The Dangers of Burnout
It meant that heart attacks stopped being exciting. I started to resent them as they now caused me to suffer. I have nowhere else to refer the patient, or the specialty doctors criticized me.
They mistreated me, perhaps because of a lack of trust, or they too were damaged by the system. Maybe it was about payments and expenses. I did not know, but the effort of constant fighting was exhausting.
The system hit me hard. It was clear: irritation, stress, discontent, three quarrels with my team and my superiors in one week. I was burned out. That was putting my good work at risk.
I felt like everything I was doing was meaningless. I aspired to become the best possible doctor through studying, traveling and sharing, but I always returned to the conditions that made me feel that all was in vain. My stagnant environment was full of burnout people, unjust deaths and endless problems regarding insufficient resources versus higher and higher demand.
I felt that each patient brought more pain than joy, even when we had excellent outcomes. It made me sick. I felt like I had unlearned hope. To make matters worse, I could not contain these emotions.
One day a patient asked me, “Am I going to die, doctor?”
I had just seen the results. It suggested cancer, but what would happen now? We wanted an expert to lead him, necessitating an evaluation by the oncologist. Still, the oncologist would not see the patient until the biopsy result, despite the imaging strongly suggested cancer. That meant we had to ask the general surgeon to do the biopsy, but in return, he asked us to refer the patient to another surgical specialty, based on the location of the tumor. So we tried, but this type of specialist did not serve in our region.
The patient’s and our growing stress and conflict eventually led the general surgeon to do the biopsy, but the patient had to wait 30 to 45 more days for the result. Only then, he would be able to go back to the oncologist. When he did, tho oncologist asked us for phenotyping. One more week passed until we finally get the patient to oncology, only to be declared too sick for treatment.
I had experienced this so many times before. Meanwhile, patients were getting more sick, and repeatedly ended up in the emergency department, sometimes got admitted, only to treat infections or pain. In the end, they were sent by the internist to die in our emergency room. They could not do end-of-life care properly. I frequently talked to an enraged family, not because of cancer, but because they were led to believe there was a chance of treatment.
My opinion is that the problem wasn’t lying to the patient about cure cancer, but how often the system don’t even give them this chance of a fight, lying about a chance to treat, but in really being just harmful for everybody because disorganization, corruption, and for didn’t care.
We do not cure death. Ever.
Sometimes we can prolong life. We hope for a good life with meaning, so that they can enjoy some more years, months, weeks or days of celebration, and prepare their wishes for a decent death with their family.
My opinion is that this realization is important not only when we talk about cancer, but any condition, even like a heart attack. We do not cure death, ever.
Coming back to that new patient, the words and the questions bounced in my head:
– Am I going to die, doctor?
– Don’t think about it now. We will take care of you.
I don’t know what the patient saw in me. To me, It felt like lying. When I said we would do our best, it wasn’t me but the system lying. Even if we as emergency physicians or I as an individual did everything possible, I felt the system didn’t care. I knew the system could do better. What could I say when I knew that the journey I want for my patients is so unachievable in the system I work in. I no longer knew what to say under these circumstances, and I felt the patient recognized that in my soul.
I felt hurt, guilty, beaten, and bitter.
That saddest thing in medicine is a doctor without hope.
I never thought this could happen to me. Not with me! How could this happen to me? I was in love with Emergency Medicine! Wasn’t I?
I’d said a billion times how I loved Emergency Medicine and didn’t know how to live without it. I’d shared my passion, convincing others that Emergency Medicine was the answer. Now, it felt like Emergency Medicine was killing me. And worst, I felt that I was not doing good for my patients as my lies were hurting them.