Wednesday, January 27, 2010


I have been neglecting this blog lately. Every time I stop by without writing something I feel a little guilty.

I haven't felt much like writing about medicine, or music, or my family, or food, or even books - all the things that I've loved writing about in the past. Yet there's been no dearth of activity in those arenas. My job is busy as ever. My music projects and those of my children occupy a lot of our energy and free time. I've recently read a terrific book (The 19th Wife by David Ebershoff). I'm still enjoying a rich culinary and family life. What's wrong with me?

I don't think it's depression rearing it's ugly head, because I'm feeling pretty darn happy, my marriage is great, I'm eating and sleeping just fine, and life is good.

There is one nagging question on the depression screens, though, that stands out in my mind - the one about loss of pleasure in activities in which one used to take pleasure. That one's bothering me. I still take pleasure in reading, writing, music, dance, family game night, great meals with great company, and all that. But I'm in a personal slump over my work.

It's more than just the difficulty of going back to work after a long break. Vacation was great, going back to work was hard, but usually after the initial plunge I get back into a rhythm and it's as if I never left. This time, though, the water still feels as icy now as on the first day back. I'm experiencing an inability to enjoy the aspects of my work that have, to date, made a life in medicine worthwhile for me.

In the past I've acknowledged that an anesthesiologist can't be in it for personal glory, ease of work, external affirmation, and the like. More often than not we get the opposite - complaints from people who don't like our decisions, lack of respect from people too ignorant about or indifferent to our duties and skills, hard decisions, tough clinical challenges, frustrating procedures, tiring days and nights, and little appreciation. The work, therefore, has to be its own reward, and for the most part, it has been. It's wonderful to relieve suffering, keep people safe, console them when they're afraid, be there for them when they need help and competence. Those have been the things that have given me satisfaction.

Since my return I've taken care of a couple of people with dangerous heart problems and seen them safely through surgery. I've helped women in labor get rid of their pain and be able to enjoy bringing their babies into the world. I've taken care of frightened children and tired elderly people. I've rescued epidurals and airways that others have had difficulty with. One airway, in fact, involved a patient perilously close to the edge whom two emergency physicians and one surgeon had tried to intubate without success. They were all at the bedside along with a couple of nurses and a couple of respiratory therapists when they handed me the equipment and let me do my thing. It turned out to be a classic "anesthesia save" of the type of difficult airway situation I've described so much already - one of my favorite ways of giving help with the work I do.

Even with fairly routine procedures we're not always entirely unappreciated. One of the psychiatrists in charge of ECTs, according to the nurses, has expressed how much she prefers the days when I'm on ECT duty, because of the tone I set, the atmosphere of calm in the room when I'm there, and the high level of care her patients receive. When I work with her in that setting, I do feel I've done good work, and that old sense of satisfaction returns.

You'd think with all this good work done, I'd be feeling pretty good about my job. The "Three Signs of a Miserable Job" as delineated by best-selling author Patrick Lencioni - anonymity, irrelevance, and the inability to asses one's own contribution to others or success - shouldn't be pertinent to my situation. But often I do feel like a replaceable cog in a big, impersonal machine, and I know this is true for many, perhaps most, workers. That's life, right? And we should just shut up and be grateful we have jobs? Fair enough.

I'll admit I'm sensitive. My satisfaction is often diminished by the sheer unpleasantness of the atmosphere in which I'm doing the work, or by workplace frustrations and politics, and amplified if the work occurs in a supportive or positive environment. This, of course, points once again to the recurring realization that I really need to have a thicker skin, that I shouldn't let external affirmation or its absence affect how I feel about myself or the work I do, and that I need to rely on my own inner sense of commitment, honor, and success to find satisfaction. I know all this. I know. I'm responsible for my own happiness. I know. I've told myself this over and over since I began in medicine.

But you know, sometimes, don't you just feel like saying, "Eh, screw it, I'm moving to Boracay?"


ShrinkingDoc said...

KNOWING something is easy. FEELING it just isn't always so easy. If we knew how to automatically translate the knowing into feeling, I think we'd have the key to happiness. I think you'll get back there eventually. I hope soon!

My good friend and one of the few truly amazingly NICE surgeons I've known told me to stay away from meetings when I started my first "real" job out of residency. I didn't heed his advice at first, worried I'd "miss" being part of some important decision. All I gained by going to meetings was frustration and headaches. Now, I just do my best to go to work, take care of patients, and ignore the politics.

It helps that, at my current job, I at least feel like my direct boss and his boss are decent people. And that, if and when a decision has to be made that impacts patient care vs. $, they will fight for patients.

Sorry, not sure what my original point was, except to say, I kind of understand, I've been there, it stinks, I hear you, and I hope things get better. Try to ignore the politics when you conscience will allow. :) You're the best, and I wish you were happy again at work!

Margaret Polaneczky, MD (aka TBTAM) said...

" I shouldn't let external affirmation or its absence affect how I feel about myself or the work I do, and that I need to rely on my own inner sense of commitment, honor, and success to find satisfaction."

You are describing a place of peace with oneself that I think we all strive for but few achieve. I for one need constant affirmation to keep going - Fortunately, I get it from my patients, who, lucky for me, happen to be awake when I am doing what I do best. It has to be harder when your patients are for the most part asleep, and then, given the wonders of the drugs you give, have amnesia about the experience later.

Hang in there.

Resident Anesthesiologist Guy (RAG) said...

I'm feeling similarly right now as well. Maybe it's the winter blahs, but I honestly haven't been real thrilled to go to the hospital either. Thanks for posting again though-you've been missed.

T. said...

Nice to feel less alone! Thanks, everybody. Had a relatively smooth/peaceful day today, so I'm hoping I was just having winter blahs, as RAG said.

kg said...

You probably never hear from those patients who don't complain, but believe me, they are silently thanking you, and likely even praying for you/about you beforehand and thanking God (or whoever) for you afterward. You, your talent, skills, and dedication, are a huge part of the successes that happen every day at your work. I second Margaret's thoughts. Know that you are appreciated and important.