I am constantly coming across articles of physicians with strong voices. Physicians that are jaded.  Physicians that didn’t go into medicine to be defined by patient satisfaction surveys. Physicians that didn’t go into medicine expecting that people wouldn’t trust in their training because the Internet begs to differ. Physicians that cringe at the drive-through mentality that patients can present with diagnoses in hand and demands for tests to be done. Physicians that want out.

As I read these articles, their sentiments resonate with my own experiences. But what we don’t talk about is what pulls us back in.

My patient in room 7 is ten weeks pregnant, terrified she might be miscarrying. She hides her thoughts by preoccupying herself with her blonde, curly haired 2-year-old daughter. Ultrasound and blood tests confirm that she is in fact miscarrying. She busies herself with readjusting her daughter’s perfectly buttoned shirt while I confirm her worst fears are true. Willing away eyes welled with tears, she nods and smiles, keeping a brave face for her daughter. I sit by her side, and I hold her hand. I try to give her hope, and before I leave, she squeezes my hand.

My patient in room 1 is dying. She is 92 years old, and her daughter is at her bedside. She celebrated Thanksgiving with her family, including her 17 great grandchildren. But her disease is progressing, and she has declined further intervention, because if this is her time, she wants to enjoy her remaining days at home with her family. And today, during my shift, is her time. Her son comes later, and asks me to please let his mom die with dignity. So we turn off all the monitors, dim the fluorescent lights, and remove her from all the wires, and let her be a mother, grandmother, great-grandmother enjoying her last breaths flooded by memories of all the love of her family.  Her daughter holds onto the necklace we had removed from her neck in our initial attempts. She sits at her mom’s side, this 57-year-old daughter and mother of four. She cries with her eyes clamped shut, and she rocks back and forth and murmurs repeatedly between sucked in breaths of air, “Mommy, Mommy, Mommy. Oh, Mommy, Mommy, Mommy.”

I rub her back. I am sure she has forgotten I am there until she turns to me and asks me to put her mother’s necklace with a small angel charm around her neck. I take the necklace and drop it through my fumbling fingers. I pick it up and drop it again. She just has one simple request. Can’t I just do this one thing for her?  The fast pace of the emergency department slows, every beep of a monitor, every hurried set of footsteps, every ring of the ambulance phone seems to muffle, and all I want is to put this necklace around a grieving daughter’s neck. One month later, I receive a holiday card from the patient’s son. It has evergreens with snow and glitter and a cardinal on the front. It reminds me the holidays for this family are forever changed. “Thank you for allowing my mother to die with dignity.”   Three years later, that card lies in my box of cherished cards and pictures from close friends, my husband, and my kids.

In room 11, first-time parents bring in their son. He is 3 months old, and he won’t stop crying. He cries during the day, he cries through the night, he won’t stop crying. Why won’t he stop crying? They have been to their pediatrician innumerable times. But right now, it is 2 in the morning, and there is nowhere to bring him but to the emergency department, and we have found nothing wrong. How could there be nothing wrong?  The three of us hold a quiet conference as to not wake the semi-sleeping baby, and we talk, not about medicine, but about my own experience with my son who was 3 years old at the time. We talk about how he cried too, and he wouldn’t stop unless we held him all the time. And we were so exhausted. My husband was so sleep deprived he was having visual hallucinations. We took turns on which day we would brush our teeth and shower.

The three of us laugh (cackle quietly) at what absurd things sleep deprivation can do to a person. We talk about how I never thought it would end. But it did end. One day, he just started sleeping.  We were so exhausted that we didn’t even notice until we had slept for four consecutive hours and woke up in a frantic panic. They listen intently. They sigh a tired kind of relief. There is someone that knows what they are going through. They are not alone. They leave with the same son they love deeply that still won’t stop crying, but feeling some sense of peace — or maybe even hope — they hadn’t had before. I didn’t figure anything out for them, but it was worth the visit.

Here is the truth. I went into medicine because I believed that if I put hard work into learning about illness and treatments, I could help people at their greatest times of need. What I now know is that medicine is about caring for people. But it is also about confrontation and conflict. It is about taking things in stride. It is about leaving your work at work so you can come home and be a mother or daughter or wife so you can preserve balance and your sanity.

Except for those moments that hit you in the gut, the heart, the soul. I hold onto those moments. Correction: They hold onto me. They roll over and over in my mind. They replay in my mind when there are quiet gaps in time. They are the parade growing and marching behind me five months later, three years later, eight years later. They keep me going.

I acknowledge that those creeping feelings of wanting out are there. I sometimes hold my breath anticipating my cracking point. But then something happens. I get a squeeze of the hand. A card with evergreens and glitter snow. A couple that just needs to know they are not alone. And it is a big red reset button. And it is worth it. And I keep going, parade and all.

Cindy Winebrenner is an emergency physician.

Image credit: Shutterstock.com