Among the people exiting the hospital, I could easily pick out the medical staff leaving their shifts. It wasn’t by their clothing or the time of day, but by the unspoken language of relief on their faces: a calm twinkle in the eyes or a gentle softness around the forehead and jaw. Dawn or dusk, the look was always there. I hoped I’d have it too when I left later that night.

I was working a swing shift in the emergency department at our rural hospital. Children and adults filled the two dozen chairs in the waiting room. Each of the twenty or so patient care rooms was already occupied and more than half of the patients had not been seen by a provider yet. Worse, there was only single physician coverage, and that physician for the next 10 hours was me.

I rounded up the troops—three nurses, the technician, and the secretary—in the fishbowl, our workstation in the center of the patient care area.

“Our goal is to get through this shift as best we can, as safely as we can,” I told them. I looked into their eyes and felt their minds racing. One nurse vigorously tapped her shoe, while another bit her fingernails. I made a conscious effort not to let my own worries show, though I had them, too. I wondered about how many patients would come, how sick they would be, and if we would be able to care for them, and ourselves as staff, safely.

The nurses dispersed and began their never-ending tasks: measuring vital signs, conducting safety checks, administering medications, and performing patient assessments. I walked from room to room; since it was winter, there was always someone with pneumonia or the flu, though broken bones, strokes, and heart attacks often made appearances. I embraced the chaos: one step, one task, one patient at a time.

The critical patient

Midway into the shift, a paramedic’s voice echoed on the radio system, “Adult male actively seizing, respiratory distress. ETA eight minutes.”

It was a call like many we’d heard before, but the reality never got easier to bear: A patient whose life was at stake would soon be here.

I asked the secretary, “Is anyone on call in case of a difficult airway?”

“No, doc,” she replied.

The hairs on the back of my neck rose. There was no anesthesiologist or surgeon on site. Just me.

I gazed out the doors of the ambulance bay, bathing in the peaceful silence of the snow over the mountains in the bluish hues of twilight. I breathed deeply. Clean, crisp air cooled the heat in my veins.

Then the lights and sirens came.

A heavyset male was brought in unconscious. Two paramedics pushed the stretcher while a third performed bag-mask-valve ventilation. Even my heart heard the patient’s gurgling as blood spackled his breathing mask.

“I tried to intubate but was unsuccessful,” said one of the paramedics, a tall, muscular male.

The patient’s vocal cords were swollen. I had to navigate through a mouth full of blood, but I couldn’t afford self-doubt. A former residency classmate’s words haunted me: “It’s not what you would do if you unintentionally harmed someone, but when.”

I quietly prayed to God for His grace to guide me. I didn’t often discuss my faith in the workplace, even though it was a critical component of who I was and where I gathered my strength. It was rare to have those conversations amongst colleagues, but in times like these, I knew I was not alone in seeking support from a Higher Power.

The nurse administered the sedative and paralytic medications. A paramedic stabilized the patient’s neck with his forearms, and I used a camera to pass the plastic 8 mm endotracheal tube through the vocal cords. When I confirmed breath sounds immediately after, we all shared a celebratory sigh of relief, a collective moment of pause to acknowledge the life we had just saved.

I coordinated the patient’s transfer to another hospital for specialized care and updated his family in the waiting room. There was no time to catch my breath or debrief. Every patient needed to be seen; some had been waiting for hours.

Time flew and stood still.

Suddenly it was 11 p.m. My shift was over, and I felt a mix of exhaustion and unease. But the feeling that rose above was gratitude. Gratitude to the staff, and myself, for safely caring for our patients. They kept coming, but we did everything we could for each one. No one had died, no one’s condition had worsened. It felt ordinary and miraculous at once.

The changing of the guard

I was ready to transition care to the next attending and go home to unwind. I couldn’t wait to feel my skin breathe after kicking off my scrubs and sneakers and to shower off the stress from my shift.

But the physician who came in to take over, a hospital administrator I’ll call Regina, threw a wrench in my plan.

Regina had been unkind to me before, joking about my height, my temperament, and my looks. She frequently remarked that I looked younger than my age and that I was “too nice to be an emergency medicine doc.” From her, this was not a compliment.

