Heavy Stuff

What a clinically heavy week it’s been. There were two sudden and unexpected deaths… After the shock, the first things I thought of as the primary care doctor in both cases were: What did I do wrong? Did something I did or didn’t do contribute to this person’s death? I felt culpable, despite the fact that on objective assessment, it’s extremely unlikely that anything I did or didn’t do contributed to either death. So, I did the best that I could to put aside that nagging, self-centered paranoia. I reached out to the families, and I’m so grateful. To hear a whispered thanks, and no blame… well, there was no more powerful medicine for my aching and anxiety. Of course, then I felt guilty for feeling relieved…

It’s been a difficult week, for sure. There’s more…. I had a telephone confrontation with a patient who I suspected was diverting their narcotics. Despite being calm, reasonable, and well within our hospital’s mandatory prescribing guidelines, the profanities and insults hurled at me from the other end of the line left me shaken. I politely hung up, and then showed a colleague my trembling hands.

That same day, leaving the office in the evening, I had a frightening encounter with a drug-seeking patient. Nothing happened, just an insistent request for a prescription… But the office was closed, and I was the only one there. It made me realize that I needed a better plan for a situation like that, and luckily, the whole office was on board with that. Within twenty-four hours, there was a list of new security measures.

These things all came on top of other clinical challenges: a surprise (very) positive imaging stress test; an unintended pregnancy; an ultrasound suspicious for ovarian cancer.

And, of course, there’s also been all the usual bread-and-butter primary care: the patient who’s been cheated on and tearfully requests STD testing; a stoic lady admitting that she’s dangerously depressed; a pillar of society revealing that she’s drinking too much. Twisting knee and ankle injuries; a diabetic with cellulitis; mystery fatigue. Mononucleosis; excruciating shoulder pain; vertigo. New breast lump; itchy rash in the groin; wheezing. The end-of-visit “Oh, and I forgot to mention, I need this paperwork filled out, today.”

I feel bad for my family, as I’ve been later than usual coming home, and somewhat distracted. But, at the same time, I’ve felt more alive, really engaged in my practice.

The more that’s going on with my patients, the more I enjoy my job… But, at the same time, it’s exhausting, draining, and gets in the way of quality family time.

Of course, when I have gotten home, I’ve been less likely to freak out about things like, the kids having a yogurt fight, or Babyboy pooping his pants yet again, or the cat peeing on the floor (all of which happened tonight).

I’ve been more likely to just smile, and hug my kids a little longer.

There’s a lot of heavy, bad stuff out there. People get sick, suffer, and die. Right now, I’m not sweating the small stuff.