‘Gunshot wound to chest, pulseless, 20 minute ETA.’  When that’s the EMS report, it gets your attention.  Despite the wonderful theatrics of modern medical shows, and the best efforts of real-world, sweat-drenched paramedics, those of us who have done this long enough can translate that report.  For the layperson it means:  ‘Dead.’

I saw that last week. And the week before I saw another tragic, unexpected death in a man not much older than me.

Twice I walked into a small room and looked into someone’s face and said, ‘I’m sorry, but he died.’  Twice there was weeping and moaning, and a woman sliding to the side of the chair as someone else tried to hold her up.  A woman suddenly contemplating life without a person of inestimable value to her happiness.

I have this theory, and I think I have written about it before.  But here it is again for the new visitor or the returning friend and reader:

Send a young man or woman in the armed forces to Iraq or Afghanistan.  They’re in country for a year.  They see combat.  Terrible things.  Or they don’t, but they see the consequences; victims of IED’s, for instance, that they have to care for.  When they return, if they come to our emergency department and say, ‘I have PTSD,’ we say, ‘I understand.’  We believe them.  And why not? Who are we, who am I, to say what event or set of events is sufficient to cause nightmares, anxiety, horrible memories, paralyzing fear?

Send a physician to an emergency department for 10 years, 20 years.  And while we admit that it’s difficult to care for the dying, the broken, the shattered; while we admit that it’s horrible to give ‘the news,’ we just press on.  After all, we get paid well, right?  And to admit the emotional consequences seems a little weak, doesn’t it?  I mean, we can power through can’t we?  It was only a dead child, it’s only a hallway full of grief, it’s only self-reflection and wondering what else we could have done!  There are patients to see.  It’s only 2 am, or 2 pm.  There are five or eight or 12 more hours to go!

So, we ‘burn out.’  ‘I can’t do this anymore, it’s the administrators!  It’s the EMR!  It’s the falling revenue or it’s the drug seekers or the shift work or the patient satisfaction…’ or any number of very real reasons to be frustrated and reconsider life.

But maybe, just maybe, it’s drinking 200 proof pain and suffering for a very long time.  What’s the toxic threshold? What’s the number of death notifications before half of us want to quit?

I’m not ready to quit.  But I’m not bragging, just stating.  I have some years left.  At least for now.  But what if you don’t?  What if you’re done with seeing deaths from car crashes and violence and new cancers and aneurysms and pulmonary emboli and all of those life-changing things?

My theory is just this; maybe what we call burnout is our own PTSD.  Our own brain saying, ‘enough.’  And it applies to more than physicians.  It absolutely applies to nurses, and to PA’s and nurse practitioners.  It goes for police officers, who are often the first to see the lifeless or dying form in the savaged car, or the bloody floor of a hotel or bar.  It goes for the first responders, paramedics and fire-fighters who jump into the fray fearlessly trying to snatch life from death.  They ‘burn out’ too.

If so, it’s OK.  To everyone who sees and intervenes in life and death situations, I say ‘ you’ve done more good than you can ever imagine.  And if you tell me it hurts too much to go back, then there’s no shame.’

That 200 proof pain is bitter stuff.


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