Shitstorm

It was 6:30 AM. I heard the garbage truck pull up in front of my house. Crap. I hadn’t put the trash out the day before, but usually that wasn’t a serious problem; they usually come much later in the day. I ran, partially clothed, to the front of my house and looked out. The truck was pulling away.

Sigh. It was not a good way to start the day.

I logged in to the messaging app for my practice and saw several potentially serious situations. One was a calcium level that was high enough to merit a call from the laboratory with a “panic” value, the other was a person with a rapid heart rate and shortness of breath. I found times for both of them to come in so we could handle things, and then headed to my office.

When I got to work I got a message from my nurse. One of my patients had died in her sleep, apparently of a pulmonary embolism. Hard to know for certain, but the husband said that was the likely cause. We all signed a sympathy card and I added a personal message of what an honor it was to care for his wife. It is always an honor when someone entrusts you with their care. I’m never exaggerating when I say that to people. I thought back on the difficult situations I’d dealt with in this woman’s life, the encounters in the office and the crises I’d addressed. Now none of them mattered, but I was able to do something for a time, to make things better. In reality, that’s all any of us can ever do.

The patient with the high calcium level came in to get labs rechecked. “I’m doing better now,” they told me. Vitamin D level was very high, so I suspected it was an inadvertent overdose of D. Typical symptoms: some mental fogginess, blurred vision, fatigue, frequent urination. Hydrate, hydrate, hydrate, and (obviously) avoid vitamin D. Repeat testing tomorrow. I spent time looking up vitamin D intoxication and the proper approach to it. Generally, high calcium levels are not dangerous (although low levels are very serious), so I could take some time with this. Still, the day was taking a bad turn. The patient left the office and I went to my desk and took a deep breath.

Then I heard something I never like to hear: “Dr. Rob…can you PLEASE come to exam room 2 RIGHT AWAY!” Courtney is usually pretty calm, but there was a tone to her voice that belied panic. It was the person with the high heart rate. Courtney had been taking their blood pressure and they “zoned out” while she unsuccessfully tried to get a reasonable number. I went to the room, had the patient lie down, put my stethoscope to their chest and heard an extremely fast rate…over 200 easily. Ed, my partner had heard the panic in Courtney’s voice and came to the room as well. I handed the stethoscope to him and his eyes widened as he listened.

“Please call 911,” I told another staff member as calmly as possible. Despite my deep concern over the patient, there is no benefit to loosing your cool in front of the patient or your staff. The first thing you do at a code is to check your own pulse, I was taught during residency. So I remained calm. At least on the outside. The ambulance came and I had printed out all the information about the patient they’d need.

“Will you come with me to the hospital?” the patient, who was doing better, asked me. How sweet. No, I am a hands on doctor who spends extra time with my patients, but that generally doesn’t include rides in ambulances to the ER. I’d just get in the way of the EMT’s, the folks who really know what they are doing in this situation. I squeezed their hand as they headed out the front door and told the spouse to let me know when they knew what was going on. Then the office was quiet again.

The rest of the day was full of lesser crises: uncontrollable vomiting, headaches that were unremitting, panic attacks that “required a work excuse,” and other primary care delicacies. By the end of the day I was emotionally spent, and ready for relief. I came home and got on my Peloton to relieve some of my tension. It was either that or beer. The class was a kick-ass session that pushed me beyond normal and resulted in a personal record for 30 minutes. Exactly what I needed.

I got off the bike and checked my messages. An x-ray result came back from a patient I saw the day before. It was bad. There was a 9 cm mass in one of the lung fields (about the size of a softball). Damn…..damn, damn, damn, damn, damn. There was nothing to do about it that evening, but I’d have to call in the morning to tell the bad news and the need for an immediate CT scan. I hate those calls. Yeah, I know that, like rectal exams, they are worse to receive than give…but making those calls is one of the most dreaded things I have to do.

I reached out for help in the midst of this shitstorm of a day. I have a woman who is particularly supportive and encouraging, avoiding trite solutions to difficult problems. I have Toot, my cat who always thinks I have the best lap in the world. I’ve had days like this in the past, but not for a long time. The next couple of days wouldn’t be fun either, as I had to clean up the debris from this category 5 day that rammed into my generally pleasant life.

I posted on the Peloton Facebook page about my bad day, and how the kick-ass workout was just what I needed. I got about 5 thousand likes (and hugs, hearts, and sad faces), and a ton of supportive comments. Social media can be a trap, a time-waster and a soul-sucker, but it can also help soothe your soul. The outpouring of support for my post did just that for me. I got tears as I read the comments. Good tears.

All of this sucked for me last Wednesday. But as I thought about the day I realized that it sucked even more for each of my patients (and their family members). It wasn’t that I was wrong to feel the pain of the day. We clinicians have it tough at times. But the whole reason I go into the office is to help the folks who are having worse days than me. Self-care is essential to give me the fortitude to handle days like that. That’s why I exercise, and that’s why I value people who I can reach out to when I am having bad days. But the hand I hold, the sympathy I give, the thoughtfulness with which I deliver bad news is my gift to those I’m responsible for. The fact that I can make some of the worst days in peoples’ lives a little bit better is a comfort to me. It gives me purpose. It gives me resolve to get up the next morning and face new (hopefully less stressful) crises. How I handle each of them will impact those people as well, even for “lesser” problems.

I’ve recovered. I still feel the aftershocks of the day from hell, but things have moved on and I am focused on handling the aftermath as well as possible.

It’s all I can do.

Except maybe to remember to put out the trash next week.