It's been a bit. The tide is turning for now, and our department is taking the fist steps towards returning towards normal. I am beginning to return to ENT duties now.
As promised, I wanted to talk about some of the good that has come from this mess. A nice 180 from the morbidity of some of the prior posts.
Yes, this pandemic sucks. For doctors, nurses, essential workers. For everyone stuck at home, working from home, who have lost jobs, loved ones. It's awful. But, there has to be some good from this, and I have seen it.
I have seen healthcare come together in a way I never thought was possible. Doctors and nurses literally flew in from all over the country to work at Elmhurst. They didn't back away from the scariest moment in a generation--they ran into the fire. People, like the residents I worked with, jumped into new fields they knew nothing about and exposed themselves both to the virus and the trauma of the experience. I saw the freaking Navy and Air-force come in and work at Elmhurst side by side with medical staff, seamlessly. I have never been prouder to be in healthcare.
I worked with incredible co-residents who I respect so much more than I ever thought possible. I worked with interns who spoke to families about their loved ones dying with a maturity I definitely did not have. I worked with chiefs who galvanized residents to work together in our health system's greatest time of need. We reached out to each other, checked up on each other, and took care of each other. We were like our own little "residency within a residency." When the ICU experience was over, as much as we were grateful, some of us, in a weird way, were going to miss it because it meant not working with each other like this anymore.
I saw the world come together to praise healthcare workers in a way I never thought I would. Healthcare is a mess--this pandemic only exaggerated that fact. And patients have been frustrated with the system for awhile, rightfully so. Medicine is a business, however, the people that work in it, on the whole, are not the beneficiaries of that business. For the first time in a long time people are starting to see healthcare workers as the caring people they are, and not a bunch of rich doctors and nurses who don't really care about their patients. Hearing my daughter, my wife, the people on the street, and the man downstairs playing the trombone every night at 7pm to cheer us, and all of the essential workers helping us through this crisis, is one of the most touching things I have experienced during this time. My daughter hears the noise, picks up a pot and stick, and runs to the window to cheer "Yay daddy." Nothing gets better than that.
I got a chance to spend time with my family that I never would have otherwise gotten. My incredible daughter is at what is one of the most fun ages and provides unconditional love. And as a junior resident, I am on call a lot and have missed so much time with her. Because of this pandemic though, I got a chance to be home with her and my wife more. I got to be there for new moments. I got to play, read her stories, and put her to sleep. I got to be her daddy more.
I got to watch my wife "on the job" since she has to work from home now. She is so incredible with the kids she works with as an OT. So creative and motivating. I never would have been able to see that otherwise. Because of this pandemic, I get to respect her in a way I never could have before.
And, overall, the experience has made me a better person and doctor.
While it's relatively common knowledge that doctors take an "oath" upon graduating medical school (think Hippocrates's "Do no harm"--although that is actually not part of the Hippocratic Oath, go figure), a lot don't know that we all don't actually take the same oath. I really don't remember the one I said at graduation. I actually distinctly remember disagreeing with the one my class voted on to give. But my oath, the creed I follow, is that of Maimonides:
"The eternal providence has appointed me to watch over the life and health of Thy creatures. May the love for my art actuate me at all time; may neither avarice nor miserliness, nor thirst for glory or for a great reputation engage my mind; for the enemies of truth and philanthropy could easily deceive me and make me forgetful of my lofty aim of doing good to Thy children.
May I never see in the patient anything but a fellow creature in pain.
Grant me the strength, time and opportunity always to correct what I have acquired, always to extend its domain; for knowledge is immense and the spirit of man can extend indefinitely to enrich itself daily with new requirements.
Today he can discover his errors of yesterday and tomorrow he can obtain a new light on what he thinks himself sure of today. Oh, God, Thou has appointed me to watch over the life and death of Thy creatures; here am I ready for my vocation and now I turn unto my calling."
There is a lot in this oath that I love. But the line I bolded has been what I say to myself whenever I find myself getting cynical. In medicine, much of my day, I'll be honest, it's really hard not to snap at people. The bureaucracy, the fear of litigation and thus the constant requests to alter orders or see consults to "cover one's ass," the punting of responsibility, and the never ending sound of a pager. Even on a good day, it drives me mad. And in that, I get lost, forgetting who I am there for. It's not for myself (although, I honestly love ENT surgeries and procedures independent of who it helps)--it's for that person who is sick or scared. It very well could be me.
But honestly, 99% of the time, I forget. I have that line from the my oath that I say to myself sometimes, but I forget to do that too.
Working in the ICU though, I couldn't forget. I saw the pain. I saw mothers and fathers. I couldn't help imaging my loved ones in those beds and it killed me. But, from that experience, that credo came to the forefront of my mind. And instead of seeing everyone as a sedated, vented patient, as a series of lab values and vent settings, I saw someone that was loved. I saw a person. And it made me act differently to the families that called all the time, worried. It made me act differently with the nurses who asked me to adjust an order again. Instead of getting annoyed, I started to see the bigger picture.
It's important to be able to distance oneself in medicine. Especially in surgery. You can't literally cut out a person's tongue, or split open a face if you think of them, in that moment, as a mother or son or loved one. But after, when they are in pain, when they are scared, you can. And--while balancing necessary distance from your patients that you need to do your job effectively--you should. I think, because of this experience, I will be able to do that now. It won't be just lip service or a line in an oath. Because of this pandemic, and this experience, my empathy has grown, and I am confident I will be a better doctor. When the dust settles, my hope is that we will have a generation of doctors and nurses that will be too. Silver linings.