When doctors need an intervention
I was floundering emotionally, but doctors are excellent at compartmentalizing
Canadian Dr. Jillian Horton tells the story of attending a retreat at Chapin Mill, a Zen centre in New York state, for burnedout doctors. An excerpt from “We Are All Perfectly Fine: A Memoir of Love, Medicine and Healing.”
I know how I’m going to die.
It’s in a tin can of a plane at an altitude so low that birds will see the whites of my eyes as I go down screaming. Whichever nondescript Great Lake abuts Toronto and broaches Rochester —OK, Lake Ontario — that’s the lake I’m dying in, today, on this plane.
The whine of the motor is deafening. The low-pitch pulsing sounds like the apocalypse. Just after takeoff, I snapped a photo of an ominous dent on one of the wings and I’m wondering whether it will upload to the cloud if I’m in airplane mode when we crash.
Then the Transportation Security Administration investigators will praise me: “One passenger had the presence of mind to give us the photographic evidence that unlocked this case for us. In her final act, sensing something amiss, she took a photo of the plane’s wing.”
But that was stupid. A better final act would have been to alert the pilot before takeoff, and then maybe it wouldn’t have been a final act. And my final final act should have been texting my husband to tell him and the kids how much I love them. Or at least going into efficient doctor mode to remind him the youngest is due for a dentist appointment, and please follow up with the roofing company to patch the outrageously massive hole a squirrel chewed in the side of our chimney. Lest we get more squirrels. By the way, I loved you.
I’m a general internist, the kind of doctor who looks after people with medical problems that sound made up. Typhilitis. Neurocysticercosis. Ankylosing spondilitis. I also look after people with less exotic problems but lots of them at once. Heart failure and liver disease and sick kidneys. Stroke and pneumonia and severe mental illness.
I work in an inner-city hospital, a rambling facility in need of a paint job, built on Treaty 1 land in a part of Canada Truth and Reconciliation seems to have forgotten, a hundred miles from the town where I grew up. I look after people who are sick enough to be in the hospital. Some of them are dying. Many of them are homeless.
Many are Indigenous and have been subjected to gross, almost unfathomable injustice, racial oppression and intergenerational trauma.
They struggle to escape its legacy, which often comes in the form of the scourge of drug and alcohol addiction.
I’m heading to a place in New York called Chapin Mill. Nobody’s sending me. I’m going of my own volition, unsure as to why, doubtful it will make any difference. In the only-in-mymind major motion picture movie version of my life, either Hawkeye Pierce or the soulful doctor played by George Clooney on “ER” have staged an intervention, since it’s so painfully obvious to viewers that I’m floundering emotionally and need to go away somewhere for at least part of one season.
Interventions don’t happen in medicine, in my experience. When they do they’re a latestage measure, akin to chemotherapy for advanced-cancer patients who have no hope of cure. Most doctors look fine, perennially, until the day they don’t. That’s because doctors are excellent at compartmentalizing.
We are also compliant and conscientious and rigidly perfectionistic, characteristics that put us at risk for choking to death on our own misery – or more specifically, overdosing on the perfect fatal combination of pills, throwing ourselves off just tall-enough tall buildings, or slitting open the large arteries we studied so carefully when we were undergraduates, with just the sleight of hand to bleed out quickly — if all goes well, in approximately five minutes.
I talk about death a lot; wouldn’t you? I’m surrounded by it. I’ve signed more death certificates than cheques, and I pay for everything by cheque.
Doctors have a delusional relationship with death. We trick ourselves into the professional assumption that death is reasonable. Not benevolent, but not unpredictable, nothing psycho about it. Birth is a Hitchcock film on a good day; death is often quiet, understated, like dealing with your accountant.
So when it shows up on our doorstep, whether for us or one of our family members, suddenly this “reasonable” death that seemed so calm and inevitable when it was happening to other people turns out to be a real handful, and we’re often woefully unprepared to deal with it.
But we also talk and think so much about death because medicine is so f---ing hard.
I know many jobs are hard. Try being a soldier deployed in Afghanistan. Try being a police officer on the front lines of the meth crisis. My friend Al is a pharmacist. Believe me, pharmacists have their problems too. All that working with doctors, some of them notorious
jerks. All that worrying, missing interactions between the red pill and the yellow, or the blue one and the white. All those drugs, spread out in front of you like Dylan’s Candy Bar minus the carbs.
One pill might take the edge off. Just the edge. What if it found its way into your pocket? What if you slipped it under your tongue? Just one. What’s the harm? That’s why they call it the edge, of course. Nothing begins in medias res. Every addiction, every dysfunctional behaviour — all of it starts somewhere.
Al and his wife came with us to the beach this past summer. We watched the kids wade out a mile into the shallowest side of Lake Winnipeg, far enough that they were dots halfway to the horizon but the water was still only up to their knees.
It was so hot that it made Al think of his first summer job. He worked at a grill, cooking meat. Behind the grill was hotter than any beach. Sometimes Al got assigned to onions. He would stand next to the sink, slicing them, working his way through an entire mesh bag. For the first 10 minutes, tears would pour down his face and his eyes would burn. Every minute was worse than the one before it.
Just when he thought he couldn’t stand it anymore, even though he hadn’t finished cutting, the burning stopped. His face was wet with tears. He couldn’t feel anything. He didn’t even know he was crying.
I think Al cutting those onions was like me and medicine. In the first few years, everything burned. Then one day the pain just stopped. That was a warning sign, and I missed it. Pain tends to serve a purpose in our lives, sending messages to keep us out of danger. When we ignore those messages, or when our nerves have been damaged by some prolonged toxic exposure and we no longer feel any pain, we mistake our insensibility for infallibility. And that’s when we can end up in serious trouble.
I didn’t know what I was in for when I decided to go to medical school.
I couldn’t have known what I was getting myself into. I knew there was risk; I didn’t know the degree. Nobody would climb Mount Everest if they knew unequivocally once they were up there they’d freeze their face off and be left with a hideous chunk of black flesh where their face used to be.
And yet, I love being a doctor. There is something so intimate, so fateful between me and medicine.
Itzhak Perelman picks up the violin and knows it belongs in his hand. When I sit down at a bedside with a person in pain, there’s a moment of deep resonance and grace: everything in my life has led me to that chair. But relationships have undertones, just like instruments. Perelman plays a concert, and it’s easy to forget he spent his life making what he just did look effortless. And we have no idea what happened in rehearsals.