She placed the stack neatly aside with all forms diligently signed and dated. The inbox was cleared. Being finally rested, her tasks of staying on top of duties and focusing on executions became briefly easier. A few patient callbacks, an eight-page disability form to fill out, a doctor to connect with, seven notes to complete and two test results to review and relay would round off the already pregnant day. The floodwaters would rise as soon as bucketing the boat stopped. Tonight would haunt her this threat of capsizing tomorrow as every evening had since her practice was created.

“All jobs are like that,” they said.

The stakes always seemed so high to be perfect in medicine. She dialed the phone number thinking at the same time about being perfect.

“Hello?” the voice on the line replied.

“Yes, this is Dr. Ehlerart,” she announced.

“Oh hello, Dr. Ehlerart,” the lady acknowledged.

“I’m calling to let you know I saw your CT scan results. You have a renal mass that is suspicious for cancer,” she let it be heard. “I know you’re in the midst of moving and your husband is recovering from knee surgery. You told me you were having a stress test soon,” she detailed.

“Yes, Dr. Ehlerart. I … I …” she fell silent.

“Bear with me,” Dr. Ehlerart inhaled. “Your lesion is small around 2cm. I will connect you with a surgeon. You finish your cardiac evaluation that will help you move forward timely with any surgery plans for this mass which will be possibly a cryoablation to freeze it or a partial nephrectomy. Quite honestly, a full nephrectomy will still leave you with plenty of kidney function if that’s needed. Get seen by the surgeon. There may be further testing. Get moved. Focus on your husband’s recovery. We have months to deal with this.”

“OK, Dr. Ehlerart. That sounds right. I … I …” she faltered.

“Are you OK?” Dr. Ehlerart dared to inquire.

“Yes, but could you call my daughter? Could you call me back after you call my daughter?” she begged.

“Yes,” Dr. Ehlerart replied, and the call ended after a phone number and a few other words of comfort were exchanged.

The good doctor called the daughter and apologized for such an abrupt disturbance and reviewed the findings and plans. Nearly 45 minutes later, she rang the patient again to tell her all was done and again to review the plan. Dr. Ehlerart loved medicine when it meant thinking a puzzle through and helping a human breathe easier.

The other test result was negative, so she expressed a message to the medical assistant to relay that bit of reassurance to the other patient.
Regarding the inbox, three more requests from the patient portal arrived while she had been busy on the phone.

“Hello. My doctor prescribed allopurinol 100 mg a day. Is this OK to take?”

Reply: Yes. Send.

“I need clearance for my knee surgery on 10/6.”

Reviewed laboratory data, medical history, medications, last note.

Reply:

To whom it may concern:

I am currently caring for Mr. Hansen. He is a 47-year-old male with stage 3 chronic kidney disease Creatinine stable at 1.4. He is cleared from a renal standpoint for surgery. Please avoid NSAIDs, including Toradol.

Regards,

Dr. Stephanie Ehlerart

Next.

“I went to my endocrinologist, and she said I have gained weight and I think that’s fluid. How can I tell?”

Reply: —

The day was growing late and time short. The reply lingered, but there was no easy answer so the participle of “have replied” hung in the air blank.

She let it slide away unanswered and thought briefly about the notion of being perfect.

The good doctor finished all her tasks otherwise and felt content for the first time in years. Everything was going to be fine finally. It had been such a relief to have a solid plan. She felt renewed and refueled. The feeling was going to be brief due to its’ nature and was derived from insidious conclusions, but it was the truest and most positive force felt in so very long.

“You look good!” everyone had noticed.

“I feel good,” she had smiled earnestly.

“We are so glad to see you on top again,” her family had beamed. They always saw her striving towards the great responsibilities of doctoring. Getting accepted to medical school and completing her training had been her wildest moments in life.

She locked the office door and drove home. Arriving finally home, she placed the keys in the tray by door and slipped into comfortable clothes.

Her husband was getting their daughter Kelly this time from daycare.

They would be home in an hour. She popped the lasagna in the oven and set the auto shut off.

Then she rearranged the chairs and slipped the sheet tightly tied as a noose around her neck and kicked the chair she stood atop away.

Away went all the never-ending flurry of timely tasks and perfectly lined but mostly senseless checkboxes. Away went the heavy hearts and endless calls to align the understandings of a complex system. Away went all anxiety from all points even within her own point of impossible perfection. She was free.

Then she flashed into a waking moment of being erased from all the things her life had gifted her, and just the glimmer of regret filled her nostrils when dizziness set in. She gasped and began fading.

The noose slipped, and she fell to the floor, unconscious but breathing in a heavy thud, back to a world where she was to be stronger and more composed than everyone she encountered.

The next day she was certain of only one thing. She would answer the last patient portal question and then perhaps “consider” checking herself in for respite. First others, then perhaps …

She had been so freed from all expectations external and internal, and now she was back again.

When did doctoring become the dangerous liaison of high responsibility, low appreciation, and exorbitant menial tasks to translate every tangible and intangible notion? When did a doctor’s life open itself up to such poor regard and poor access to a defense against perfection? When did the noose look like a gateway to a solution that would free the doctor from being just tired?

Jean Robey is a nephrologist who blogs at ethosofmedicine.

Image credit: Shutterstock.com