I seem to constantly skirt trouble. Writing and medicine are fractious bedfellows – a marriage not always congenial. On one hand, to write well, to truly produce good work, you have to crack yourself open and claw out the truth for examination in the light. No fluffing around, avoiding the difficult topics. No wilful blindness to your own biases. No doing stuff to be liked. No pretence. Writing about medicine, on the other, requires a good deal of restraint – case anonymity takes precedence over all things of course, but there are other filters that must be applied to heed the hallowed principles of justice, autonomy, beneficence and nonmaleficence.
And thus it was that I recently screwed up. Barrelled off down a self-righteous path signposted with hurt and backlash and paved with bricks lain down by a lack of situational control. I’d missed the turnoff to wisdom. Hadn’t looked up at the blazing, devilish warnings lit bright in front of me.
A Monday night in ED, when most of the world should have been home with Netflix, I was instead at the fluorescent front of an incoming tide of methamphetamine addled bodies. This crisis is described in the media as an epidemic, but this seems to suggest something temporarily sweeping the globe, soon to be contained with some ad hoc planning, a few masks, and a vaccine. Somehow that night there was a convocation of all the worst elements of this culture flooding through the doors, and all of the worst qualities in me. Tipped over by a huge speeding beast of a man exuding violence from his sweaty pores, who, in addition, was the final straw in the night of one of our most seasoned and resilient nurses, making her walk out of the department in tears, I had had enough. He was one of several; person after thunderous person. I was short with the patients, particularly those who were substance affected, and functioned at the minimum level to provide safety without much to spare. I went home and wrote my heart out, planning to send my polemic far and wide. It was time for the world to see the naked truth of the methamphetamine problem, and I would be the one to do it! The Guardian would take it! I’d go viral! I described the evening in my signature, over-blown, adjective-smothered way: the fury in this man’s rage-dilated pupils, his towering violence towards the staff – in particular the petite and softly spoken nurses at the front desk whose main job is to quietly care for others, the blood from where he’d cut himself spattering around like confetti, the ragged holes he’d punched in the vending machine, the watery fear I felt in my innards having to walk out and face him, then another, despite the safety net presence of our superhuman security staff. I wrote about how prevalent this is in the seams of our beautiful Australian cities, and how the wash of metabolites floods into our sewerage every day. I pontificated about the societal ripples that had reached a point where methamphetamine use was so widespread. Oh, I was on fire. And how witty I was, bestowing upon it the title, ‘Full Speed Ahead’.
I sent my piece to a trusted friend and colleague, expecting an admiring pat on the back. Instead, he returned it, gently reminding me of Hippocrates, ‘Wherever the art of medicine is loved, there is also a love of humanity.’ He graciously pointed out that there was a lack of professional compassion and respect in the piece, and, though this was a terribly important and emotive topic, all I would do was play into the stereotypes of sensationalism, lapped up by the media and public alike. It’s not very ‘kind’, he said. And, of course, he was spot on. I re-read the piece and its indignant frenzy, then folded it up and put it away. But not before I used it as a big, clear mirror. I asked myself what was it that had thrown in the spark, and why was I such a tinderbox? By having to explore the situation in such detail, I realised it was the responsibility I felt as the ED Consultant in charge; that somehow I’d let my staff, this one nurse in particular, down. And I’d let myself down. It was disappointment in myself. The way I’d guillotined kindness both during that night, and afterwards when transcribing it onto the page. None of these things would I have understood had I not written it into words, and had someone else read it. Doing so crystallised for me, once again, the duties we critical care clinicians have in this wild melting pot of humanity. Our role is to have much more than hefty knowledge. It is also to rise above one’s own humanness to attain humanity. And sometimes it will be necessary to manufacture kindness. This is not always easy, I am painfully aware. But without some underlying compassion and kindness for whoever walks through the door, our jobs might well be impossible.
There is a great deal of talk about burnout in medicine. It’s a complex term, and, like the methamphetamine crisis, is vastly multi-factorial in cause. Another trusted colleague remarked recently that the entirety of emergency medicine seems burnt out. I suspect many other specialties feel the same. Simple answers are not apparent. I cannot speak for the greater community, but I can speak for myself. One of the causes has to be a lack of agency, of control over your environment, and the amorphous, unnamed distress that results. Recognising when this is a contributing factor is a start. This whole episode – the writing, the reading, the rewriting – was, at the very least, an exercise in understanding kindness. From others, to others, to myself. Forgiveness for being a fraught and fallible human. Being open enough to learn how to do better.What is the point of writing this piece though, this sideways look at the original topic, for a public forum? I know not. Perhaps ask why I write at all. Again, I don’t know, except that is possibly one of the few ways to truly understand something, and to communicate that truth to maybe only a single individual. If one person reads it and says, ah, yes, that could have been me, but now it won’t, then the writing of it has some worth.
‘How to…’ An Instruction manual for those in Critical Care