I am in such a strange state of mind. I find myself missing many people and events in my life and yet I also find myself becoming more reclusive in the times I have away from the hospital. I occasionally find opportunities to spend time outside the hospital with other residents or sometimes new people I have just met in hopes of building a personal life in this new city to balance my work life. All it requires of me is the enthusiasm to leave my house and interact with these new people in a simple, social situation yet I struggle to find that enthusiasm and it is getting harder. I don't care to tell my story or ask other people theirs. I spend my entire day asking other people their stories and then being empathetic with their feelings. When I make plans, even when it is something casual and social, it often feels like another deadline, another responsibility - another item on my overburdened schedule that must be met. It is this very viewpoint that is the biggest sign that my life is so out of balance and the biggest hurdle in my ability to regain some balance in my life. I see that.
Most people think of me as an extrovert rather than an introvert. I try to be gregarious and social when in the hospital, friendly and conversational. When I am with my patients I am often, not always, truly emotionally available. I reflexively empathize with their pains and struggles. I share their emotions compassionately and they can sense that. I try to allow them to express some of their fear and pain and frustration with me as a sounding board and then I try to direct their emotional energy toward something constructive. I try to lighten the mood of those around me when I can with a joke or a quick response. I even write a blog for the world to see. By all outside viewpoints I am rather outgoing, but outgoing is not extroversion in my book. When I tell people I am more of an introvert they usually laugh. It is true though. I once heard the definition of extroversion as the state of being where a person needs to be social, interactive and with other people in order to "recharge" and introverts are those that recharge alone, isolating themselves and "their inner world" to gather their thoughts and feelings. Extroverts absorb energy from everything around them to recharge. Introverts drain their batteries to give back to all that is around them, then they recede from the world to fill them up again. I can't think of a more socially and emotionally demanding role in society than an emergency physician and I am starting to see the toll it takes on me and my life. Perhaps it is because even though I am an introvert I still crave meaningful, personal and close interactions with people. I simple cannot stand flimsy, fake and superficial interactions. They drain me and tire me and I find them totally without value so I strive to make most interactions real interactions. I would rather go deep than wide in this respect. Emergency Medicine is a field that requires both though.
I usually have about 5-6 patients I am seeing at any given time in the ED and usually 2-3 of them are "sick". This is actually a very low number, by the time I am 3rd year resident we are expected to know and be following up to 10-20 patients at a time and half of those could be "sick"! When we say "sick" in the Emergency Department it means something different that general colloquial use. For us "sick" means acutely ill with potential life threatening implications requiring a high level of medical care. A badly beat up person after a car accident that is bleeding from their scalp and limbs is often not "sick" unless there is an artery or head bleed involved. Alternatively, an older person with a cough, fever and dehydration may not seem as dramatic since there is no bleeding, but they often have the potential to suddenly "decompensate" and require intubation and ICU care, so they often qualify as "sick". I balance the complainer in the ED that requires emotional validation for their suffering after a sprained ankle with the stoic WWII veteran that may have perforated a bowel and is becoming septic but even then still won't complain much. The diversity if wide, but what is required of me is deep, either emotionally or medically. Trying to stay present and offer care for this huge spectrum is challenging. I usually have a stack of charts which adds to the burden. I must document things correctly for the sake of the patient and the attending that must come after me to review them. I also have the personalities of about 4-5 nurses, several consultants one or two attendings and about 2-3 other residents to contend with - all different and all requiring a fast adaptation of speech, approach and mannerism. In short, I feel responsible for about a thousand things per shift, not just the patients or medical decisions but for the thousand interactions I have every minute of my 13 hour shift.
I want to be a thorough doctor. I want to be a friendly doctor. I want to a fun and relaxed resident. I want to be on equal footing with the attendings and the drug users so that we connect well and work together. I want to sound competent to the consultants. I want to be respectful of the nurses and the hard work they do. I try to adapt myself and my style, speaking and behaving, to the people I am around so that we all work comfortably and effectively together. To me that is part of the responsibility of medicine. To make people feel comfortable, safe and respected when they are in this difficult situation. I don't always succeed and honestly, as time goes by and I get busier and more is expected of me I fall short of it more and more. But I still feel the pressure to do well. The responsibility. First and foremost though, I must treat my patients quickly, accurately and effectively and I am still learning. When I have a shift where I don't connect with those around me, where my charting suffers, where I am not "on my game" I leave feeling disappointed in myself, the process, the hospital and the world around me. I am drained. I see that I am taking one a huge emotional burden every day and it takes everything that is "extroverted" out of me to do it. Responsibility for that which is outside of myself is the place I find myself in but one very much at odds with who I am in many ways...