Regina was an authority in the hospital, though I didn’t admire the way she worked. Regina always insisted I stay well beyond the end of my shifts to care for patients, but she never hesitated to leave her own without wrapping up. Not wanting to waste my energy, I always kept silent, though I felt a twinge of dread each time I worked with her.

I learned from my father that while it’s a joy to work with people you get along with, the real test of character is how you approach difficult interactions. He emigrated from India in the 1970s, overcame discrimination, and served as chair of the Department of Anesthesia at a New York City hospital. Because of him, I knew my worth. I had confidence in the empathy and compassion I gave my patients. No one could take that away.

Still, I felt a sting when Regina looked at the dashboard upon arriving and asked mockingly, “Why are there so many patients?”

Someone else might have brushed it off, but I saw it for what it was: a cruel burn. We were short-staffed and lacked resources; how could she not acknowledge that?

I wanted Regina to see me the way I saw my colleagues at the beginning of the shift, the nurses, the technician, and the secretary. I acknowledged their humanity and spoke to them in a way I’d hoped would bring out their best.

I knew I deserved the same. My humanity needed to be recognized too. I was more than a cog in a machine.

But Regina kept needling me. “I need you to function,” she snapped in front of the staff. I firmly kept her gaze and stayed still but my body immediately went into survival mode. I became hyperaware of my surroundings, the beeping of monitors, the humming of computer fans, the dull buzzing of fluorescent lights above. My toes curled with unease.

While she scrolled through patient charts, she doled out what felt like a punishment. Though I was several years into my career, Regina demanded I work an additional shift to “shadow” another physician, as if I were still a student. My ears burned. I refused to show any emotion, however; not reacting was my strength. I was well-groomed into silence and submission by medical culture.

Stepping into the physician lounge to regroup, I phoned a colleague, another physician administrator, for support. “I’m sorry this happened to you,” he said. “She’s made many other docs cry, including me.”

A reckoning under the stars

A queasy hangover lingered as I completed my charts. More than a knot in the pit of my stomach, it felt like a fundamental reckoning with my profession. Regina had held her leadership role for years. Why was her behavior tolerated, even condoned? Did I need to become like her to fit in? Did the fate of my career depend on earning her favor and the favor of people like her?

At the same time, I felt badly for her, debasing herself for the sake of her job, unaware of and uncaring about the harm she caused.

What was I working so hard for, sacrificing time away from my family, jeopardizing my own health and well-being only to be devalued by administration? I asked myself these questions repeatedly and knew many of my colleagues had done the same.

My mind ran: What, exactly, was the role of a physician? Were we expected to attend to a predetermined number of patients per hour, regardless of how sick each one was? Were we expected to excel in every scenario regardless of our work environment, without demanding a closer look at the system itself?

And why did it seem so hard simply to help people?

I put on my coat, enveloped in its warm comfort. As I walked out of the hospital, I tasted salt on the corners of my lips from the tears streaming down my face.

Above, the rich purple-black star-studded sky stopped me in my tracks. The full moon cast a glow on the sleeping earth. As I inhaled, the winter air expanded my lungs. As I exhaled, the residue of the last few hours dissipated. Inhale, exhale. My breath echoed the circle of life.

The Creator had made this universe with such intricate design, tending to trillions of different life forms. Realizing that I was only one, and this administrator was only one, and this work bubble was a tiny melodrama in the lens of the Entire Creation, it was as if the Cosmos itself had zoomed me out of my situation to expand my perspective.

Who was I? I felt the answer emerge from my core. I was one with the Creation, contributing to a larger humanity. My bubble of work did not define me. My being and value, the meaning of my life, extended far beyond these hospital walls. I helped save my patients’ lives. While the world slept, I also deserved to rest, to be at peace. As I walked through the parking lot to my car, I paused and made snow angels with my sneakers.

At the time, I didn’t yet know that in six months, I would leave that hospital for the last time and start a new position in a different medical center. I would never work with Regina again, and in the months that followed, my memories of her would shift: One day I would be grateful to her for teaching me and for being an example of what I didn’t want to be. I would look back and be thankful for my faith and inner strength that grounded me that night and each and every day, keeping me from losing my sense of self amidst a broken system.

One day soon I would step out the double sliding doors into the sunlight and feel relief, just like the staff I had seen on their way out the afternoon prior.

Jessica Singh is a physician wellness consultant.