RustedFox

Go to the ER now, or you'll have a stroke.
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I wrote a letter to my Dad the other day. This is a little piece of it. Many of you know that I've been particularly crispy as of late. I figured I'd post this here because some of you let me know that you enjoy my writing, and I'm probably looking for some help and advice. I see a counselor regularly. I'm going to be okay. Forgive some of the language; I had to write it so a person with limited medical knowledge could read it.

**** BEGIN COPY-PASTED SECTION ****

That’s what it comes down to.

I’m this close [ ] to casting it all off, and saying: “Go eff yourselves. Atlas has shrugged.”

I would love to see a hospital administrator come down to the ER at 2:35 in the AM to assist with a critical patient. He or (more likely, she) wouldn’t know what the hell to do, but they love to parade around in a crisp and pressed white coat with their name embroidered fancily on it.

TAKE IT OFF, YOU POSEUR! (sic) YOU NEVER EARNED THE WHITE COAT! WHAT MAKES YOU THINK YOU CAN WEAR IT? THE CLOSEST YOU GET TO A PATIENT IS BEHIND MY DESK, AT A SAFE DISTANCE FROM ANY PATIENT CONTACT, WITH A CLIPBOARD IN YOUR HAND, CRITIQUING ME, MAKING SURE THE CHECKBOXES ARE CHECKED. GET THE FUUCK OUT OF MY WAY! YOU ADD NOTHING TO PATIENT CARE, YET YOU HAVE HEALTH INSURANCE, A 401K , AND LOTS OF OTHER BENEFITS THAT I DO NOT.

Nobody respects our profession. To the admins, we are all just sheep with a bell around our neck so the shepherd (an administrator) can count the flock. You don’t see me wearing dog tags, camo, or jump boots! You know why? BECAUSE I’M NOT MILITARY! I can’t handle an M-16. I can’t handle a grenade launcher… and I DON’T PRETEND TO ! To the patients, we are just waitstaff that should jump at their every need, lest their be a "4" instead of a "5" on the Press-Ganey Survey. GASP!

There was a movie a few years back called “The Watchmen”. I highly recommend you watch it. It really is right up your alley. It is set in the mid 80s, during the height of the Cold War and the concept of “Mutually Assured Destruction” These were the days that you were stockpiling canned food under the basement stairs in (my hometown) not far from the pool table. (Yep, I remember. I used to re-arrange them by size and by variety because I was a kid, and I liked to play with blocks. Or Cans. Cans are like blocks, but they don't stack the same way, so you have to THINK it thru.

EXCEPT: the superhero in the movie; “Dr. Manhattan”, who won the Vietnam War for the US (in this alternate timeline) and is holding the Soviets at bay (because he can intercept a nuclear launch with his mind power) decides to leave Earth for Mars, because he can breathe/exist anywhere and has no interest in selfish human conflict anymore.

He is not subject to the frailties of human physiology. Interstellar travel? No problem. He creates himself a palace of glass on Mars because… it suits him, and he can watch the Americans and the Soviets destroy each other if they like. He is no longer interested in taking a side, in an almost God-Like role.

The underlying conflict is: “Well, who Watches the Watchmen?!”

After some time, Dr. Manhattan is alone on Mars, and says (to nobody, because nobody is listening besides the viewer).


“I quite prefer this small red planet, to that larger blue planet.”

10 years in medicine has taught me that “Only those who can’t understand… they are tasked with watching the Watchmen.” And the Watchmen… aren’t superheroes, at all. They're just trying to do a job that eats away their sanity."


I quite prefer this small red planet, to that larger blue planet.
 

bravotwozero

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You have talent, I’ll give you that. This needs to be published - somewhere


Sent from my iPhone using Tapatalk
 
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RustedFox

RustedFox

Go to the ER now, or you'll have a stroke.
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I can't help but be reminded of Pink Floyd's "Animals", with the concept of the pigs (CMG brass), the dogs (admin), and the sheep (we, the docs).

PIGS:

BIG man! PIG man!
Ha-HAAA; charade you are!
You well-heeled big wheel!
Ha-HAAA; charade you are!
- and when your hand is on your heart!
You're nearly a good laugh
...
Saying "keep on digging!"
Pig stain on your fat chin.

