Per unitatem vis – ‘Through unity, strength”…
A patient died in our unit last week. A child. His parents were two of the loveliest, bravest souls I’ve ever encountered. I looked after him on a series of night shifts. He deteriorated, slowly but surely, over those nights.
I found it hard to look after him. When he became agitated, he’d settle if his hair was stroked. His parents did it if they were around, but on nights they took the opportunity to sleep, and so the task fell to us, his doctors and nurses. As I stood there by his bed, stroking his hair, I couldn’t help but think about how hard this was for me. Then I’d admonish myself, thinking how much worse it was for his family, let alone for the little boy himself.
He died during the day, so when I came on again for my last night, he was gone. The staff were shaken. The handover process was subdued, and prolonged by some much needed general chatting and debriefing. We hugged, and we talked about all the patients we’d lost this term (intensive care has an unfortunately high rate of loss compared with my previous general paediatric jobs). We tried then to remind ourselves of the successes, and talked about patients who made us smile, and patients who’d made it through against the odds.
It’s often like this with difficult events. The juniors rally around each other as best we can, and sometimes there’s a debriefing session with seniors – not always though, which is sad. It’s a vulnerable time for all of us, particularly as doctors in training. I myself tend to feel overwhelmed with a sense of inadequacy for the job. Will I ever be smart enough? Skilled enough? Strong enough? For an occupation in which these are the stakes? I inevitably contemplate alternative careers at this point, for on the alter of my own self-judgement, I always come up wanting.
No wonder doctors quit, burn out, became depressed, even suicide. Every day in medicine we walk a tightrope, holding aloft the heavy burden of our patients’ needs, praying at every moment that we don’t all come crashing down together. If we make it to the other side, to the end of the day or the end of the shift, and all is still intact, we’re grateful, but we rarely acknowledge the strength it took to make that journey.
Doctors – medicine is brutal. It’s also wonderful, mysterious, joyful, and an absolute privilege to practise. A success can bring us to dizzying heights of elation, but every failure rocks us to our core. At times we’ll all feel like frauds, like failures, and like a change of career. The important thing is that it’s normal to feel that way. I believe many of the doctors who take their own life have an extremely misinformed concept that they are the only ones who feel lost.
When we lie to each other and say all is well all the time, this myth holds. There is great power instead in being honest with one another. In admitting that we don’t have it all together, and reaching out for help and support when times are tough. We must focus on a change in the medical culture in which no doctor is ever left to feel alone in their pain. If we don’t, we stand to lose much more than pride.