Stress and Burnout
I must disguise the truth.
Because of HIPAA.
I must hold these heavy truths within my small-framed body. Because of HIPAA, I can't tell you the real reasons I'm so upset--the death tolls, the suicides, the real-life people who are my patients and the real tragedies that they suffer. I have to change the identifying facts about this person or these people to the point that they are unrecognizable. They are my secret, my deep, dark secret that can fester inside of me and cause me to feel terrible. Incapable of saving. Inadequate at what I do, because what I am expected to do is everything.
“What do you think?”
“How long does she have?”
…”We need you here.”
Pager rings. Just 5 minutes to get to the ED. Calling down as I rush to the trauma elevators, they tell me over the phone "Shots fired at a hotel in downtown Los Angeles." I know that place...
At least 3 people arriving. The ED is bustling, preparing for their arrival. Blade and Prolene stitch in my scrub pocket, I am ready. We are ready.
For a moment the ED almost seems silent.
You wake at 5:00 am. You exercise, eat, rush your daughter to school. You arrive to work at 7:30 and review the schedule with your team. You see a man with shortness of breath and a new arrhythmia, a walk-in patient with a severe headache, a teenager there for a sports physical who admits she’s binging and purging. You're already running behind.
She was here for her diabetes. Her blood pressure was high, she said, because she expected me to scold her. She hadn’t brought her log, but her sugars were in the 200s overall. Not good. She hadn’t been exercising, but she had been taking all her medications.
Again we talked about options: cut out carbohydrates, increase exercise, add medicines. She admitted a predilection for bread, and I talked about mood eating: how stress can drive us to eat. She smiled back at me, shaking her head. I mentioned our counselors and the option of coming just to talk. She shook her head again, but her smile broke and her eyes closed.
Her one son, whom she brought here as a six-year old, had been deported back to a country he doesn’t know, where he has no one, where life is dangerous.
I have always been too enthusiastic. Out of all my classmates, I sang the loudest at birthdays, I laughed the longest at jokes and I asked more questions than anyone else. In fifth grade, a firefighter visited my class; after I'd asked my third question about how fire suits actually work, I remember hearing some classmates groan and seeing my friend Thom lift his arms up and, in mock agony, flop down on his desk. I tried to be shy, really. I would go for a few days sitting on my hands during lessons, but, inevitably exhausted by my inauthenticity, I would soon find my excitement uncontainable once more.
“It is no measure of health to be well-adjusted to a profoundly sick society.” -Jiddu Krishnamurti
How many times have I tried to begin writing about my experience of stress and burnout?
I’ve lost count.
Each time I begin to write, detachment renders me into pieces like a jigsaw puzzle. Where are the straight edges? Where is the frame? What is supposed to be where all of these empty spaces are? Where is the box lid with a picture to guide me?
A few years ago the medical library where I had worked for six years relocated from a building outside the hospital to a space inside the busiest area of a busy hospital. Prior to the relocation, I rarely entered the hospital or did so only when my energy felt sufficient to handle whatever I might see, hear or smell. It helped that I worked an evening schedule. After 5:00 p.m. the hospital was almost unpopulated.
Seventeen years ago, I was in an environment seeing thirty patients per day, spending more time on documentation than patient care, and longing to focus on just spending time with my patients. I hated the rushed appointments, the endless coding and the administrative burdens. I interviewed practice managers, read a lot of practice managment magazines, and interviewed a lot of physicians. One thing was clear: 99% of the frustrations came from filing insurance.