DOGS:

And after a while, you can work on points for style
Like the club tie, and the firm handshake
A certain look in the eye and an easy smile
You have to be trusted by the people that you lie to
So that when they turn their backs on you,
You'll get the chance to put the knife in


Seems so appropriate.

SHEEP:

Hopelessly passing your time in the grassland away
Only dimly aware of a certain unease in the air
You better watch out!
There may be dogs about
I've looked over Jordan, and I have seen
Things are not what they seem
...
What do you get for pretending the danger's not real
Meek and obedient you follow the leader
Down well trodden corridors into the valley of steel
What a surprise.
 

gamerEMdoc

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On a totally unrelated side-note, if you haven't watched HBO's "The Watchmen" series, please do yourself a favor and go watch it. One of the best seasons of TV I've ever watched, and excellent sequel to the original material.
 
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RustedFox

RustedFox

Go to the ER now, or you'll have a stroke.
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Appreciate the kind words, all. They help. They really do.
I'm really, really going thru a difficult time in life.
Pretty sure I'm ending a lot of things in life; but not my LIFE, so don't worry about that.
Every now and again, when my fingers go clickety-clickety-clack, I'll post it on here so you can laugh, cry, critique, whatever. Give me a digital slap if you feel it's warranted.

It helps.

When I wrote the original post, I imagined myself as Staff Sgt. Barnes (Tom Behringer) from PLATOON, screaming at some useless senior officer to "not tell me how to run my war", and whose brain is so mangled from the war that he loses his grip on reality.

"Y'all talking about killin'? Whatchoo know about killin'? You smoke this stuff to escape reality? I AM REALITY!"
 
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Fox800

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Appreciate the kind words, all. They help. They really do.
I'm really, really going thru a difficult time in life.
Pretty sure I'm ending a lot of things in life; but not my LIFE, so don't worry about that.
Every now and again, when my fingers go clickety-clickety-clack, I'll post it on here so you can laugh, cry, critique, whatever. Give me a digital slap if you feel it's warranted.

It helps.

When I wrote the original post, I imagined myself as Staff Sgt. Barnes (Tom Behringer) from PLATOON, screaming at some useless senior officer to "not tell me how to run my war", and whose brain is so mangled from the war that he loses his grip on reality.

"Y'all talking about killin'? Whatchoo know about killin'? You smoke this stuff to escape reality? I AM REALITY!"
Sending some dark rum your way. Hope it all gets better, pal. I'm planning my escape from this madness and I just started.
 
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**** man. Even from you this is dark.
Okay, let me get creative here.

We have a nighttime "nurse manager" or "house supervisor" or whatever title they want to call themselves by.
One guy.
One guy in particular.
Works only nights.
Perfectly pressed white coat. Every time.
Name embroidered on the left chest. Typical alphabet soup after that.
Rather effeminate. The wrist is particularly limp when he checks the boxes on his clipboard.

But when I get that STROKE ALERT or that SEPSIS ALERT at 3:18 AM....
The sununvabitch is right there.
Lording himself over me.
Because "Ooooh! Look! Do the medicines! Fun! - but I don't want to do the medicines; you can do them."
Right outside "ROOM 7" (our resusc. bay)

I walk out of the resusc. bay and tear off my gown, strip off my gloves.
I'm sweaty, I'm panting. The gloves stick to me as I tear them off.
I have goggles, and the beads of sweat are on the perimeter.
You all know the feeling.
Your ass is wet, and you're not sure if you sh!t yourself, or if you're just sweating down your crack.
(For the record: You're just sweating down your crack. Doesn't matter; smells awful either way.)

And the first thing you hear, from Nick McNurseyManager is:
"Well, did you do x-and-y-and-z? What were those TIMES?"

He knows not to ask me this, because of the look that I gave him one night.
The look said: "You stop until I can tell you to go. Don't open your gob before that."
It was pretty much the "1000-yard stare".

But you know what ?

You know what I want to do?

Oh, I want to hurt him.

And I know how I would do it.

I wouldn't actually assault anyone like this. Here comes the humor, but every good joke has a kernel of truth.

One thing you should know about me, is that I'm 5'6'', 170 pounds. 17% body fat. I'm "athletic".
AND I grew up with a name that's Slavic in nature, and in America, is more often associated with being a girl than a boy.
So, like the "Boy Named Sue", I grew up quick, and I grew up mean, and my fists got hard, and my wits got keen.

