Guilt is a 4 Letter Word

The strangest thing happened to me this week. I woke up one morning and literally could not move my neck to the right side without a searing pain shooting up into the back of my head. Sort of like someone surprising you by yanking on your hair as hard as they can. Or greeting you by whacking the back of your head with a baseball bat. Yep, some morning. Of course I cursed myself and my pillow for lack of a better etiology of said immobility and proceeded to take ibuprofen and get on with my day. I taught my PBL class as usual and the plan was to meet my husband for lunch and then head home to rest (and take more ibuprofen) before heading into work for the night. I got through class alright but while eating lunch discovered I could not lift my fork to my mouth without a spasm of pain. In fact, I couldn't use my right arm much at all without being reduced to a cringing mass of tears and yelping. I judiciously checked my self for nuchal rigidity and fevers. Nope, no meningitis or novel H1N1. Just a good old fashioned...neck pain? My dear husband put pathetic me into a cab for the ride home, sparing me the embarrassment of wailing on the bus. Once I got home I had a dilemma. If I couldn't use my right arm and neck pain was getting worse (I was just waiting for the fever, rash, and photophobia so that I could run across the street to the ER and cause a public health panic), could I really perform procedures and resuscitations and stay up all night while giving my job the focus it requires? Well, no. But does that mean I should stay home? I literally sat at my kitchen table (with a heat pack around my neck) for 30 minutes pondering this reality. I came to the conclusion that I couldn't do it. At that point I couldn't even undress myself. And I was scared. What the heck was going on?! So I called my boss and told him I couldn't work my shift that night and explained why. He completely understood and told me to let them know how I was feeling the next day. And do you know what I felt when I got off the phone? In equal amounts to the physical pain I was feeling (plenty, I'm no baby) I felt...guilt. Guilt because I was a physician who couldn't repair myself well enough to fulfill my obligations. Guilt because my boss was so generous even though he would have to scramble and find someone to cover for me in the next 3 hours. Guilt because that meant someone would have to spend the night unexpectedly in the hospital after a full day of work. Guilt because that someone would likely have to apologize to their families for not being able to come home because "someone called in sick". And it didn't end there. Back at work last night, everyone was gracious enough to ask how I was feeling and tell me that if I needed more time (I didn't) they would have covered more of my shifts. The attending who covered for me that night has a 3 month old breastfeeding baby at home AND was up all night performing an exchange tranfusion on an infant. Oy! If my thighs were as well toned as my guilt muscle I would be strutting on the beach til December.

I started to think about this. Why on earth did I feel so guilty about something over which I had little to no control?! I know plenty of people who will call in sick when they have the sniffles or a headache or just need to take a 'mental health day'. Some of you may identify with the feeling that as a physician, we are supposed to perform our duties unless we are patients in the hospital ourselves. Physicians who come to work come hell or high water are revered as being 'committed doctors'. I know a critical care attending who spent so much time in the hospital his wife would have to beg him to come home to spend time with the family. He was exalted as a model to which we should strive. But really? Does that make one a better physician? The novel H1N1 protocol for healthcare workers at our hospital states that anyone with a fever and influenza-like symptoms must stay home for 7 days from the last day of fever. Anyone. The nurses take this very seriously. The doctors? I bet you dollars to doughnuts they are laughing and wondering how they can evade the infection control officers. Unfortunately, I'm afraid in this culture taking an unscheduled week off work is tantamount to handing in your 'good doctor badge' and who really wants to deal with the guilt when there is work to be done?

Winds of Change

At what point does one go from being "with it" to being "old school"? I guess I should know the answer to this question because clearly I passed it a few years back. Let me paint the latest scenario for you...I taught my first Problem Based Learning (PBL) session today for second year medical students. What a fun experience! It was so refreshing to be among students who really get excited to use such terms as tachycardia and hypotension and who volley back and forth the merits of exotoxin vs endotoxin in the production of fever with as much fervor as a Wimbledon match. I sat back in my chair beaming like a proud grandparent much of the session. But the fact that I am a good ten years older than all of them doesn't bother me, I hardly notice. No, here's what did it. We had a tutor kick off meeting before the actual sessions began. The PBL coordinator started talking about different technological resources to utilize in order to enhance our interactions with the students. Then, out of her mouth came the words Twitter, mesh terms, portal, and RSS feeds. I know about half of you reading this blog are thinking "Yeah, so what?" and the other half will understand when I say I began to feel like I had missed that lecture and there was now going to be a quiz.

I know what Twitter is. Scratch that, I've heard of Twitter but never actually used it. I find it vaguely uncomfortable to say things like twitter and tweet and take myself seriously. Thus, I have found a way to exist happily without it. And that's not all. I only recently created a Facebook page after increasing levels of peer pressure. Mostly I look at other people's pictures. I did not have a Palm Pilot in medical school or residency. I do not have a Blackberry, iPhone, iTouch, and only use my iPod on shuffle when I run. I prefer books and paper to screens and stylets. My white coat pockets were always stuffed with reference books and notes and never once did I fall victim to a dead battery when I needed information. My cell phone does not have a camera, a keyboard, internet access or the ability to make playlists. In fact, it was free with my phone plan and was once lost by Wrigley Field and returned to me the next day by someone who tracked me down. The thing is the size of a stick of butter and indestructible.

I used to snicker at my parents and grandparents for being so overwhelmed at the thought of using the internet or paying bills online or downloading pictures from a digital camera. And now I am that person who is frightened by this 'new fangled' technology. When did this happen?! Apparently, if I want to continue down this road to being a clinician-educator, I need to open my mind to the wonders of modern communication. Ok, i'll embrace change if it makes me a better physician. But don't expect me to tweet. That's where I draw the line.