It’s not like me to be sad or fearful for a long time. With age, experience, and mindfulness, I’ve learned to let go of negative emotions quickly, But things were different when I was in my medical training in 1990.

There was an event that shook me for several weeks. I perpetuated my anguish by isolating myself. I had no one I felt comfortable talking to about this.

Lack of Decision Support

I was on night call at the hospital. When my shift began, I got sign-out to follow up on a CXR. There was no helpful context or history given. When I looked at the CXR, there was an area which looked like fluid had infiltrated the lung. It was in a nonspecific pattern.

It wasn’t pneumonia because the patient didn’t have fever or a cough. I needed to decide whether to give a dose of diuretic, but I didn’t feel I had enough information to decide. Indecision paralyzed me, as I weighed the potential harms and benefits of my actions.

My Decision

I went to see the patient, to talk to her and listened to her chest. The CXR is still vivid in my memory, but I can’t recall her face. I wanted to call someone for help, but I didn’t feel that I could.

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There was a strong, unwritten code at that hospital, at that time. Residents were not supposed to call attendings. They were supposed to just figure things out. I sat at the nurses’ station for a long time considering what to do. My conclusion was that the patient was stable. My plan was to continue to observe.

Aftermath

The next day, I heard from a friend that the attending had been angry at Morning Report. I didn’t follow up with my friend’s comment to ask exactly what he had said, but I knew he had referred the case to the Quality committee. This was not a disciplinary committee, but an investigative one.

The attending never spoke to me directly. I was left to guess what I had done wrong, what he had expected me to do. For weeks after that, I was sad and fearful, but I expressed it only when I was alone. My confidence was gone.

Depression

I took to wearing my Celtic cross again, the one made of olive-green jade set in a silver framework. One weekend, a few weeks into my depression, I remember falling face down across the bedspread of our bed. It was mid-morning, with white light filling the room. I clutched the cross in my hand and wept silent tears. My chest felt tight.

I look back on this time with compassion both for me and for the attending. Direct communication between us would have averted my suffering. He was new in his role and felt more comfortable having the Quality committee do his communication for him. This didn’t help me, as they didn’t find that I did anything wrong. For me, the system that strongly discouraged me from calling the attending that night gets the blame.