When he opened his lispy mouth, he would quickly get a rising head-butt, right in the nose.
That would stun him. I'm just short enough to make it happen with some kinetic energy.

Then, that white coat would come off. I'd roll his arse twice on the ground to get each sleeve off; presuming that I knocked him down with the head-butt.
No blows below the belt. No. No. No.
No eye-gouges, no dirty tricks.
No "Ric Flair" moves.

I don't want to punch him.
I don't want to kick him.
That's just barbaric, and doesn't send a message.
I just want him to sting and cry.
And be embarrassed to be parading around to pretend that he's something that he's not.

I'd drop that coat on the ground next to him.

And I would say: "Once you can get up; and once you can pass STEP 1-2-and-3, then you can wear that coat." If I see you in that coat again before that; you better take it off. Fast."


Of course, I would never do any of this; but damn.
I'm sure 90% of the docs reading this have thought these exact thoughts at some point.
Sent from my Pixel 3 using SDN mobile
 
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RustedFox

RustedFox

Go to the ER now, or you'll have a stroke.
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**** man. Even from you this is dark.

Sent from my Pixel 3 using SDN mobile
I'd never actually hurt anyone.
But I'm not a shrinking violet.

In the WWF (WWE?) Fantasy-Land, that how it would go down.
I thought I was trying to make that clear with the Ric Flair joke.
Nobody would be hurt, but I want to embarrass the wannabee.

Remember when DONALD TRUMP was a WWF star and elbow-dropped some chump thru a table?
THAT'S the joke I'm trying to make. It it came across poorly, I'll re-write-it.
Maybe I should have included some lines like: "My Theme Music plays as I exit the room." Or something like that.

Don't take me seriously, here: I'm just trying to make a joke in a violent society where there's a face and a heel.
 
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CajunMedic

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Then, that white coat would come off. I'd roll his arse twice on the ground to get each sleeve off; presuming that I knocked him down with the head-butt.

And be embarrassed to be parading around to pretend that he's something that he's not.

I'd drop that coat on the ground next to him.

And I would say: "Once you can get up; and once you can pass STEP 1-2-and-3, then you can wear that coat." If I see you in that coat again before that; you better take it off. Fast."
Better yet. Let's make it like the motorcycle clubs with rivals . Anyone other than a physician wearing one in the ED, gets it forcibly removed and we keep it as a souvenir. Hang it up in the fishbowl or lounge.
 
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RustedFox

RustedFox

Go to the ER now, or you'll have a stroke.
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Better yet. Let's make it like the motorcycle clubs with rivals . Anyone other than a physician wearing one in the ED, gets it forcibly removed and we keep it as a souvenir. Hang it up in the fishbowl or lounge.
Seriously. I don't care if we (physicians) all start wearing black leather vests with "EMERGENCY PHYSICIAN" patches on the top rocker, with our location on the bottom rocker, and a big red cross in the center.

It would at least set us apart from the NP/PA/RT/Admin/Whatever crowd, and let the patient know that they have been seen by a true, blue, PHYSICIAN. Someone who is responsible for the care and what happens. Someone that cares. Someone with a PLAN. Someone that can ask questions to. Someone they can get answers FROM.

Maybe we need to look more bad-ass. Of course, Admin wouldn't go for that.

I hate it.

I hate it a lot.

Some of our nurses are so old and out of touch, that they still tell diverticulitis patients: "No nuts, seeds, or popcorn."
I seriously interrupted one last week saying this.
"Stop telling these old wives' tales. No surgeon has ever found a popcorn kernel, a seed, or a nut in a diverticulum."
She looked at me, mouth agape. There's that look again. The "hop-hop-hubbada-hubbada-hubbadda" look.
Like I had wrecked her world.

If the guy with the black leather vest says something; maybe they'll listen.
 
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GeneralVeers

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Some of our nurses are so old and out of touch, that they still tell diverticulitis patients: "No nuts, seeds, or popcorn."
I seriously interrupted one last week saying this.
"Stop telling these old wives' tales. No surgeon has ever found a popcorn kernel, a seed, or a nut in a diverticulum."
She looked at me, mouth agape. There's that look again. The "hop-hop-hubbada-hubbada-hubbadda" look.
Like I had wrecked her world.

If the guy with the black leather vest says something; maybe they'll listen.
The same look I got from my marginally competent and supposedly educated NP last night when I told her:

1. Vitamins don't stop you from getting a cold
2. Anti-oxidants have never been shown to promote health, and in fact may contribute to cancer.

