Driving home at 2 am

With 38 days left in my fellowship (and in my 2,922 days of training) I have been thinking about the last 8 years a lot. It is an odd nostalgia that runs the gamut of emotional extremes from joy to sadness to excitement to apathy. 

The following is a journal entry I wrote on December 23, 2011. It was my last year of residency and I was reflecting on my years since medical school then as well. In the beginning of my 5th and last year as a resident I seriously questioned my choices and what my future would be. A lot has changed since then and this go round as I reflect instead of questioning the "Why?" I find the feeling of gratefulness dominates for my many opportunities and all of the people who have helped me along the way:

Its been a while since I have written. I am a chief resident now and I am attempting to make sense of all of the thoughts, interactions, events, and absurdities that have happened over the course of my almost 5 years of residency.

If you have been around me in any recent months, you might know that the fired up human being I have always been is somewhat diminished and tired. In other words I am Really really REALLY burnt out. Currently I can't imagine anything better than never working again, but I still press on because in residency that is just what you do.

It is like a heightened form of senioritis. The kind that afflicts high school and college students who are nearing the end. The lack of effort might be there but in residency it is more a lack of spark and luster that penetrates all the way into your eyes and thus into the depths of your soul.

In this dull and apathetic state that it is hard to care and hard to feel. If I am perfectly honest, some days it is hard to brush my hair. Very little excites or impresses and even less inspires.

It is in this moment that I have lingered ever since my return from Vietnam until last night.

I found myself on call, night 7 of 7. I was exhausted with a baseline level of annoyance that probably emanated from me like a horrible odor.

It was my last night on call and I was home and going to bed "early" at 1028 PM (sleep being one of the few things I still felt passionate about); but as soon I closed my eyes my phone started ringing. It was 1032 PM and the caller was the junior resident on call. There was an intra-operative consult at the big house, a gunshot wound that had partially transected the ureter (the tube between the kidney and the bladder). Trauma surgery was requesting our presence in the operating room.

With resignation and absolutely no hesitation I was dressing in scrubs and grabbing my keys and wallet while simultaneously talking to the junior resident. I was in my car before we even got off the phone and dialing my attending before I pulled out of the neighborhood. As he answered, I heard the same fatigue that I felt, a deep and dark tired that is not derived from physical strain, stress or lack of sleep; but the emotional kind that comes from working absurdly long hours with the constant expectation of perfection. He, just as I had done with the junior resident quickly gave his projected time of arrival and probably in the same fluid motion I had performed; began heading into the hospital to help the man whose abdomen was open in the Trauma Operating Room.

When I arrived and was met by the junior. Into the trauma room we went asking for exactly what we and  my attending would need. Looking back now I wonder: How did this happen? When did this become my space? When did I stop hesitating? When did I stop questioning myself? When did I really become a doctor? a urologist?

The case went well. The patient was thin. The OR staff was great. Everything we asked for was available. The ureter was easily freed and re-anastomosed (reattached) end to end. It took an hour from start to finish to complete our part. In and out. Like clockwork or a well choreographed dance. It wasn't about paperwork and phone calls and all of the non-doctor things we do every day. In that moment, we were the technicians we were meant to be.

After we finished and I was driving home struggling to stay awake and for the first time in months I didn't feel miserable, I felt purposeful. This was it. This was what I came to do. It was a sincere and pure moment of love and respect for my job, pride in my choices, and self-content. It came to me in a weird place, on an unlit highway at 2 am on a Friday morning, and at a time that couldn't possibly be more appropriate. It was the end of long week of call nights followed by hard days spent with very sick patients. I finally had the answer to the question that had been looming over my head for months:

"Why do I do this?"

Because I couldn't imagine anything else.