15 August 2006

Surrendering the Queen to Brutus

Ask any of us employed full-time in the medical field and we will tell you we're always wary of our 'thirds'. 'Thirds' in the sense of the third major call of the day, the third major unexpected surgery, the third major fuck-up by somebody who didn't know what they were doing, and...unfortunately, more often than not...the third person under our collective watches that will die. I have been involved casually with medicine since I was six years old when my father became ill with his terminal illness; I have worked in some capacity or another in the field most of my working years since the age of 16. I learned to dread the 'thirds' early on and their impact. After the second patient has died, it becomes almost karmic to patients and staff alike as the 'reviews of patients' become a bit more serious, depressing, and even morbid. A dear patient of ours at the clinic kids he has been given 'the watchful eye' by staff as a potential 'third' at least seven times now. He is convinced when he does go, though, he will not be a 'third'...he thinks he's cheated death enough by now to warrant being a 'first'. For what it's worth, though, I hope he gets his wish. I can only imagine how unsettling it must have been for him those seven times (and frankly for my own father for the last five years of his life) to go home knowing that your own caregivers (who truly care and love you as extended family) fear you won't be coming back to see them again.

That said, life and death make up a good deal of our jobs. Those who choose these professions know it, deal with it on our own terms, and accept it somehow and at sometime. Many of us (myself included) don't deal with it well privately, but can create the most stoic faces in public. Some of us (myself included) have or used to have to find 'alternative' (and frequently very harmful) ways to block out some nasty emotions. Some of us (myself included) have lied awake at night staring at a dreadful ceiling, contemplating what will happen when we die and how we will be cared for by others...and more importantly from the immediate perspective, have calmed ourselves enough to sleep in the very hopes we'll wake for the next shift. On good days, we have the best jobs in the world. On bad ones, we come home and stare at our ceilings and plan another life for ourselves...a better, hopefully happier one, where the job truly ends when you leave work. Depending on the field of contact one pursues, some of these emotions run deeper for others. To this day, I will never forget the first man who died in front of me at the emergency department right down to his clothing, his dentures, his dear wife desperately wringing his hands to elicit a response that would never return...and that man's death came ages (and people) ago, almost 18 years ago now.

These things, I like to believe anyway, make those of us in this field appreciate life in a bit different way than most people do. If you help with a birth or help save a life of a child, you develop a much greater appreciation of those who barely survive or have been born into an ill-equipped world. If you ever have to witness someone being told of a dear one's death or even have had to hold the hand of those dying alone, you develop a much deeper appreciation of what you don't want your life to be at the end. If you've ever had to ask for money to help those who've passed get cremated and a decent service, you develop a much richer apprehension of how, even in death, we are all separate and left on our own. And if you've ever had to wrestle away a sparring and spurnful lover from his/her fool, you develop a much deeper understanding of what can drive a person to surrender all reason due to rage. The scars one takes away from this job are deep, educational, and complete.

But you also get immune to feeling emotions...any emotions. You simply have to. If you survive in this field for any length of time, one must develop another whole persona in which to live. Actors are just that and are free to remove those masks at any time, and apparently now for any price. Those of us who are required to hit our marks perfectly everyday for the sake of life and death don't have such luxuries. You develop another persona to keep yourself sane or you perish. You know, though, it's time to move on with your life and your career when your bad days outnumber your good ones and you find yourself hoping more that your dreams are real than what's going on in reality.

As one would reason, it is with great convulsions almost when certain emotions do break through our carefully constructed barriers. Frequently it will be something wonderful, grand and kind...like a birth of a child or long-awaited marriage. Sometimes it's something far more humble and ordinary, like a long overdue job promotion or retirement. Congratulatory thanks or plaques are appreciated but frequently overkill...we all know what is the internal drive for our co-workers and friends. For the rare few, it is fame or notoriety. For some, it is money. But for many...most of us, in fact...it's going home tired but competent, knowing that we did everything that we could that day to the best of our ability. Some days this means laughter and cheers, some days it's anger and resentment and fear. But, even among those of us who know how to wear the mask very very well, sometimes emotions do come pouring through...we can only hold them back so far.

So it is with great sadness that I write this entry, as I process my raw emotions even now. For years those of you who have known me and supported me know of my personal journey, my illness, my loves and dreams lost. And I think you also all know my personal resilience, to bounce back in the face of adversity...with the love and support of good friends such as many here. For at least the last half decade, many of you have suffered through my countless dreams of a life away from medicine, away from the 'traditional' American life, away from a set-upon '30 year fixed mortgage and 2.5 children' path so many others blindly follow. As many of you know, my dream life has been to immigrate to Australia and 'start' the new phase of my life...my ideal life, even if it means completely solo...there. Accordingly, I have thrown my entire waking moments here recently into that dream: improving my health (which is good, btw, I just have a nasty virus that medicine will greatly improve), paying down my debt, getting additional skills for prospective employment. Without even noticing it, my preparations have been in thirds, too, so against all history and common sense, I was remarkably hopeful when I received my third letter about my future Australia plans. But today...a day I'll probably be focusing on for some time in the future with great distress, so be warned...today I learned my fate regarding the dream I've held onto so long, so dear. Today I got the official news and I learned my dream...is not to be, nor will it ever be.

I am shaken to my very core. I am angry. I am crestfallen. And I wallow in my own pity, which I will have to overcome and conceal by tomorrow's light because the mask must be back in place, the smile friendly, the dress appropriate and reserved. My patients and co-workers with their struggles, their dreams, their hopes...they'll need me then. But that's tomorrow. In the meantime, I have to find the reason to this happening. A reason, any reason really. And all I can do is stare at this damn ceiling and wonder what the hell went wrong. Springsteen, in what is my favourite song by him in "The River" asks: "...is a dream a lie if it don't come true, or is it something worse?" You know, folks, I don't have the answer to this, but right now I find myself wringing every last morsel of hope out of mine. And it's still flatlining before my very eyes.

So tonight I surrender myself to my emotions...all of them, good and bad, from both my public and private selves. And I just need to have a long, painful cry and mourn.

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