What does it cost......

Lately, I have been seeing a lot of writing from Pamela Wible MD and today I re-read her article about doctor suicides. This time in the Washington Post. As I read through these articles, and reflect upon how medicine has changed during my lifetime, I am struck by the degree to which I have seen the humanity scrubbed out of the system. I think about the times during my career when I thought, ‘you know, it is not worth it anymore to do this, I should just go.’ It is not so much that I wanted to be dead, really, I just wanted out. It is funny, the urge just to get out, I have heard that urge voiced by many people over the years. They have not wanted to be dead, they really wanted an opportunity to leave a life that lacks good choices. They were opting to start over, and there have been times, where I was, in fact one of those people.

Lots of doctors kill themselves in hospitals. They jump from hospital windows or rooftops. They shoot or stab themselves in hospital parking lots. They’re found hanging in hospital chapels. Physicians often choose to die in a place where they’ve been emotionally invested and wounded. (Emphasis added) Pamela Wible, MD Washington Post.

When I look down the list of ‘causes’ that she has assembled, they ring true. I can feel the pain that comes with losing a patient, I still remember the first patient who ever died on my watch. I remember the family had already gone ahead to Salt Lake City as we waited for the helicopter to pick her up from Dugway. I remember how we worked to keep her alive, so the helicopter could take her to the bigger center. I remember sitting in my office afterwards, crying hard because I had let her down, I had failed her, her family, myself. Each death that has followed has held a little more sorrow for me, each one has given me the opportunity to see suffering up close, and personal, and notice how it flows within my system as well as those around me.

Malpractice suits can be devastating . Humans make mistakes. Yet when doctors make mistakes, they’re publicly shamed in court, on TV and in newspapers (that live online forever). Many continue to suffer the agony of harming someone else — unintentionally — for the rest of our lives. (Emphasis added) Pamela Wible, MD Washington Post.

I recall how I have been brought before the College of Physicians and Surgeons to have my work reviewed, questioned. That feeling of being judged, being judged for the work you did, for giving your very best, and feeling that somehow your best was not good enough. Not good enough, so that you will be punished for your failures, as if failure itself was not enough punishment. The opportunity to have others review you work, point out your shortcomings, has a heaviness to it that cannot be erased. Even if the tribunal finds that you did what you should, there is a taint that lingers for years that you are somehow not that good, that you are somehow not living up to your potential, that you are letting people down. And the fatigue that comes from the relentless second guessing that occurs after these moments wears upon your soul.

Assembly-line medicine kills doctors. Brilliant, compassionate people can’t care for complex patients in 15-minute slots. When punished or fired by administrators for “inefficiency” or “low productivity,” doctors may become suicidal. Pressure from insurance companies and government mandates crush these talented people who just want to help patients. Many doctors cite inhumane working conditions in their suicide notes. (Emphasis added) Pamela Wible, MD Washington Post.

Having your practice audited by the billing authorities, as they review your documentation, finding fault with the way that you record your work. The approach of guilty until proven innocent hurts, it has a familiar feeling, that somehow you are not doing what you should. The process leaves you feeling like you have somehow committed fraud, that feeling lingers long after the process is completed. You feel like the work you have done is somehow not enough, that the efforts you have made to do the right thing are insufficient. You are caught between doing the work that patients need, and producing the work that the system needs to justify your payments. The relentless grind of the work, never really knowing if what you are doing is enough, if the efforts you are making will satisfy the examiners, so you second guess, again and again. Once again wondering if what you have done is right.

No time for our own pain. Like everyone else, doctors have personal problems. We get divorced, have custody battles, infidelity, disabled children, deaths in our families. Yet working 60 to 80 or more hours per week immersed in our patients’ pain means we often have no time to deal with our own. I’m always surprised by how often nonmedical people tell me they are shocked that doctors have the same mental-health issues and personal problems that everyone else has. (Emphasis added) Pamela Wible, MD Washington Post.

There is always a pressure in this work. There is the pressure to see just one more person, to work one more person into a schedule that is already full, to just take one minute and call in that prescription. There is pressure when after a long day, the hospital calls and the families want to talk, they want to understand why their loved one is sick, what is being done, and how it will all turn out. There is pressure when patients want answers as to why they are sick, and, when the work up has been negative, ‘we don’t know’ is not a good enough answer. There is pressure when people want something that I feel uncomfortable giving them, when they are asking me to do something I feel is bad medicine. There is that sick feeling at the end of the visit when they walk away mad, you feel like you have once again let people down, by trying to do your best. And when you take a moment, when you take some time, to take care of yourself, there are always those who are mad that you are not available exactly when they need you.

These decisions, these pressures, so many that do not in any way involve taking care of the person in front of you, they take more from doctors that many suspect. It is hard enough to treat the illness, to have the compassion when your levels of fatigue are high, to be present in this moment with the suffering in front of you, then to step out and move on to the next person in need. It is hard enough just to do the actual work of being a physician, that I wonder at times why anyone would choose this path. And so, I sit here, having once again read through an article about how so many doctors leave this world behind, I am sad. I am sad for those that left, for the suffering they had to endure, for the suffering they leave behind, and for myself as I see the ripples of these same difficulties flowing and swirling around in my life. Once again, I turn my attention back to my breath, and back to my heart, I ask what is needed in this moment, and I give to myself those things that this world cannot give to any of us.

If any of resonates for you, and you happen to be curious, and wish to study it more, do not hesitate to drop me a line. If you would like to know more about my work, or to work with me, feel free to contact me. I post regularly to Instagram (@gilgrimes), Twitter (gilgrimes) , Medium and Facebook (gilgrimes) about whatever arises from my meditation each day. And if you would like to stay in touch sign up for my newsletter (probably once or twice a month at most).