I am post call. I worked thirty hours in a row with 20 minutes of “sleep” (aka answering pages while lying down). I am in the pediatric intensive care unit these days and the number of pieces of data to interpret, management decisions, pages to answer, and things to worry about are all a hundred-fold moreso than anything I have ever experienced. Is there a word for feeling simulateously more energized, more exhausted, more competent, and more incompetent than ever before? And sadder. I fantasize all day and all night of escape, yet when we finish rounding in the morning and I am relieved for the day (relieved!), I find I cannot leave. I walk around to the rooms of the children who were sickest overnight and listen to their lungs again, exchange a few words with their parents, make sure their nurses don’t need any orders to be put in. I have carried these children with me for thirty hours — or have they been carrying me? I have worried over them literally breath to breath to breath, watching the loops of their inhalations and exhalations on the ventilator for clues on how to help them. It feels wrong to leave. I can slip out of the PICU and re-enter the unbroken world but they cannot.

The hours after I return home have a strange emotional architecture. Everything is superlative: If I eat a cheese sandwich it is the BEST cheese sandwich I have ever eaten. Then I take the BEST shower I have ever taken. My bed has NEVER felt so good. My house and my loved ones radiate an aura of perfection. Could the light coming in through the kitchen window be more golden? Then suddenly my stomach clenches with the memory of a mistake I made or that I think I might have made on one of the patients from overnight. I want to turn on my laptop and log on to the electronic medical record and check but I don’t because that would mean crossing a certain line in the sand that I cannot cross if I want to recover enough to go back to work tomorrow. “The patients are fine,” I say to myself, half believing it. I take a nap for a couple of hours then E comes home and shrieks with delight as she climbs into bed with me. I am filled with an almost painful degree of adoration for her every feature and action. I can’t stop touching her cheeks, her elbows, her cute chunky thighs. She points to a picture of a cup on the back of the New Yorker and says “cup” and I am convinced that she is the SMARTEST toddler that has ever drawn breath. It’s 4pm and I should be taking her out to the park or reading her a book but my body feels like the nerves are no longer connected to the muscles. I can’t. We turn on a movie and she watches it while I close my eyes. She is incredibly wiggly and I find myself wishing she would just be still for a few minutes. A voice inside my head whispers “You are a terrible mother.” I know I am not a terrible mother, I know it to my core, but every time I am post-call, my exhausted head fills with this same toxic thought. “You are a terrible mother.” I have been apart from her for too long, I think. I feel like crying but don’t. I am so fucking tired.

In summary: Euphoria –> anxiety. Euphoria –> guilt. Exhaustion. Et cetera.  Do other people experience this?

C makes my post-call afternoons and evenings feel celebratory. She says, “I am going to make you a special dinner” and even if she makes the same tacos she might make on a different night, I feel like they are directed towards me especially, patching the holes with love. I am acutely aware from moment to moment of how lucky I am.

On this particular day, C puts on music during dinner, Bach’s Piano Concerto in G Minor (the second movement of this performance by Glenn Gould is crushingly beautiful). The familiar first chords hit me as if from the distant past, as if delivered via gramaphone from some deep phylogenetic place.  I can feel each harmonic shift and small arrival in the music zinging down my spine, up through my neck. I am vibrating. E, perceptive of her parents as all children are, grabs my hand and C’s hand and starts pumping our hands up and down with the beat. I remember myself suddenly, the person who is capable of wonder and pleasure in beauty and intimacy and gentleness.  It’s like the poem by Yehuda Amichai: “Forgetting someone is like / forgetting to turn off the light in the backyard / so it stays lit all the next day. / But then it’s the light / that makes you remember.”

How long has it been since I was myself, I wonder. Hours? Days? Months? Minutes? I’m too tired to remember. At work, I walk fast and feel resentful when people start taking too long to do something. By necessity I am always doing more than one thing at once and a part of my brain has taken on the role of air traffic control, evaluating the tasks that need to be done and figuring out ways to get them done more efficiently. I page a consult while calling back a nurse who has just paged me, calculating that I will be done with the current conversation before the consultant calls me back. I send a document to the printer and stop by a patient’s bedside to give a parent an update on my way to the printer. Sometimes things are so busy that I don’t get to see all the patients I am taking care of overnight and they remain just headers on sections of my to-do list.

Smith

[ ] Call social work

[ ] Check urine output

[ ] AM labs

At the same time, there are hot spots of tragedy and horror that I have to suppress in order to function. A toddler who fell into his family’s pool while his father ran in to answer the phone and is now neurologically devastated. A baby who was shaken and is now neurologically devastated. Otherwise healthy children who have been maimed or paralyzed in accidents. Babies with cancer. And at each bedside, a parent whose desperation and fear is barely contained.  I want to throw my stupid to-do list away and hug them. I want to wail and keen and pull all the tubes and lines out of their tortured bodies and give them some peace. What I certainly do not want to do is lift the dressings and view the wounds, literally or figuratively. But I must and so I do. I calmly check my to-do list boxes and manage the smallest of details. I know cognitively that this is in their best interest, that what I am doing is helping them. But sometimes it doesn’t feel that way.

Now, at the dinner table with the people I love most in the world and vibrating to the music I love most in the world, I find myself crying. “They are suffering so much,” is all I can say. They are suffering so much. I am both contributing to and palliating their suffering and I have to live with that. It feels good to feel something.

E looks concerned so I wipe away my tears and we get on with having a marvelous evening together. We have a dance party. We tumble on the couch. We read books in bed. We take a bath together. Gratitude. Joy. Endless gratitude and joy. I try not to think about whether or not there are any potentially cancerous cells lurking somewhere in her bone marrow. I mostly succeed. Later C and I eat ice cream sundaes (see above re: C’s ability to make the ordinary seem celebratory) and then turn on a movie. I am asleep before the opening credits end.

It was a good day (that was also two days). Maybe there are some people for whom the hard stuff and the amazing stuff can be separated out, but for me they always bleed together, each arising as a result of the other.  I dream of a life that is easier, less complicated, containing fewer contradictions, less work, and less ache, but not really. What I really dream of when I sleep is my daughter, running down the sidewalk beside my partner, kneeling in the grass, picking up a perfectly round stone and looking up at me with amazement. I dream of the ceaseless oscillations of heart beats on monitors, lab values that I have to understand, the bodies of my patients, swollen and wounded. All of these things are bound together by love, by the best that I have to offer the world. This is the life I have chosen and perhaps even the life I have been chosen for, depending on what you believe.  I am grateful for it.