Every mama bear fiber in my being was screaming at me that I shouldn't be there. The patient's lips were moving, but the words were basically “wah wah wah” as if Charlie Brown's teacher were speaking. All I could hear over and over in my head was the phone call from my youngest about his brother's accident at camp. “Mom, Cole's hurt. He's in the ambulance.”
My eyes were seeing my patient, whose normal-looking ankle was only sprained, but my heart was imagining my son grimacing on a backboard with his grossly deformed ankle. I was supposed to be practicing medicine as usual, but I couldn't. I was a wreck.
An hour or so before, as soon as I'd learned about his injury, I'd gone right up the chain of command. At 8:30 p.m., it could have been possible to find coverage for my night shift given my family emergency. What I got instead of coverage for my shift was a grace period for being late while I sorted out where the ambulance was taking my son and made sure his father was on his way. As I got into my car, I coached my ex, who hates hospitals and gets nauseated just by the loss of a baby tooth, to be calm and cool when he got to Cole's bedside. Then, instead of driving to the ED to which the ambulance was taking my child, I drove to work.
Despite my angst about my son, my mentality was still “the ED is my responsibility.” I thought naively that reporting the fact that he was going to require conscious sedation in another ED would have been enough to convey that they needed to give me leave. I should have directly asked for the night off. Yet I didn't because medical training has convinced us that there is no asking off just before a shift. “Either we're rounding with you or rounding on you” is the teaching. When I got to work, the doc who was there with me until midnight sweetly offered to handle the ED by himself for a few hours until Cole's ED visit was over. I told him no because if wait times went up or if there were a bad outcome, I would be held responsible regardless of whether my child was having an emergency.
The indoctrination that doctors who take sick days are “soft” begins in med school and continues throughout our careers. EPs will work even if they are hooked up to an IV, dragging their poles around the ED. Sure, that might involve physical misery, but once we push through the pain and exhaustion, we can still lay our heads on our pillows feeling like we upheld our altruistic principles and our commitment to colleagues and patients. There's not much cognitive dissonance in sucking it up and working through a viral syndrome.
Doctoring v. Parenting
What's harder in my opinion is working despite our child's health emergency. The emotional conflict we feel while working when they're sick is worse than the physical discomfort we feel while working when we ourselves are sick. Unfortunately, because of the widespread indoctrination that we should work through everything, we are expected to perform when our own parents are on their deathbeds or our children are in ambulances. If we don't, we fear letting down our colleagues or, in today's culture of medicine where EPs seem to be replaceable, even losing our jobs. Terms like “abandonment” are thrown around if an EP thinks of leaving during a shift. It's a way of handcuffing us to the ED and sends a very clear message: “Suck it up. Your personal needs take a back seat. Show up to take care of everyone else's crisis and have your crisis on your own time.”
I'm sure I'm not alone in believing that nothing should matter more than our children. If it came down to a choice between motherhood and medicine, motherhood would win every time. I will gladly accept the circadian insult of night shifts if it means being there more often for my sons. I know that women balancing parenting and doctoring spend more time on child care than our male counterparts do, and I am glad to do it because my kids are my first priority. Being there when they have a medical emergency is my duty. Those are my priorities and core values.
The conflict between our core values as parents and as EPs creates significant cognitive dissonance. Receiving a text with a photo of an ankle looking like Cole's looked that night would make most people drop everything to be with him in the ED, but I still showed up to work. I've never felt so much inner turmoil during a shift. Parenting may be first on our priority list, but our careers don't always allow us to realize that ideal. Physicians valiantly do what it takes to meet the high expectations placed upon us, but we're far from invincible. The cognitive dissonance produced by choices we are forced to make will ultimately affect all of us and our families.
Only time will tell what impact my absence made on my son's little psyche. My ex went instead of me to be with him in the ED, and despite his best efforts, he was a disconcerted, pre-syncopal maelstrom of nerves. My son knew I should have been there. “Mom, Dad flipped out and almost passed out. I wish you had been there” was his comment after. The impact on me of not being there when my son needed me will be a lifetime of guilt. I learned that night that the medical system will take everything if we let it. There is no line. If there were, I would have stuck to it and walked out, prioritizing my son's emergency. I am not alone. My boss not long before had worked while his mom was dying.
That is the type of sacrifice expected of us. We let our families' emergencies take a back seat to everyone else's, becoming martyrs to our patients at the expense of our own loved ones. After that night, I examined my contract, and it says, “In the case of a personal or family emergency or illness, although the Physician has the absolute right to take leave, the Physician shall make a good-faith effort to arrange for alternative coverage.” The reality is we are actually allowed to take leave for a family emergency, but that is not the culture of medicine.
If we want physician wellness, we must stop forsaking everything for this career. I've learned the hard way that despite deep sacrifices for my job like the one I made that night, there will always be someone unhappy with me, so it's not worth it to compromise the other parts of my life that I cherish. Our children deserve to have us with them if they have a health emergency. We need to remember what's important and assertively advocate for ourselves and our families. It's up to us to protect what we hold dear.