Also for bonus points, take the oxygen off of an active STEMI patient with normal SaO2 and see the reaction the nurses give.
 
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The train has left the station a long time ago. Even nursing students are wearing long white coat now. What has happened to medicine?
 
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RuralEDDoc

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RustedFox I always like your posts and think you have a great deal of insight into the problems of emergency medicine. It seems like you take all the bull**** personally which is unfortunate. The admin and nursing and patient BS is very real but we didn’t create it, we have little control over, and (for the most part) we aren’t responsible for it. Sending you good thoughts and wishing the best for all of us in the trenches. (Wishes aren’t enough - take care of yourselves, folks, no one else will do it for you).
 
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RustedFox

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Go to the ER now, or you'll have a stroke.
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RustedFox I always like your posts and think you have a great deal of insight into the problems of emergency medicine. It seems like you take all the bull**** personally which is unfortunate. The admin and nursing and patient BS is very real but we didn’t create it, we have little control over, and (for the most part) we aren’t responsible for it. Sending you good thoughts and wishing the best for all of us in the trenches. (Wishes aren’t enough - take care of yourselves, folks, no one else will do it for you).
I'll take every thought and prayer I can get in these, the dark days. Thank you.
 

GeneralVeers

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RF....I get frustrated too. Usually about the things that are an impediment to my RVU production at work. I try not to bring it home or dwell on it. In fact, on my days off I rarely think about work. My suggestion would be to compartmentalize more and not let the stupid nonsense bother you on your downtime. Life's too short to worry about arrogant administrators, incompetent midlevels, or greedy CMGs.
 

gamerEMdoc

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One of the best pieces of advice I got when I was burned out at one point almost a decade ago and constantly thinking and anxious about work was to take up a new hobby from scratch and get obsessed about it. Something where your mind had to be active and learning (I was specifically told video games couldn't count). Painting, guitar, a new sport, etc. I started golfing and was determined to become a good golfer. I hadn't golfed since college and was terrible back then. I joined a course, regularly shot over 100 but kept going, watched golf videos in my spare time, read books on golf, started filming my swing, putted in my house, etc. I've watched my handicap continue to creep down and I'm at the point where I nearly break 80 now.

That along with regular exercise and getting back in shape were two of the main things that drug me out of burnout. Completely changed what I thought about. I now get more ticked off after a bad round than I do after a bad shift, and there are far less consequences of a bad round of golf.

Anyway, RF, best of luck dragging yourself out of the burnout doldrums. So many of us have been there, its truly an awful place.
 
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RustedFox

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One of the best pieces of advice I got when I was burned out at one point almost a decade ago and constantly thinking and anxious about work was to take up a new hobby from scratch and get obsessed about it. Something where your mind had to be active and learning (I was specifically told video games couldn't count). Painting, guitar, a new sport, etc. I started golfing and was determined to become a good golfer. I hadn't golfed since college and was terrible back then. I joined a course, regularly shot over 100 but kept going, watched golf videos in my spare time, read books on golf, started filming my swing, putted in my house, etc. I've watched my handicap continue to creep down and I'm at the point where I nearly break 80 now.

That along with regular exercise and getting back in shape were two of the main things that drug me out of burnout. Completely changed what I thought about. I now get more ticked off after a bad round than I do after a bad shift, and there are far less consequences of a bad round of golf.

Anyway, RF, best of luck dragging yourself out of the burnout doldrums. So many of us have been there, its truly an awful place.

Yeah, these days are pretty dark.
I seriously will get so worked up over stressful items at both work and home that I'll puke.

I had a shift today. Not a good shift.
Plenty of abuse.
My car is broken down. Need a new clutch. Wife is out of town with family, so no spare car.
So, I uber'ed to work and back home. No biggie. The clutch will get fixed.
If you're gonna drive a stick; you're gonna have to replace a clutch. That's to be expected.
I'm not worried about that.
I uber'ed to work. On time. No problem.
Work is work.
Work sucked bad today.
I'm not gonna list why. I have already. A few times.
I clocked out, went across the street to the pub, and ordered a drink. Moscow mule, to be specific.
I noticed my hand shaking as I picked up the copper mug.
I didn't even get the cup to my mouth.
I got up, left everything at the bartop, and walked calmly but briskly to the "family" restroom.
I power puked.
Bile. The Dr. Pepper that I drank on-shift.
I politely turned on the faucet, got a paper towel from the dispenser, and wiped out the sink.
Took a look at myself in the mirror. Presentable.
Walked back out to the bartop. Called my UBER.
Drank my drink; got my ass home.

