Last July, I burned out. I was moving from the first (also deemed Intern) year to the second year of my 3 year residency. The role of the intern, and thus the year long internship, is typically heralded as the most stressful of all the years of residency. Most of the clerical burden falls to the intern. Partly through a hierarchical power structure, and partly because that’s always how it’s been done, the Intern is responsible for writing all of the notes on patients whether they are coming, going, or have been there for weeks. The never ending grind of this clerical task is, of course, extremely educational, but at times can be tedious to the point of mind-numbing monotony, and is always stressful. Once finishing your Intern year though, a fresh new batch of interns is available to take on that task and you progress to the rank of Senior Resident. This was supposed to be an opportunity for less time to be spent with your nose in a computer, and more time face to face with patients; less time spent typing, scrolling, editing and more time spent actually making decisions; less time being an Intern, more time being a Doctor. So suffice it to say that when I made the transition from Intern to Senior on July 1st 2016, it was with welcome arms. After 6 brutal back-to-back inpatient months leading into this, the first block of my second year, I was already on the edge.  Looking back, I had endured that last Intern Block simply through sheer will alone, certain that the magic of being a senior would alleviate all my troubles. Boy was I wrong. Imagine doing all of the work of an Intern, with one less level of oversight, all the while still expected to perform all of those tasks of a senior. I was already physically, mentally, emotionally, and spiritually exhausted, and after only getting through the last Intern block with the hope of a lighter payload come July first, the realization that I was now required to pull double duty was just too much to bear. I burned out. I gave up. I remember vividly sitting in our terribly “cozy” 10x10ft rounding room at about 8pm, on my first of a string of 6 night shifts.  The fluorescent lights of nearly unbearable intensity filling the room with disorienting luminescence, as I sit languidly staring into my computer in sheer panic. Questions of such existential matters began flying out of my head, “Why am I here?” “What am I doing with my life?” “Why am I doing this?” Each one pulverizing my spirits more and more as I sank lower and lower into my chair in hallowed despair.  Eerily, I began hearing the words “I don’t know what to do,” repeated over and over. Softly at first, then louder. And louder. Somewhere between the decibel level of crowded-room conversation and airplane tarmac, I realized that it was me who was talking. “Strange,” I thought, “Because I know exactly what to do.” I wanted to RUN. To GET OUT NOW. I wanted to break out of those deathly 4 walls and into the hundred-plus degree Tucson July air and go absolutely anywhere, anywhere but here. I began to seriously consider my options. “So there is an attending, and she is more than capable of handling these patients, so more than likely no one would die. But...what if something really did happen?” As I seriously pondered the possible implications of literally walking out on my Job, the phone rang. Caller ID: 694-5868. Every resident in the entire hospital has this number burned into their memory. Famous for calling right before, (or right after) signout, this was the number for Patient Placement, the central office who distributes admissions. My heart sank. I was getting an admission. I ruefully answered, noted the ED bed number and hung up before a litany of self-pitying remarks came flowing from my mouth on the unsuspecting and undeserving Operator. I began looking up the patient, getting a sense of what I was getting myself into.  Mr. Woolworth, 84yoM, Hypertensive Emergency, NSTEMI. I quickly opened a note template, populated all the objective data, and whipped up quite the comprehensive assessment and plan, pleased that I could do so in such a short time, without ever laying eyes on the patient. “Get in, get out, lets make this a quick, straight-forward admission,” I willed to myself in my head while descending the 2 flights of stairs to the ED.

Arriving into ED bay 31, I met Mr. Woolworth. He was tall, sitting up in a low gurney his eyes were exactly on the level of my 5 foot 10 inch frame, while his feet emerged from under his hospital sheets, dangling out over the edge of the bed frame. He was a slender but strong and wiry African American Gentleman, who appeared to be not a day over 65. His huge white Afro rose in stark contrast to his Dark Chocolate complexion, with even darker freckles dotting his cheeks. He looked at me with a smirk that revealed his jovial spirit and matched his southern drawl.  "Hello Mr. Woolworth, My name is Dr. Schatz, and I'm going to be taking care of you upstairs." My outstretched hand became engulfed in a firm yet gentle embrace with a wide palm that I could tell from its coarse texture, was no stranger to hard work. My H&P questioning was met with all sorts of witty aphorisms that characterized his joie de vivre, sayings such as “I’m alive ain’t I?” or “The good lord brought me this far, why should I stop now?” I couldn’t help but be endeared by this man, partly by his handsome exterior, partly by his youthful exuberance, lighthearted demeanor, and genuine zest for life.

It was somewhere between asking him if I could listen to him, holding up my stethoscope(“What, chu ain’t been listenin to anything I said so far?”) and re-cycling his blood pressure cuff (210/170, “But I’m tellin’ ya’ll, I feel fine”) that I realized I no longer had that feeling of panic. I was still in his ED room 45 minutes later, chatting with him about whether or not the cafeteria would be able to provide vegetarian meals(“Doc, I don’t eat nothin’ with a face”),  when my phone rang again. 694-5868. Silencing the phone, I notified Mr. Woolworth that I had to go, promising to see him again on the 4th floor. As you might expect, he offered me a gracious and genuine "Thank you" from the bottom of his heart for taking care of him. I smiled, and accepted.

As I stepped out, answered the call, and accepted the admission, a smile slowly spread across my face.

Thank you, Mr. Woolworth. From the bottom of my heart.