Valium

There’s an ugly rumour going around.

One of the more “senior” doctors in our hospital is suspected to be addicted to a very specific substance that’s easily available as a stat dose in most wards and the Emergency Unit. The rumour goes that this doctor prowls around after-hours, looking for an exhausted, unsuspecting intern and then hands them a “patient file” with a request that they just fill out the stat dose order while they rush to theatre or some other urgent obligation.Upon their returns, they hand the prescription to the nurse in charge of the drug key after-hours (it’s a scheduled substance) and then scamper off into the night to feed this horrible addiction.

I don’t like gossiping talking about the specifics of this rumour with other interns because, if it’s untrue, it’s causing irreparable damage to this doctor’s reputation. If it is true, it’s kind of an open secret at this point and I’m shocked that this doctor’s peers haven’t reported them as an impaired colleague after all this time.

Wait, am I really shocked?

Let’s take a quick look at my peer group. I know (of) at least two interns with substance addiction issues. One has been through the “impaired colleague” ringer and has sought help on multiple occasions–mostly having been forced to after being busted working while under the influence. One has never really been “outed” as most interns with intimate knowledge of the situation treat it a bit like a darling personality quirk. I don’t know these doctors personally, but I know that those that do are deliberately and knowingly turning a blind eye despite knowing the risk this alleged behaviour poses to patients and themselves. I sometimes find myself judging the chit-chat around these issues–I don’t find the behaviour of an intoxicated doctor on duty the least bit amusing, but our intern WhatsApp group seems to pride itself on making allusions to reckless behavior just before a night shift–but I also, dare I say it, understand it. There’s an empathetic humour switch that goes on when we look at the consequent behaviour that results from some of the more destructive coping mechanisms that people under stress are infamous for utilising. Some drink their sorrows away, some spend their sorrows away, some sleep their sorrows away.

Instead of being completely reviled, a piece of each of us relates.

 

Sure, doctors aren’t special snowflakes. Everyone has stress in their lives, and every occupation has its downside. I also don’t dare presume that occupational stress is the only (or even the main) reason that some individuals who just happen to doctors fall into certain traps. But the data doesn’t lie. We’re at (very high) risk.

I read a quote somewhere years ago that said:

The stethoscope is the most expensive piece of jewelry I own.

It cost me my youth.

Cue melodramatic violin solo.

In technical terms, getting through medical training literally costs years of ones youth. So, sure, cry me a river. What most people underestimate though, is the more subtle (yet devastating) ways medicine figuratively sucks the life out of you.

When I was barely out of my teens, I saw my first dead body. I had to spend a few years with that body. Midway through that first year, I was 50% through with stripping off parts  of the skin, detaching specific muscles from their insertions on the bones, and removing sets of internal organs. I had to peel off their face to fulfill a “learning objective”.

Sound horrific?

This is basic anatomy class in most medical schools where cadavers are dissected.

Now, when described like that, most people’s skin would crawl and the idea of it would make them feel sick. Some people would have moral or religious objections to such barbarism. Some would not be able to push through that first incision without dissolving into hysterics. That kind of a learning experience (although a privilege and necessity) can be traumatising.

Yet future doctors are expected to shut off those parts of their brains and get on with it from day one.

You may think I’m picking the worst, most outlying experience to prove a point, but I’m not.

Every other week someone five minutes from death is rushed into the Emergency Department. Every doctor in the vicinity drops their current patients, grabs their gloves and converges around the resus bay. Our training kicks in, we get into a rhythm, roles are assigned, monitors are attached, reversible causes are identified and treated, basic investigations are done. Hands are clamped tightly to a lifeless chest, compressing like our lives depend on it. Lines are placed, shocks are administered, tubes are inserted. We fight and we push and we do what we can…and sometimes we still don’t manage to bring them back.

Gloves are discarded, time of death is called and the curtain around the bay is drawn.

Then we’re expected to immediately go back to asking the patient we were previously busy with whether their back pain pain is relieved by anything.

We should be asking ourselves whether our pain is relieved by anything.

Because it is painful. Watching someone die is heartbreaking. Watching someone die after you’ve done everything you can to make sure that they don’t is soul destroying. Yet we don’t get a minute. We can’t always retreat into a corner and cry for them. We can’t break down when the relatives who brought them need to break down. It’s not our time; it’s not “our” loss. But it feels like it is. And I feel like a robot and an imposter as I fix a pleasant and professional smile on my face to deal with the next patient as if something incredibly sad has not just transpired.

valium
“Sometimes it’s beauty and sometimes it’s pain, sometimes it’s sunshine and sometimes it’s rain.”

It’s not just beaurocracy and rapidly falling compensation models and inhumane, unsafe working hours. It’s the rare twenty three year old who came in with bloody stools and got diagnosed with aggressive, metastatic colorectal cancer, who you have to look in the eye every day as you both pretend he isn’t dying. It’s the more common infant brought in by her hysterical mother  after their informal housing caught fire, with charred skin over more than 50% of their little body. It’s hearing her screams, begging you to save her child as you and four other doctors race against time and probability to get venous access and an airway. It’s the old man being kept for “palliation” that looks deliriously at you everyday as you manage his pain but do little more than that. And you just feel years older every day of the week some weeks. So old and so tired.

So sometimes you hold onto a high so desperately so that it numbs the low. Or find a low so comfortable that you barely register a dip.

We all cope differently. Some of us just stop caring. We go to work, do our jobs and then move swiftly on with life outside medicine. I tried that, briefly, but I found that shutting off my emotions only led to the floodgates bursting in the middle of the night. Some of us try to glamourise other aspects of the job. We spend exorbitant amounts of money because we “deserve” it, and the convenience and temporary happiness we buy can staunch the frustration and discontent, if only for a moment. Some of us try to build external avenues of expression. We create or we do and in that find that there are still little pockets of light even in the darkest of days, but we also find reasons to consider giving less of our lives to the thing that perpetuates the darkness. Some of us throw ourselves into our relationships with the people we love, creating a safe haven and a safety net for when things get too heavy, or a dangerous dependency that could make things heavier.

Some of us find more literal ways to anaesthetise ourselves. Truly some of us chase a high, or find a way to get appropriately low.

I don’t condone it, but I understand it.

This stethoscope is damn expensive.

 

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