No job should make you puke.
 

BoardingDoc

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Yeah, these days are pretty dark.
I seriously will get so worked up over stressful items at both work and home that I'll puke.

I had a shift today. Not a good shift.
Plenty of abuse.
My car is broken down. Need a new clutch. Wife is out of town with family, so no spare car.
So, I uber'ed to work and back home. No biggie. The clutch will get fixed.
If you're gonna drive a stick; you're gonna have to replace a clutch. That's to be expected.
I'm not worried about that.
I uber'ed to work. On time. No problem.
Work is work.
Work sucked bad today.
I'm not gonna list why. I have already. A few times.
I clocked out, went across the street to the pub, and ordered a drink. Moscow mule, to be specific.
I noticed my hand shaking as I picked up the copper mug.
I didn't even get the cup to my mouth.
I got up, left everything at the bartop, and walked calmly but briskly to the "family" restroom.
I power puked.
Bile. The Dr. Pepper that I drank on-shift.
I politely turned on the faucet, got a paper towel from the dispenser, and wiped out the sink.
Took a look at myself in the mirror. Presentable.
Walked back out to the bartop. Called my UBER.
Drank my drink; got my ass home.

No job should make you puke.
Can you take a vacation amigo? Maybe cut back shifts? I know this stuff is easier said than done. I'm just coming off of 10 shifts in 11 days and I was getting pretty punchy about halfway through and was thinking the same thing, but of course you then think "if I take a vacation, I just have to compress the pain into an even longer run to make up for the week I'm off" or if you cut back you have to deal with the loss of income. Feels trapped a lot of the time.

I'm taking a mini vacation at the end of this month and have made a project of coming up with things to do while on vacation. I used to be a big fan of just taking a vacation to sit, have some drinks and do nothing, except with EM I feel like doing that was the same as saying "I'm just going to not do my job right now" which is not the same thing as "I'm going to do something fun right now."

As other people have mentioned above, getting a hobby or project (drinking and video games do not count) can be really helpful. I'm starting to tinker around with a raspberryPi to build little gizmos and it's becoming a fulfilling timesink and something to look forward to on a daily basis.

If none of this seems to work, it's also helpful to remember that our colleagues in psych help out with more than the paranoid schizophrenics and personality disorder disasters that we see in the ED and can be really helpful to talk to.

Best wishes amigo.
 

GeneralVeers

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RF, if you are becoming physically ill after shift then something is wrong. I've had a lot of bad bad shifts, but none have had this effect. I've had insomnia and felt awful a few times when I was worried about getting fired, but job loss is my biggest anxiety.

Hobbies are great, but do you have any non-medicine friends you can hang out with and talk about things other than medicine?
 

Fox800

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RF, I hope it all works out for you. I've enjoyed your commentary over the years. Honestly...from a medical student to an attending. I've learned from you, from GeneralVeers, and from others during my road to attendinghood. We've never met, yet your words have had an impact on a stranger.

I hope you find the healing you need.

I also wish that we had some kind of peer support group on here.

That's actually not a bad idea. Let me think about this.
 

dchristismi

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Um, I'd posit that we already are a peer support group. (Although it is perhaps rare to see it bared beyond PM)

I know a few of you in real life, worked with a few, and drank with a few.
I've asked some of you for serious advice about life/work/crises, and have been asked the same questions by a few of you.

We bitch, we console, we vent, we chime in with condolences, reassurance and, for the most part, kindness. (and sarcasm, black humor, and that reminds me, we haven't had a good Fatty McFattypants thread in ages.) What else is the "Medicine Sucks" thread beyond pure peer support? Or Birdstrike's tearjerker posts of old? I am reminded of my grandfather, 82nd Airborne, European Theater, who only talked about the war with his buddies after a good many drinks. While we are certainly not veterans of the battle of the bulge, we have some of the same scars. We have a bunch of funny stories too, but the dark side does seem to leak out when we're among friends.

(And keep me posted RF. You can always text or call. You know this.)
 
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