I was having a bad day. It wasn't just a single big bad thing happening, it was a lot of little ones.  My main emotion wasn't anger or frustration, it was overwhelming annoyance.  Some of my emotion wasn't even caused by work; I hadn't been getting much sleep and so my emotions were raw.  I wanted to bitch and moan to someone and tell them how bad my life is.  It's not bad, but it does sometimes help when you get complaining out of you.

I sat down to start with my next patient, mind filled with reasons to gripe.  Then deep inside a little voice called out to me and said, "Don't go there!  You don't want to lose focus; you never know what you will miss.  Would you want your doctor to be distracted?"

Distracted.  Where have I heard that word before?

Deep breath.

I looked up and the patient in the room smiled at me.  She had no idea of the battle going on in my head.  She had no idea that the self-pity was fighting for dominance.  She had no thought that I was focusing on anything but her.

Deep breath.


Mind clears and focus regained.

I start talking to the patient.

Dread and Terror

This is an essential skill in my profession.  It is impossible to see the wide range of emotion without having a dimmer switch for your own.  The cost is too big for me to miss something important that gets said because of my own emotion.  It's hard sometimes, but squashing my own emotion is the only way I can get through my day and still do a good job.

When training to be a doctor, one of the biggest skills you can gain is to overcome dread and terror.  Dread is the feeling you have when the OB calls you and says she has a 36 weeker with thick meconium (the baby poops in the amnionic fluid - it's a sign of distress and can cause very bad lung problems) and worrisome heart tracings.  Dread is the feeling when moonlighting as a 3rd year resident in a rural ER and getting an ambulance call for a car accident.

Terror is what you feel the first time you face each of these situations in their rawest form.  With dread you do a lot of praying that the worst won't happen.  With terror, it happens.  Somehow you have to face this.  Somehow you need to overcome this and do your job.

A saying that has stuck with me since residency is, "What's the first thing you do when arriving at a code?"  (A code is when a patient in the hospital has cardiac and/or pulmonary arrest). "Answer: check your own pulse."  If you don't master this skill as a resident, you are going to have a very hard time dealing with this in the future.  Fall apart once, and it is harder to prevent next time.

I don't have as much dread anymore.  I hardly have any terror.  But I do have lesser emotions and I have the added danger of complacency.  I can get complacent because I have done this for 15 years and it is familiar.  I can get complacent because I am told I am a "good doctor."  But what you have done in the past does not matter to the person you are seeing now.  Accomplishment is fine, but it makes it no less important to focus hard on what you are doing now.

This is why I am so tired by the end of the day.  I am not physically tired; I don't see patients while running a half-marathon.  It's emotional fatigue that causes trouble.  It's the long-term persistent stress that wears you down.

Deep breath.


I haven't been blogging as much lately.  It's not because of the podcast taking all of my time.  I seem to have the ability to whip things out when I need to (this post has been written entirely in the time at work prior to my first patient).  It is the emotional fatigue that tells me I need to stop and refocus.

This is a deep breath.

My kids need me.  My wife needs me.  My patients need me.  Then there is that other person I need to take care of: me.  Calm the frenzy.  Still the waters.  Refocus.

Deep breath.