The price of responsibility is high for an introvert such as myself and that is why I spend what little time I have outside the hospital isolated in general. It makes it harder and harder for me to balance my workload with a social life because the few hours I have off I need silence to be reclusive in so that I can recharge. By the time I have enough solitude to quiet my mind, fill my batteries and the desire to be social with humans outside medicine and the walls of the hospital returns I find I have to go back to work. I had the day off today and I slept 12 hours straight last night. Some nights I don't sleep well at all or when I do I dream only of more emergency patients, being within the hospital, solving problem after problem. I sense urgency in my dreams and I wake unrested. The exhaustion comes not from simply being awake, but from being responsible for so many people and events all the time. I know I am someone that has craved this responsibility. This is in part why I went to medical school, I wanted to be responsible for people, to have the knowledge and power to repair their injuries and illnesses. As I travel through residency though I see this knowledge is coming with greater and greater burdens. I can't detach myself from it. I can't do the work and simultaneously not care about the people which is what is required to unleash the weights from the role. It sounds more and more like an addiction actually. A compulsion. The deeper I get into medicine, the more I learn and the more I take on. The more responsibility I crave and strive for the greater the weight felt in my life and upon my being. It feels like it will crush me some days. I have seriously walked through the hospital late at night and seen the man emptying the trash cans, rolling his janitorial cart down a basement hallway dimly lit with fluorescent lights, and I have envied him and his lack of responsibility at work for anything greater than the trash cans. Keeping a hospital clean is such an important part of the whole process yet it is devoid of so much of the responsibility. Does he go home at night worrying that the door handle he forgot to clean might have transmitted an eventually deadly virus to someone unsuspecting? I am betting not. Yet we go home and wonder whether or not we should have ordered that one other lab test, or perhaps given more steroid or not given a steroid.
On the rare occasions I get a few days off I notice that I return to normal after a day or two of being home and alone. I then have the energy and enthusiasm to rejoin the outside world but I must first make time to "decompress" from the demands of residency. It is not that I don't desire more personal interactions with people and those around me, I do, but I don't have the emotional energy for it often. I am trying to find more and more ways to invest in myself simply so that I will feel whole enough again to participate in the world around me. This is all made more difficult by being in a new city without any close ties. In Seattle I had a small group of close friends, people I could share my inner world and thoughts with in such a way that it did not feel draining. When I had a few moments off I could both recharge and gain the perspective that being with other offers. But here I find that everyone is a stranger. Many friendly, quality people that would probably make great close friends given the time and effort to build those ties, but I can't find the time or energy to do so despite the need for those ties. I feel a bit trapped and I just wait and hope that when residency is over I can return to my life somehow. Then I will have a reduced work load, less learning and more emotional and mental space for my life and those close to me. I dream of working 1/2 time or perhaps 3/4 time so that I can better balance these demands with my other needs. . . away long enough to find the energy for my inner pursuits, my friends, perhaps love and hopefully time to rebuild closer ties to my family. All these things can enrich my life and they make it possible for me to have more to give to the people that need me in the Emergency Department. I know my life outside offers me the ability to be a better physician. It is a delicate balance that when done correctly enriches both aspects of my life. The personal can feed the professional and vice versa, but when slightly out of balance, such as my life is now, I feel that one destroys the other rather than enriches it. I really get the sense that this is not so hard for many other residents. I see residents that are married, dating, having children... rich lives outside the hospital so I wonder how they do it? Do they simply have more energy than I do? Less demands of themselves perhaps? Have the balanced the responsibilities in such a way that the whole generates more for them than the demands of the parts? Perhaps I will figure it out during this process, for learning that sort of balance and personal insight would truly be a great achievement.
This blog is one small way that I can maintain some of my personal time. It is not an act of extroversion but an act of escape from extroversion. I can delve into my inner world, investigate my thoughts, feelings and observations in peace and quiet without the demands of the world around me. I write this mostly for myself, but by placing out into the world it also satisfies some aspect of my need to stay connected with the world outside myself. I do not believe you can remain healthy at either end of the extreme. Totally introverted or totally extroverted. I strove for ambiversion I think. The center. It may not be an actual place or destination, but an idea that continually pulls us back from the extremes. I am spending a lot of time in the extremes these days and it is a learning process. I am more aware each day of the weight that my new responsibilities as a physician place upon me and I hope that I can find the ways to balance it. I think being a physician gives you great insight into what being human is, but it certainly comes at a cost. You see a lot of ugliness but you can also see the beauty in it. How to find a way to balance this knowledge & responsibility while remaining whole outside the hospital is hard. It is probably my greatest personal challenge throughout this residency and one I hope I can achieve.
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