Hello Darkness My Old Friend
My friend Nick, the ER doctor, called me the other day to tell me that one of my patients had died under his care. He didn’t have to do that, but he knew I had followed this woman for several years and knew her family well. She had nearly died under my own care a few years ago, but through outstanding work by the ICU and other nurses, had survived and gone home to her grandchildren and had seen the birth of her first great-grandchild. She had thanked me for saving her life, when in truth, I had been largely responsible for her getting in trouble in the first place.
I hung up after the call and was suddenly overwhelmed by a rush of shame, despair and a feeling of loss so powerful that I had to stop the car and cry. Images of dead and dying patients flooded my head for reasons that I still don’t understand. I felt as if I had wasted most of my life pursuing an illusion and that the cost to my family and myself had been too high for too small a gain.
I have been shedding a lot of tears lately. Those who have read these posts or who have read my novels know that I am at heart a hopeless romantic. Even my cynical, curmudgeonly rants are based in a vision of how things should be rather than the pragmatist’s view of how things actually are. I have always been sentimental, but as I have aged, I have found my control slipping. I tear up at trivial things. I’m liable to cry at the movies or over a piece of music. I’ve been known to get choked up over Hallmark commercials.
My chosen profession makes a science of the study of mayhem. We see awful things every day; unexpected death and destruction salted with heavy doses of sadness and futility. Yet our training and our ideal of professionalism forces those of us who chose this life to view those events through the artificial lens of detached objectivity. How can we analyze this patient’s course in order to learn from it? What could we do differently? We remain in control and dispassionate to the end. But that is a lie. Those events affect us no matter what sort of outward calm we display.
We all have regrets about our life choices, even the good ones. I know that. But my reaction to the regret I felt and the flood of memories of all the times I failed to save a patient was completely over the top and frightening. Somehow my worth as a person has gotten all mixed up with my worth as a surgeon. There seems no separation or balance anymore. I still haven’t recovered my equilibrium.
I have never placed much credence in PTSD as a disabling condition. I know it is a real response to traumatic events and that people may be profoundly affected by those experiences, but I always felt that one recovered by soldiering on and drawing on ones strength to learn from the traumatic event. I have often felt helpless and inadequate when faced with a patient who was so ill or injured that I could do nothing to help. You learn to deal with it, to put it in a box and do what you can and move on. Sometimes, though, the box is too full, or the walls are thinned by fatigue or age or by assaults from several sides at once and the whole thing opens up and dumps a load of pain on you. In those times, you need a safe place to cry, or to scream at the sky, until you can recover your self-control and resume the work. But the darkness never really goes away.