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Here's my column from this month's Emergency Medicine News. I hope you enjoy it. It should also be at www.em-news.com. Confession, it has been said, is good for the soul. I think it’s true. In fact, I wish that we good Southern Baptists would have confession every week. Our Catholic brothers and sisters get it off their chests, but we carry everything around inside, pretending to be good and proper without ever admitting that we had naughty thoughts about someone we shouldn’t, or that we kicked the dog or neglected our sick friend. I think it’s time for confession. I’m doing it for me and for you. I want you to know, and be assured, that you aren’t alone, however normal or abnormal you may be. And I’m doing it so you can say, if nothing else, ‘at least I’m not as crazy as that guy!’ Here goes: I don’t like to do CME. CME is boring. I know, in a computer age, with cool programs, CD’s, multi-media lectures, and all the rest, I should be enjoying every breath-bating second of reviewing articles in medicine. I don’t. I like poetry. I like novels; especially historical ones by Bernard Cornwall. (I’d like very much to fight the Norsemen with Alfred the Great; or to fight Alfred with the Norsemen. It seems it would be so much more rewarding than fighting the infection control nurse or the JCAHO inspector.) I like children’s books, and love to read Shel Silverstein poems to my children. The beauty of words entrances me; the story of humanity moves me to tears; the Holy Scriptures leave me speechless; the materials and methods section of any given article sometimes leaves me with seizures and vision loss. I don’t really like doctors very much. I mean, I like my friends and co-workers. But far too many doctors are arrogant, heartless, profane and difficult. I have cats who are better listeners and far less judgmental. Imagine that! A cat less difficult than a doctor! But there it is. Doctors embarrass me when they reduce patients to mere annoyances, and they anger me when they speak to me as if I arranged my entire day to ruin theirs. Sometimes I want to scream at them. Sometimes I just want to reach them and say, ‘What if it was you? What if it was your wife? Your child?’ I confess, I don’t think many of them would get it. ‘But it isn’t,’ they might say and continue to be angry at me. Sometimes, I look forward to not practicing at all. I wonder what it would be like to retire and have a job that requires less mental gymnastics. I think it might be nice to be the night security guard in a mall. To walk around, check doors, and embrace the thunderous silence and darkness, knowing that no one outside was coming in to die, or to ask for me to rearrange their personal crisis. I think it might be nice to enjoy the night that way. I hate the way that humans are broken. It fills me with sadness to see them; children with no parents, parents who lost children. I look at them and my heart breaks for addicts and drunks, for the lonely and depressed and frightened. I fear for the children who hold their arms extended to me, as if to say ‘Please, take me with you…these people are crazy and you seem not to be. Can I be your child now?’ I wish I could glue all the pieces together; I wish I could melt and reforge them the way only God can. I hate the way I am incapable of fixing them, of comforting them, or of raising their dead to life. I hate my incapacity. Now that I am older, and medicine is busier, I sometimes find myself in a trance. As I sort through six or eight people with only slightly difference stories of chest pain or abdominal pain, I feel as if I’m slipping into some fugue, losing my touch with any reality or ability to organize it all. I’m better than I was, and good at what I do, but it feels every year as if I’m worse, because more demands fall upon me. I want to run away, some days; to run home, or to run back to school and shake my medical educators and say ‘You didn’t tell me this! You didn’t tell me it would be like this! Now what am I supposed to do with all of these people?’ Sometimes I stare into the distance and wonder. I’m crazy as a bedbug. Yes I am. I worry about my children growing up too fast. I worry about their educations and safety, and my wife’s health and happiness. I try to give it to God, but I hold onto it like a deity, as if not to worry is to lose control. As if not to worry is to turn my back on an angry monster. When I’m tired, I think about being old and demented, and wondering where everyone went. I’m afraid I won’t understand, and will just be a great lump of lonely. I’ve certainly seen them; what if it’s me? When I’m very tired, I imagine all the things that can happen to the ones I love, having seen those things first-hand. It has been said ‘Fatigue makes cowards of us all.’ I’m a coward. I’d give it all up if my family needed me to do it. I love them more than any job, title, money, position or procedure. I love them so much I find it painful to leave them; but shear delight to come home to them. They are, far more than this temporary losing battle against death, my reason to be. It was fun being called doctor. Now, after all these years, I like my name better than my title. Edwin, old English, ‘prosperous friend.’ Doctor is boring and sterile by comparison. At the end of the day or night, my hands hurt from washing and my knees and ankles from walking. My brain hurts from thinking and I just want to rest. And yet, I don’t want to succumb. I’m young! I’m strong! I’m not weak or old. But sometimes I feel like it. I think, between you and I, that many people like being sick, that many people love drama and that too much of my job has to do with legitimizing life crises and bad decisions by calling it something medical, or in Latin, and treating it with a prescription. Most people we see need prescription dose truth, as in ‘There’s nothing wrong with you. You can go home now!’ I’d write that one for free. I’m sure it’s on the WalMart $4 list. I don’t mind being paid. I think being paid is good and proper. It is the way I support my family, give to the causes I believe in, and help legislators waste tax dollars. I think I should be paid a whole lot for what I do. And sometimes, I shouldn’t be paid at all, because someone can’t pay me and I understand. I’m a capitalist who believes in sometimes giving it away. I swing both ways, it seems; an economic switch hitter. A hooker with a heart of gold, like all of you. Sometimes I say mean things. Sometimes I think inappropriate ones. I snap at nurses from time to time, and make snippy, sarcastic remarks to patients’ family members. I ask ‘what’s your emergency?’ I can be abrupt and unkind. I have a ways to go. That’s it. I have a ways to go. And we all do, after all, don’t we? But until we get there, we might as well be honest with each other. And we ought to be honest with ourselves. If you need someone to confess to, drop me a line. I won’t judge you. I’ll probably say, ‘yep, I did that too!’ Isn’t it nice to know you aren’t alone? |
