The house is asleep, and I can’t turn off my brain. I just cried my way through an episode of Seal Team, especially the part where two Seals are opening up to a psychologist about feeling broken. One says he’s tired of pretending he’s ok, that he has PTSD and needs help. Later he breaks down and his wife folds him in her arms, and tells him she’s there to pick up the pieces.

I feel like that Seal. Maybe that’s why this show resonates with me. After all I’m not one for gratuitous violence and warfare; I’ve often asked myself if I only watch it because I have crushed on David Boreanaz since he headlined Buffy and then Angel. But no – now I see, the hell they go through reflects the hell we go through in medicine.

These days it’s really hard to self-reflect, and to allow others to read my words or feel my emotions. There’s just too much pain in our world now, and everyone is suffering. What makes my pain more important than my neighbour’s? Nothing. But I’m going to allow myself to write about it and let others read it because maybe it will give you, the reader, license to sit with your own grief by feeling mine.

Every day I go to work, it’s a minefield. I never know what or whom I will meet and maybe destroy, and be destroyed by. When I pick up a chart for an ankle sprain, that patient could be the woman whose husband pushed her down the stairs and that’s why she sprained her ankle. Or the chest pain in a 20 year old man could be lymphoma. Or the constipation in the 40 year old exceedingly kind looking man with the soft accented voice could be new rectal cancer.

After a minor car accident a few months ago, the X-ray of her ribs was normal and my patient was sent home by the physician she saw at a community hospital in Ontario. She was still in pain three months later, so she presented to the ambulatory side of our ED. I figured, when I saw her, maybe a small fracture was missed and it’s not healing well, or perhaps it’s all just muscular pain. My clinical assessment found tenderness along one rib in particular. Repeat xray showed something not quite right, so I ordered a CT. Before even reading the whole report, in my haste to keep going and see new patients, I called her into the reassessment room. She met me smiling and thanked me for the analgesia, that had dramatically improved her pain. Reading the concluding statement of the report as I stood across from her expectant face, I took a sharp breath and without the ability to self edit I said “oh no, I’m so sorry”. Then “let’s sit down”. Her face froze. I had fucked up. I had stabbed her in the heart with my stupid words. Thankfully her husband was there and guided her to a seat. A harbinger of doom, I read the words aloud that sealed the fate not only of herself, but of her lover and her family, forever changing their lives.

Metastases. Multiple. Unknown primary.

Her eyes, wet. Her husband’s eyes meeting mine, knowing. The world shifting.

It was however, as if she already knew. The gnawing bone pain waking her and keeping her from sleep could only be one thing. And she knew. She just knew. And she tried her best to be strong for her husband. Together, they accepted the words, the plan, the further CT scans that found a large lung cancer. Together, they stoically met the dangers with swords in hand.

And me – I am devastated. Crushed. Heartbroken. Not only by the diagnosis and knowing what comes next, but by my failure. My failure to keep my mouth shut, to hold, to wait. Maybe it’s burnout, exhaustion, sleep deprivation. Maybe it’s stupidity. Maybe it’s delirium. No matter what, it’s awful.

So I know how those soldiers felt, in their moments of emotional agony. I feel it too. Emergency Medicine, medicine in general, hurts my soul in ways I never knew it would. Sometimes I wish I didn’t know what I know. Walking into a room after reading a triage note, and already knowing what I’ll find. Knowing the diagnosis and the denouement of my patients stories way before they do. Prophecy of sorts, based on training and experience. And prophets have never had it easy. Foresight is a curse, a crutch, a needle always stabbing just that right spot where the pain is always fresh.

Medicine also lifts me. Sometimes. But lately? Nope. It has drowned me.

And I feel broken too. Hoping somehow to mend the pieces, sew them together like the wounds I’ve fixed at work, stitch them or crazy glue them until it’s possible to continue. The Seals on the show say “ignore and override” – this can be said for physicians and nurses as well. But it’s not the right thing to do.

I hope by reading my story and hearing my struggle it can help you with yours. Don’t let Medicine crush you. Fight back, with all your strength. Talk about it. Write about it. But let it out. In the space between people there is healing – there is space for all the hurt inside to come out. Though you may be scared to burden others, if they care for you, let them be your parachute.

4 thoughts on “Ignore and Override?

  1. Thank you , Sara, for these heartfelt words. These are difficult times and the distance from our families and friends make them even more arduous to navigate. Namaste 🙏🏻

    Liked by 1 person

  2. OMG, thank you for sharing. This brought me to tears. I feel this so much. I feel like I am on a speeding train that is also underwater. Burnout doesn’t begin to describe it. Thank you for your vulnerability and sharing your story. Today it made me feel less alone. Keep writing, keep sharing. Keep caring.

    Liked by 1 person

  3. “Ignore and override” is our equivalent of “ compartmentalizations.” We used to be proud of how we EM folks compartment our lives and emotions. We shake off the last code, then move on to the next patient with a smile, and apologize for their wait time. There is that next survey score you can’t mess up. But we shouldn’t have to. We’ve all seen too much of the darkness in humanity. I remember that SEAL episode well.

    Liked by 1 person

  4. Dear Sara,

    Despite the overall gloom of your most recent dispatch, I hope that you and the entire family (including your parents) are in good health and, so far as possible, in good spirits. As always, I was profoundly impressed by your dedication to your profession, which must be more difficult than ever given the current pandemic. Personally, I doubt whether we shall ever conquer this dreadful disease. To my mind, it signals the end of our civilization and I confess that that is precisely what humankind now deserves, given our criminal neglect of the beautiful planet with which we were blessed. In Israel, we are currently witnessing the fourth wave of coronavirus. Ironically, while we dealt rapidly and efficiently with the first wave, during which the population was far more obedient to government edicts regarding lockdown and masking, the current wave is in no small part due to current disregard of rules. The Garden of Eden all over again?

    Please give my warmest regards to your parents and tell your father that I would love to hear from him. Is he or Chuck making any progress in sorting your parents’ collection of family letters and documents? I think it is so important to preserve this material, not only for the benefit of the family themselves but for posterity. It is the raw material for social history and perhaps you might contemplate donating it to an appropriate institution that would make it accessible to a wider audience, particularly one that is familiar with the various languages in which our forebears conducted their affairs.

    Be well and keep writing!




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