Saturday, June 13, 2015

The Emotional Well

A year ago, I made the transition from the many hats I wore at Deaconess (pharmacy practice in adult/pediatrics, emergency medicine, and women's health) to a pediatric emergency medicine clinical position at a Level II Trauma Center. The transition has been a difficult one. The medication end was, believe it or not, the easy part; the hardest has been the constant emotional drain. There's a certain amount of empathy required when caring for sick children, moreover ones with whom you have no personal connection. This generosity is one of the things that I value most about each and every one of my teammates in the emergency department. Yes, teammates. While the medical hierarchy is certainly in place when it comes to decision making, there is a real sense of camaraderie that pervades the group, probably because of the nature of our work. Everything boils down to "for the kids."

With that said, there is no ready shut-off valve when the cases become hard. I don't remember my first adult code. I can remember every pediatric code that I've been in. I remember the accidents, the bad parenting decisions, and the non-accidental traumas, or NATs. Non-accidental trauma. It's a pretty phrase for what is, in reality, child abuse. When you work so hard to save lives, one of the most difficult things to fathom is an adult attacking their children, especially when I know women who would give anything to be a parent and can't for biological reasons.

Perhaps what makes these so memorable is that creeping sense of futility. Less than 10% of children who code make it to discharge. The reality is that we often sustain life just long enough for parents to say goodbye, or we leave them with the heartbreaking decision of whether or not to pull the plug. Sometimes, as in the case of hangings, the brain injury is severe enough that the most humane thing would be to let them go. And still we do our best to preserve life, because we believe that every life is precious.

Amongst all this is the difficulty in finding emotional support amongst family and friends who aren't in healthcare. Obviously details are kept mum due to HIPAA reasons, but what little you are able to share, such as "we lost three babies this week," seems to generate some variation of "Oh that sucks, I couldn't do what you do," or "Oh, I'm sorry, I'll pray for you," or my personal favorite, "Oh. Let's talk about something else." It's the equivalent of "That's nice, dearie" and a pat on the head. There's this unwillingness to just sit and share in the grief and the weightiness of life and death and the things that we can't control. I get it--it's a terrible feeling. As humans, we dislike pain, which is generally a good thing. What irks me is the misinterpretation of what it means to share a burden and help to carry a load. It isn't passing the ball to a higher power so that He can deal with it. It means allowing yourself to be uncomfortable so the other person isn't all alone. By all means, yes, pray, but do so together. Pray with them rather than for them. It's a subtle distinction, and it makes all the difference.

So what do you do when the emotional well runs dry? I recently came across an article in The New York Times indicating that awe is what inspires us to care for others. In the past year, I've sought out ballets, operas, orchestra concerts, art museums, and musicals. Glorious, transporting (if oftentimes expensive) reminders that there are wonders out there that are greater than ourselves. That the world still contains good things. My first thought upon reading the article was, "Oh, I've been self-medicating. Nice." Then I realized that I was taking care of myself because you can't rely on other people to take care of you, a realization that was as self-empowering as it was sad.

This post turned out to be a bit of a rambling jaunt through the jungle inside my head. It's currently an untamed mass of frustration, anger, hope, and weariness. So yes, maybe I tend to treat myself a little too often. Yes, I probably do have a baking problem. And no, I don't find your misguided quips about suicide particularly funny. I was in that mental space half a lifetime ago, but that's a blog post for another time. This one appears to be a plea for just a little sensitivity from those who work outside of healthcare towards those who do. Or towards people in general. I've heard it's good for you.
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