Burn, Baby, Burn
by Rosalind Kaplan, MD
I would love to write something lovely and lyrical, full of truth and important insights, today, but I am, unfortunately, paralyzed by the exhaustion and frustration of a really difficult day attempting to provide medical care. Okay, that's not entirely fair to myself or my patients. I did, in fact, provide medical care. In a twelve hour shift at urgent care, I saw 45 patients, most of whom had fairly simple problems with clear-cut solutions. I also took 20 or so phone calls from physician assistants looking for supervision of their work at other urgent care sites in my system, and I served as a preceptor for a nurse practitioner student. That is a little more than I think one physician, even an efficient and organized physician, can reasonably handle in a day. I tried very hard to give proper attention to each patient, each PA and to my student, but I felt like I was being pulled in a thousand directions, and I didn't have time for bathroom breaks or meals. I had to 'make' the time by eating while walking, peeing really fast (don't ask- I know that sounds crazy, but it's true!) and keeping my water bottle filled and next to my computer monitor at all times. This is not a reasonable way for anyone to live, but it was my lived life yesterday. And the lived life of so many other medical professionals.
Today, I'm cleaning up the mess from yesterday, completing all the charts I didn't have time for yesterday, double checking my work to make sure nothing fell through the cracks, checking in with my student. I am nursing a tension headache left over from yesterday's stress. I will recover, but is it worth it?
It is clearly not in anyone's best interest for one person to try to be several people. In fact, I was supposed to have an experienced physician's assistant, who would have picked up much of the patient care, by my side yesterday. But someone called out sick from another site, and there were not any 'extra' bodies to fill in, so that PA was pulled from my site, leaving me with this onerous assignment yesterday. For me, the hardest thing is feeling I could have done things 'better' if I'd had time. Cutting corners when it comes to patient care and student learning just isn't okay with me. I have been accused many times of being a perfectionist, told I need to 'curb my expectations', but it doesn't resonate. I want to do my best, and it's hard to feel that 'good enough' is 'good enough.'
I looked carefully, today, at my patient care. I managed to do all the essential stuff. And I was as kind and patient as I could be, but at the end of the twelve hours, I felt my patience shift and dwindle. I didn't feel, and likely didn't act, with the kind of empathy and caring that I did earlier in the day. I have to cut myself a break here--I got no empathy or kindness all day, and couldn't care for myself. So of course I began to run out of steam....but that doesn't make it any better for the patients. And my student. I feel the worst for her. She is paying to go to school and she needs to learn the clinical skills that I have to teach her on the fly. I may have learned by the 'see one, do one, teach one' method when I was a student, but I don't remember feeling this time-pressured. Things happened slower, I think, thirty years ago.
And yes, I let the powers that be know how things went-- that the stress level got higher than it should have. They know it wasn't really okay. But will that keep it from happening again? Doubtful. Nothing really untoward happened, so they'll rationalize that it was 'fine.
Well, yesterday's over, and I have to let it go. Until the next yesterday. How many times until I burn out again?