Emergentology

Dr. Despondence, Languishing in the ED

Figure: EP life, first person

Figure

Bleh. Meh. I'm just kind of over this. Everything.

I recently read a New York Times column by Wharton psychologist Adam Grant on languishing, and it definitely hit the spot: “It wasn't burnout—we still had energy. It wasn't depression—we didn't feel hopeless. We just felt somewhat joyless and aimless. It turns out there's a name for that: languishing.

“Languishing is a sense of stagnation and emptiness,” he wrote. “It feels as if you're muddling through your days, looking at your life through a foggy windshield. And it might be the dominant emotion of 2021.

“Part of the danger is that when you're languishing, you might not notice the dulling of delight or the dwindling of drive. You don't catch yourself slipping slowly into solitude; you're indifferent to your indifference. When you can't see your own suffering, you don't seek help or even do much to help yourself.” (April 19, 2021; https://nyti.ms/3bCYUpy.)

Languishing certainly hit all the right notes for me, but I still felt like something was missing from how I've been feeling over the past few months. Languishing doesn't include the exhaustion that I feel from being nowhere near the finish line of COVID-19, while the vaccinations are making the rest of society feel like it can open back up and go back to normal. As ED volumes have begun to climb back to pre-pandemic levels, it just feels like “yes...and.”

Yes, and keep doing all the COVID stuff:

• Wear a gown and face shield.
• Keep the patient under investigation if he says “shortness of breath” or “fever” or “cough” or “runny nose” or if he is hypoxic or tachypneic because it's all on you if you miss a single case of COVID.
• Delay the patient's care and hold him in the ED until his COVID swab comes back, and then the consultant will see him because the ED staff are more than happy to hold patients in their infinite beds and see undifferentiated PUI patients, but no one else needs to.
• Make numerous additional phone calls and play phone tag with family members, caregivers, nursing home staff, and durable powers of attorney because no visitors are allowed.

Yes, and go ahead and see all the other patients who have decided to show up at the ED without our getting any additional resources when we were already nearing our capacity to keep the plates all spinning in early 2020.

So, yeah, languishing ain't cutting it as a term for how I'm feeling. Throw languishing and some more garbage into this ED cauldron, and then it might start to be an authentic elixir:

• Boarding patients in the ED
• Practicing hallway medicine
• Acting as some sort of limbo-yet-also-solution for our broken, poorly funded mental health system
• Compassion fatigue, which is different from burnout (but can lead to it), a common consequence of exposure to patient experiences and suffering combined with roles that require empathy
• Vicarious trauma, the internal shift in emotions, spirituality, and worldview that occur over the course of indirect exposure to trauma
• Burnout, a triad of emotional exhaustion (nothing left to give), depersonalization (negative, callous, and detached responses to others), and reduced sense of personal accomplishment (feelings of competence and achievement in one's work)

Simmer one part global COVID pandemic in there with some Oil of Languishing and a dash of all of the above, and there's your recipe for how I've been feeling.

You know those horrible, horrible days of your career where you have an absolutely devastating case—maybe a young cardiac arrest or an absolutely overwhelming trauma—and then after it's all over, you start to think about what happened, and then realize you still have seven hours of a shift to get through? That's what it feels like right now. Except it's not one case, it's a year of cases, and you don't even know if your shift will ever end.

There's no time to reflect, process, or grieve about this past year. There's no pat on the back, ticker tape parade, or sigh of relief. It's just, “Welp, let's keep going. Three more ambulances just showed up.”

I think I've come up with a term that maybe fits how I'm feeling: medical despondency. Despondency itself has a pretty good definition: a state of low spirits caused by loss of hope or courage, but I actually like the Latin roots even more. The adjective despondent is from the Latin despondere, from the prefix de- (from, away) and spondere (to promise).

“Away from my promise” is as a good descriptor as any, I guess.

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Dr. Walkeris an emergency physician at Kaiser San Francisco. He is the developer and co-creator of MDCalc (www.mdcalc.com), a medical calculator for clinical scores, equations, and risk stratifications, which also has an app (http://apps.mdcalc.com/), and The NNT (www.thennt.com), a number-needed-to-treat tool to communicate benefit and harm. Follow him on Twitter@grahamwalker, and read his past columns athttp://bit.ly/EMN-Emergentology.