaught of psychological warfare on you.

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The hardest part is that time doesn’t stop to allow you to recover. You still have to go to work. You still have to take care of patients. You still have to talk and interact with people. There’s nowhere to hide. I was offered the opportunity to take time off... and I wish I could take like a month off to be honest… but I also know myself… and I know that if I took time off… I was not going to be able to come back. So you’re stuck in the open… exposed… and hurting… with nowhere to hide.

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You also find yourself in this weird catch-22. There’s a lot of outpouring of support. People really want to help. But a) you’re not sure what you need b) you don’t want to really be around people c) but you don’t really want to be alone. I wanted people to know that I was hurting… but I also wanted to kind of be treated like I was normal.

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I worry about how this is going to affect me in the long run.  Am I going to become the kind of doctor that I hate?  Am I going to be someone that orders everything even when it's not indicated just because I'm afraid that there's something lurking that I can't see coming?  I don't want to be that doctor.  It's like being a parent that never lets their kids out of the house because something bad happened once.  I'm afraid this is going to happen to me. 
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But as I write this... I know that I am getting better.  It’s taken me a few weeks… but I’m finally starting to do a little better emotionally. I don’t find myself feeling like I’m going to throw up every few minutes. I don’t find myself breaking down emotionally at odd times during the day. I’m functioning better though the day.

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But I am really exhausted. I can’t seem to get enough sleep. I can’t seem to fight through the fatigue.

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And I’m still not myself.

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I don’t feel like joking or laughing. I don’t feel particularly friendly.  I don't know when or if I'm going to be that person again. 

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I know I’ll get through this. I know that God is with me and always has been with me and always will be with me.

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But it doesn’t change the fact that I’m hurting… and it’s going to take me some time to come back from this.

Normal

The other day, I did my first endometrial biopsy with a polyp removal. It was a pretty cool procedure. I won’t go into details, because it’s likely to induce severe nausea and sympathy pain. But needless to say, it is not a simple snip and cut. It’s not the craziest procedure in the world, but it is also pretty significant. The procedure didn’t go so smoothly at first… there are a few variables when doing this. My patient was amazing. She handled the whole procedure with incredible grace and dignity. Afterwards, I sat and talked with her and discussed what to expect. She took it all in. Then she asked if she could ask some questions. I was expecting questions related to the procedure and her risk of having some kind of cancer. Instead, she embarrassedly said that she just was never able to ask anyone this, but wondered if she was normal… down there. To hear this initially, sounds like a joke or somehow inappropriate. But it was actually such a pure moment of vulnerability and innocence, that it took my breath away for a moment. It’s such a simple question. Am I normal? I think most of us on some level walk through this life with a sense of this at some point or another. We all just want to have a sense of normal.


I don’t think most people would know it, but for most of my life I have felt like an outsider. Part of this was due to the fact that I was a military brat and had to move so much. I went to 7 different schools growing up and moved 9 different times. I never had that lifetime best friend. I never felt rooted in a community or with a group of people. I had a younger sister growing up, but we were 5 years apart. This was before the time of the internet when staying in touch was made easier by email and facebook. So I was constantly re-establishing myself. I was always the new guy. I was always the guy on the outside trying to find a way in. And on some level, I am grateful for this experience, because I feel like it forced me out of my comfort zone and I have become very good at making conversation and making connections with new people. It’s how I became a “socialized” introvert. But the truth is… no matter how comfortable I got or how many friends I made… I still perpetually felt like I was on the outside being allowed in as a guest. And I don’t think that feeling has ever gone away.

I’ve been in Northern Virginia more years than anywhere else in my life. And this is where I would call home. I know an awful lot of people through all my years here. But I still constantly feel like an outsider. I still have that feeling of wishing I was part of the scenery, not the perpetual guest. I always feel like the friend that people may like and like having around. But not that core friend that is always part of the group. That sounds so high school, I know.

I know that a significant part of this is my own fault. I am constantly in flux. I grew up a military brat and then went on to an adulthood of nomadicism. All of my jobs before school have been stepping stones to medical school. Medical school was transient. Even residency has been transient, because I am temporarily living with my parents and who knows where I will be after graduation. My hours are limited. So even when I am free… I am free for brief stretches… and that often takes a perfect alignment of all of the stars to do something. And after a while… I think people tend to give up on you… because what’s the point? He’s always busy or too tired to do anything. It’s a frustrating cycle. But I still wish people would try harder with me. It’s a selfish, slightly childish statement… but being busy does not equal wanting to be left alone or ignored.

Mother Teresa said, “Being unwanted, unloved, uncared for, forgotten by everybody, I think that is a much greater hunger, a much greater poverty than the person who has nothing to eat.”

It’s something that I think about a lot in the context of my life and my job. I think growing up the way I did… has made me super sensitive to anyone else out there who feels like an outsider or is striving to feel like part of the group… to feel… normal. My patient asking me that question made me realize something about myself as a doctor. It’s really important for me to put people at ease and feel welcome. So when I sit with my patients, it ends up being really important to me that they feel ok about what’s going on with them and feel that they are walking away with a sense of how things are going to evolve. It’s part of why teaching has always been important to me. I carry that feeling of being an outsider all of the time, and I know how much I wish I didn’t. So by extension… I really value being able to take that feeling away for others. Helping others understand their illness, making them feel at ease with their problems, making people feel cared for and listened to… all of that goes a long way towards making a person feel like a “normal” person… making a person feel that they are no longer on the outside looking in. In a lot of ways, I wish my life weren’t like this. I wish I could feel normal. But the truth is, I am also incredibly grateful to have the privilege of knowing that I am making others feel normal… even if I don’t feel normal myself.

Romans 8:28
28 And we know that in all things God works for the good of those who love him, who have been called according to his purpose.