When is it time to quit?

It's been so long since I've written, and so much has happened. I just got back from a shift that has me thinking and this is my outlet I suppose. In the last few months, I've settled into life as an attending physician, received my final piece of paper that affirms my credentials and everything has gone on as usual in the ER - life and death, hopes affirmed and crushed. Many days I wonder if the constant parade of tragedy and drama in the ER is something that will eventually fail to move me, and if so, will that be my cue to leave or a sign that I have finally come into my own?

Tonight I watched someone die a slow and painful death. I tried what I could but in the end all my trying amounted only to prolonging suffering. It wasn't my fault my patient died that way, but the system - which includes me - could have done better. We could have done better and yet we didn't, because of politics, miscommunication, a tragedy of errors from start to finish. Nobody was to blame - yet everybody was.

I have seen people come and go in the ER. I have seen many die...and many more live. I've agonised over decisions, told countless families that their loved ones are dead, put myself in that place as the doctor they will always remember as the one that told them that terrible news. I do it all the time. Week in, week out, I've told patients terrible things in the ER, broken devastating news to families. I've sat through awkward silences, through crying, through screaming, through breakdowns and more. It gets easier each time I do it. But it never gets easy.

Sometimes, though, I wish it would be easy. Sometimes, I wish I would be unaffected by it all. It is hard. It is hard, what I do. It is hard to be that person that is the bearer of bad news. I am almost never the bearer of good news. I am not the surgeon that beams with pride when he tells families he got all the tumour on the first go-around. I am not the medicine physician that the family thanks when their loved one finally goes home well. I almost never have wonderful news to break. All the patients I "save" leave my department alive but only barely so. All the patients I "lose" I have to bear the burden of breaking the news. I am never the hero. And I'm all right with not being the hero. I'm all right with that because I know that what I do matters.

But sometimes, like today, I find myself feeling something odd. I find myself feeling grief. It's a grief I don't understand. Maybe it's because I'm only human and what I do is hard. Maybe it's because so many of patients die with nobody beside them except the ER staff - because death in the ER is usually unplanned and sudden, and families have usually not arrived in time to be there. Maybe it's because I still have a heart.

I ask myself if I will ever recognise the day that it becomes time for me to quit this field of medicine which I love more than any other field of medicine I have experienced. Is it the day that I realise I no longer feel any grief, however terrible and tragic the situation? Is it the day when I can do all the things I do and face all the things I face without feeling a thing myself? Will I recognise it as my time to go, or congratulate myself on finally having come to a place in which I have become so experienced, so senior in my position, so established in my skills that I no longer feel regret?

ER physicians burn out at an alarming rate. The ones of us that do make it a lifetime career - I've seen it in my colleagues, in senior physicians that never seem affected by what goes on. Do I want to be like them? On the one hand, I can't imagine never doing this work, I can't imagine pursuing a different field. And on the other hand, I wonder whether to lose the heart that lies somewhere beneath my professional shield is to lose my soul.

I love what I do. But what I do is hard. And days like this - after shifts like this one - I ask myself if I will know when it is time for me to quit. It is not now. It is far off yet. But I wonder how many more patients it will take, before I no longer experience grief however terrible the situation.

I wonder if that moment will signal the beginning of the end for me.