Highs and Lows

On one of my first overnight shifts in residency, a patient was brought into the emergency department after passing out on the doorsteps of our nearby psychiatric hospital. Lots of things happen simultaneously when patients come into the ED like that. Among those, this patient happened to get a dose of narcan. She regained consciousness shortly after this.

It was during this time that I talked to her. She told me she was checking herself into the psychiatric hospital. She’d been struggling for awhile and it was finally time. She knew that she was a danger to herself, likely to others as well. She told me she had tried to kill herself with pills, but changed her mind which was why she was heading to the hospital.

Then she lost consciousness again and all her stats (blood pressure, heart rate, oxygen saturation, etc.) were heading in a bad direction. She got more narcan and woke up again.

It was touch and go all night. She was a very stressful patient for me, a new resident. I made the decision to start her on a narcan drip, but this had to be monitored very closely overnight so her blood pressure wouldn’t bottom out.

Her husband came and all three of us spent the night monitoring her and talking. They were so grateful that I saved her life. She wanted help. She wanted to get better. At the same time, she also kept saying that she had nothing to live for, messed everything up, would take more pills, would run her car off the road, would slit her wrists.

Morning came, along with the end of my shift. I was exhausted from the lack of sleep, the weight of my decisions, the fear of messing up. But I had saved a life and that was huge. 

She was stable for transfer to the psychiatric hospital and I was bringing her the final paperwork before I left. That was when they told me that she had decided she no longer wanted to go to the psychiatric hospital. 

It was my job, then, to tell them that she would have to go. With her attempt and her repeated statements and plan overnight, she was deemed a danger to herself and would have to go, even against her will. 

I thought it would be ok, that they'd understand it was protocol and for her safety. After all, we had just spent all night together. They had told me over and over how grateful they were.

Boy, was I wrong. She cursed me out. Her husband stood over me, threatening me with physical violence, with destroying my career. He backed me into the hallway where all the other staff and patients watched as he berated me.

I was spent. Physically drained from lack of sleep. Mentally drained from trying to keep her alive all night. And emotionally drained from this attack. There was no longer fulfillment from a job well done. There was no satisfaction that I had saved a life.

There was only exhaustion.

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I feel like this is so much of medicine nowadays. I love being able to make a difference for someone and it fills up my “purpose” bucket. But because healthcare administration won’t accept that resources like energy and time are limited, I am frequently forced to choose between being a bad doctor or a bad mother.