by Robert Lanz, LCSW
“Do you go to sleep as soon as you go home?” I asked Dr. P. as he rubbed his bloodshot eyes, ran his fingers through his hair and pulled on his nose in an effort to stay awake. We were sitting just outside one of the surgical suites and it was well past midnight. From the way he looked, I thought he was through for the day. I glanced over his shoulder at the schedule board and saw he was due back at six a.m. to do an appendectomy.
“It’s hard,” he said, fighting a yawn. “It won’t matter tonight because I won’t have time to go home. I’ve got surgery at six and I’ll be in my office at nine and back here again tomorrow night. I’m sure there will be at least one trauma in that time so I probably won’t get out of here until three tomorrow morning. I’ll sleep then, no problem.”
“But what about the other nights. How do you get to sleep? Do you do self hypnosis, relaxation tricks or what?” I asked.
“I’m an insomniac. I don’t sleep. I can’t sleep. I feel guilty about sleeping. I have about thirty patients here in the hospital and at any one time three or four of them are critical and I’m not sure what’s going to happen to them” he said without any sense of self-aggrandizement. A humble guy, I thought.
“When I lay down and close my eyes, I’m thinking about those patients. What didn’t I do? Why can’t I do more? I can never sleep,” he continued.
“You’re afraid if you go to sleep and something happens to your patient it will be your fault,” I surmised.
“You got it, Bob. A guy dies. What am I supposed to tell his wife? Sorry about the complication. I wish I could have saved him but I was asleep.”
Jesus, I thought. What a load to carry. This guy worked his butt off to get into a good college so he could work even harder to get into a good medical school and then worked extra hard to graduate and get into a grueling five-year surgical residency. And for what? Incredibly long hours, insomnia triggered by guilt over his imperfections? I was impressed. Dr. P. had the kind of focus in life I admired almost to the point of envy.
Well, I thought, he could sit around feeling guilty if he wanted, I was going home, no matter how much admiration I had for him. I needed some sleep. That night in bed I thought about Dr. P. laying awake in his bed, thinking about his patients and I couldn’t sleep either.
Two weeks later, a young man was walking down the street at night in a bad part of town, a place where a lot of people get shot. Maybe he knew that but didn’t care, who can say? Anyway, someone shot him three times. He came to the trauma center, where in five minutes time, he received a thorough enough evaluation for us to determine that he was going to die. We gave him some IV fluids, called the anesthesiologist and whisked him off to the operating room in very critical condition. Within thirty minutes of being shot he had been brought to a trauma center, gotten a transfusion and a CT scan and was on the operating table where the insomniac Dr. P. was trying everything he could to make a difference. He was applying all those years of education, training and experience, ignoring the fatigue, trying to save a life.
As I was doing my job, keeping the victim’s family informed of his deteriorating condition, I wondered if they had any clue as to the energy it took over the years for Dr. P. to be where he was, doing what he did. I guessed they hadn’t. They had other things to think about and so did I. This shooting victim was one that Dr. P. and his team weren’t going to save despite all of their skills and years of training. Some things are not fixable no matter how much sleep is lost over them.
I eased the family into death mode, increasing the bad news incrementally as I shuttled back and forth between the surgery waiting room and the OR. Finally Dr. P. came out, pulled off his mask and simply stated to me, “It’s over”.
I nodded. “Do you want to tell the family or do you want me to do it?”
“I’ll go with you,” he replied.
We delivered the sad news together. The family cried, cursed, threatened, fainted, screamed and finally joined together in a group hug and sobbed. We watched, waiting for the moment they would look to us for help. They wouldn’t know what to do next without it. About the time that moment approached, Dr. P. left, saying, “If you need anything, Bob will be here and he can contact me.”
He looked exhausted, but I knew he wasn’t going somewhere to sleep. Talking to the survivors was the part of hospital work he couldn’t do, didn’t want to do.
After I helped the family view the body, speak to the police and contact their minister, I left them there in the surgical waiting room. On the way back to the ER I took a shortcut through the doctors lounge. Dr. P. was there doing some paperwork, shoulders slumped, red-eyed again. He looked up at me and shook his head from side to side.
“Man, you’ve got a tough job. I don’t see how you can do that every night,” he said, returning his focus to the form he was completing.
There was nothing he could have said to that would have been more rewarding. Respect coming from a man who I respected to the point of envy. Mutual respect. I guess it would be our secret. Someone dies, someone earns the respect of an esteemed colleague. Life in the ER and the OR is life in the extreme. And a lot of the time nobody ever knows that but us.
Many times since that night I’d thought about telling Dr. P. what an honor it was to receive the compliment he had given me, but I always decided against it. I didn’t want him to have to be worried about having to do it again some time. I sure didn’t want him to lose any more sleep over it.