I just finished a five week stretch of clinical service, including four weeks in the hospital seeing inpatient Palliative Care consults and one week at our local Hospice House. This stretch also included two weekends of coverage, the most recent being this past weekend. Now…I realize that most people work every week, but keep in mind that in the past five weeks, I worked a twelve day stretch…twice. And my work isn’t easy. Sometimes it’s really effing hard. This past week I walked into a patient’s room and quickly recognized that he was dying. I know the other doctors who had been taking care of him recognized he wasn’t doing well, but nobody acknowledged that he was DYING…and dying quickly. This was the first time I had met this patient and his family. So on my first visit, instead of getting to know them and formulating a plan for the coming weeks and months, I had to tell them that he was dying. I think that deep down in their guts, they had been suspecting that this was the case, but hearing the words broke them. In the brokenness, they were able to rally together and soak in his last moments. He died peacefully with his family by his side. Not on machines. No tubes, no compressions, no panic. Although his death was a good death, having these conversations never gets easier.
This past weekend I covered the entire Palliative Care service. I did have a lovely heme/onc fellow helping out, but the weight of our 45 person census was on my shoulders. Saturday I had some complex follow ups with an intense family meeting planned for the afternoon. Then the new consults started coming in.
Pager: New consult heart hospital
Pager: New consult 4th floor
Pager: New consult 6th floor
Pager: New consult Cambridge
Pager: New consult 5th floor
Pager: New consult heart hospital
Pager: New consult Cambridge
Pager: New consult 4th floor
Cancer
Heart failure
Liver Failure
Respiratory failure
Uncontrolled pain
Trauma
Refractory nausea
Cancer
We muddled through the weekend and did the best we could with what time and resources we had. Fortunately Sunday was merciful and there were only three new consults. I got through the weekend knowing that this week is an administrative week. That means that I have non-clinical time to get caught up on everything that I’ve neglected for the past five weeks. Emails, teaching, dentist appointments, hanging out with my kids, holding my best friend’s newborn baby, medical student small groups, grand rounds…and cleaning my desk.
Now, I loathe Monday mornings just as much as the next person, but a Monday morning with administrative time, following five weeks on service is nothing short of glorious. So when my phone rang at 9:00 this morning, and the voice at the other end asked me if I was coming to see patients today…because I was on the schedule, you can imagine the soul-sucking agony that came over me. I really didn’t know whether to laugh or to cry. My boss texted me shortly thereafter and let me know that there had been a scheduling snafu and asked if I would be able to cover the Hospice House this week. I texted her back and let her know that I was hanging on by my fingernails after five weeks on service.
“Got it! No problem.”
And that was it. My boss, who is probably infinitely busier than I am, volunteered to cover the Hospice House without a second thought. (In all fairness, our administrator probably had LOTS of thoughts, but she carried on and made sure that our Palliative Care universe would continue spinning on its axis, even with the last minute change of plans.)
I’m still decompressing from the last five weeks. I kind of trudged through the day in a fog, but as I was sitting waiting for my kids to finish their music lessons this evening, it dawned on me. I am so, incredibly fortunate. This is how life is supposed to be done. My boss heard me. She respected my feelings. She understood that I was hanging on by a thread and she jumped in to protect me. Dang! I am so grateful.
I know that I am not the only person in the world with a hard job. There are people in the trenches every day doing work harder than mine. But I hope that we as doctors, as professionals, as parents and as people, can listen to each other and actually hear each other. I hope that we can respect each other and jump in to protect each other when we hear that call for help.
Life is hard. Work is hard. Parenting is really freaking hard. Keep loving each other and protecting each other. I am able to keep doing this hard, but important work because I know that I am surrounded by a team of people that gets it. Thank you, friends.
A little help goes a long way.
I hope you all have a wonderful week.
drbartlettpear.com 
My bad.
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