Three of us are in the call room with sputtering lightbulbs and the faint, omnipresent odor of basement rising from the stained carpet. We are all second year residents, on call at the private hospital that I have taken a necessarily angry, but somewhat perverse, pleasure in eviscerating on a near daily basis for the past few weeks.
The conversation was initially light, joking about cafeteria food and the possible bad admissions we’ll get tonight. And I don’t know how we get there, just as I don’t often remember anymore how I got to work, or have made it through over half of residency, our thoughts turn serious.
The resident on the transplant service says that she’s worried that one of her patients will die tonight. “She’s so fragile right now,” she says, “and on my last call, another patient, he just died in front me. I’m so scared.” She trails off, fidgeting with her shoelaces. The other resident and I nod, understanding everything she hasn’t said.
I voice my immense sadness about a patient who I took care of on the hematology service last month who has come to this private hospital for care. Chemotherapy has obliterated his immune system and he has a partial bowel obstruction. The tall, athletic man who used to joke with me every morning and his small, pretty wife are gone. The man now looks small, pale, scared, face bloated by steroids, hair fallen away. His wife is quiet, a small pillar of strength in an otherwise dismal situation. My heart broke when I saw him, I could barely contain my tears. “He…he had the most awesome hair,” I said. It was a weak substitute for the words I couldn’t bear to say. The acknowledgement of his rapid death, his immense suffering, his change from healthy person to patient.
The other resident, a close friend, suddenly drops his voice low and soft. “I’m broken now, I think.” He doesn’t say anything else. He’s said everything we’ve been trying to express. Suddenly I am so aware of how young we are but how old we feel, how tired I am, how heavy my heart, head, and eyes have become. He continues. “I used to go above and beyond and now I’m so angry and tired. It’s so hard to care. I used to care. A lot. And I’m scared. I feel broken.”
I try to lighten the mood, stressing that maybe we’re not broken, we’re just realizing the immense responsibility and privilege of our position. But my words are empty. He’s struck a fear I’ve always had. The fear of being broken. Of having always felt broken, trying to find wholeness in medicine, coming only to realize that I’m the same kind of broken as I was before. Maybe worse for it.
In the morning, I go see the patient I spoke of to my co-residents. When the patient’s wife and I step out of the room to give the X ray technician some space to take an abdominal x-ray, I see that her eyes are shiny with tears. “He…he hates that tube so much.” she says, voice breaking, hand waving generally in the area of the nose. I make a weak joke and suddenly I’m hugging her and her tears are hot and wet, soaking the left shoulder of my scrubs. My tears are coming but I silently berate myself, keep it the fuck together, she needs you strong, even if you can do nothing for him, even as he dies before her eyes this is the only thing you can do.
I let her weep. My left hand idly pats her shoulder, I murmur “it’s okay” in a sleep-deprived, exhausted, empty-sounding voice. My pager screams, demanding my attention. My phone buzzes non-stop with texts from my attending.
