c'est facile.

I've been waiting for this to happen to me. For quite some time, I have known there might come a time when I may no longer care about anything related to my job...

Recently, I got called in to work a 24h call shift that I forgot I was supposed to be working. If things don't make it onto my Google Calendar, they do not exist to me. There are too many demands that have no pattern whatsoever for me to keep track of them all. It is absolutely ridiculous.

So, yesterday I was scheduled to be the senior on the medicine service with a new intern. After last night, I have now worked with every single new intern on either their first or second call shift as a resident ever..... I drew the short straw there. But, actually, the interns are all pretty great and it is sometimes fun and amusing, and even occasionally refreshing to be around people who are excited, nervous, and curious about this job before those feelings inevitably get replaced by apathy and cynicism.. or emptiness.

I was so pissed when I got a call at 7:02 wondering where I was.. I was mostly pissed at myself for forgetting and making the team wait for me. But also pissed that I was working because I hate to work. Nevertheless, I got there at 7:08 or so, which wasn't too bad... And within a few hours, I was in a better or even a good mood. I have been very restless and palpably uneasy with my free time lately.. It was strangely comforting to have the hospital running my life again.

It is always an interesting experience to be the "Saturday Mole." You don't know any of the patients at all and have to pick up a team of them for a 24-hour period only.... Who comes up with these brilliant ideas, anyway? At our hospital, we cover ICU, IMC, medicine, and the OB deck... It's a community hospital, so it's not like some huge academic service, but it's stressful nonetheless to not know anything about all of these people and then be immediately responsible.

Shortly after sign out in the morning, one of my junior residents approached me about a patient who needed to be intubated. In that setting, here I am. Never met this woman before, and describing to her why we need to mechanically ventilate her lungs. She consented, and I asked her if there was someone we should call.

I felt nothing whatsoever. I went through the motions of getting her a tissue, then simply started setting things up to put her out and intubate her.

This void of emotion has never happened to me!

When I recognized it, I almost felt panicked for a minute by my mechanical process, then I just had to move on with the day. After all, you can't force yourself to care... No point in dwelling.

Later, I got called by OB and there was a woman there for abdominal pain and vomiting. She was 36 weeks, contracting, and reports that she was vomiting blood. She had the distinct dental hygiene and skin sores that you only see in people who abuse Meth... These are the things you start noticing about people when you do this job... You can smell a fat person coming before you see them, you can feel a drug seeker approaching by the upset in your stomach, you can see schizophrenia in someone's eyes, you can taste the blood in coffee ground emesis, you can know the truth behind a lie telling you "I don't do drugs"....

Again, nothing. I just went through the motions of doing what needed to be done. I had no feelings of anything! No pity, no sadness for the baby, no regret or remorse for the failed system.. Nothing.

It struck me again. But then I got paged to the ICU and ran off..

In the ICU, this family of 400lb+ EACH people were angry and upset about the poor care their family member was receiving.. and they wanted me to know all about it in great detail... Never mind that I have had nothing to do with this person's care or life circumstances at all... I was the victim of the moment. I walked in to the smell of: obesity, shit, and cigarettes...

I left that room light as a feather. No feelings. No anger, sadness, frustration..

This is an interesting protective mechanism.. I wonder if I am only depressed and burnt out and this will pass, or if maybe this will be the new me? I have been wondering if this would happen to me at some point because I have noticed it in other physicians and nurses. I also wonder if this will make me better or worse at this job to be freed from so many emotional burdens, but at the cost of not caring about the outcome.. It was like - for the first time - I suddenly recognized that I have no control over anything and it doesn't matter anyway. I just have to do it because I have no choice in the matter... This is what I do.

It almost makes me sad because this is not at all what I intended from all of this, but...

I'm not sad. I'm off. And going hiking.

C'est facile.

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"I shall revenge myself in the cruelest way you can imagine. I shall forget it."

— John Steinbeck (The Winter of Our Discontent)

"What destroys a man more quickly than to work, think and feel without inner necessity, without any deep personal desire, without pleasure - as a mere automaton of duty?"

— Friedrich Nietzsche