Doctor as Dragon Slayer

What happens when who I think you think I am changes?

Musicians in Nashville are sort of like ruins in Rome. There are so many extraordinary ones that something or someone who would be the main event in another place, just blends into the landscape. Everywhere you turn, you’re stumbling onto incredible music. Last week, while traveling with my sisters, I had the opportunity to experience Nashville’s musical magic again. As I stood in a club that was far hipper than anywhere I’ve hung out in the last 10 years, sipping a hard kombucha (did you know that was a thing?), the delightfully earnest Eva Cassel had just finished her set about heartbreak. 

Then a writer I had never heard of before, Megan Stielstra, stepped to the stage. The theme of the event was heartbreak, so I was prepared to hear her speak about romantic heartbreak. She opened with an essay about divorce and leaving Chicago in the early days of the pandemic; so far, so good. It was a funny and heartbreaking tale weaving together who she was in her early 20s with who she is now. Two thumbs up for sure. She also mentioned the recent and raw heartbreak of her dad’s death. The way she spoke about her fears about his heart disease while he continued living in Alaska, big-game hunting and her longing for deeper connection with him felt poignant and true. However, I was not at all prepared for how she spoke about her doctor: 

“Heart disease?” my new doctor asked. I liked her immediately: her silver hair, her enviable shoes. Later I’d love her intelligence and, later still, her respect for my intelligence even when–especially when–I acted bonkers. She removed the weird spotty growths from my arm and she told me they weren’t cancer. She diagnosed my thyroid disorder and fought it like a dragon. She helped me understand my own body and demanded that I treat it with kindness, even when–especially when–I was stressed or exhausted or scared.”

A self-portrait of myself as a dragon, created after reading When Women Were Dragons by Kelly Barnhill

She spoke with reverence about her doctor, like she was a glamorous mythic hero, who also served as the straight-talking friend who demands you expect better for—and from—yourself. Tears started welling up, very unexpectedly. Comedian and Substack author,

Alex Dobrenko`

, recently wrote, i am who i think that you think that i am. He included this quote:

 “I am not who you think I am; I am not who I think I am; I am who I think you think I am.” —Charles Horton Cooley

What Stielstra shared about her doctor changed what I thought other people thought about me. What if I am someone’s dragon slayer and just didn’t know it? Not to be grandiose, but this is legitimately plausible. Just the weekend before we found ourselves in Nashville, I put in a chest tube to relieve a collapsed lung and shocked someone’s heart back into the right rhythm. I have saved lives. I have been told I am the reason someone got sober. (Holy cow, that was a moving conversation!) If I were a dragon slayer and felt heroic doing my work, would I still be this burnt out? Or would feeling like a hero simply make the necessary change of paths even harder, because then I would be adding patients to the list of people I am disappointing if I leave. 

One of the blessings and curses of working in Emergency Medicine is that your patients aren’t seeking you out or counting on you, specifically, to solve their problem. You are interchangeable with the dozens of other doctors that could be working any given shift. While I like to think that I am kinder than most ER doctors, it doesn’t really matter, because as my daughter is told at preschool, “You get what you get and you don’t throw a fit.” 

This interchangeability has left me with a somewhat (very?) unhealthy way of measuring success in my job. I call it the “points above replacement” performance review. In other words, it only feels like success when you make a diagnosis someone else wouldn’t have been able to make, or if you come up with a unique solution to a problem. What if I save someone’s life in a way that my colleague also would have? That’s just what’s supposed to happen. As you might imagine, it’s a lot harder to feel professional satisfaction or to feel your impact if the bar of success is not simply to succeed, but to succeed where others would have failed. 

I think that one of the saddest things about medical culture, which is certainly not unique to medicine, but is, perhaps, perfected here, is how the drive to achieve leads us to blow past real, major achievements. I barely batted an eye at graduating medical school or residency or fellowship. On to the next one (achievement, I mean). On the other hand, we wallow in our defeats indefinitely. I suspect that continuing to drag these failures around means that we either become master compartmentalizers or take failure uniquely hard…or both. Because, in medicine, we generally consider something that is inevitable for everyone—death—to be a failure, you can imagine that things occasionally get messy. 

And that takes me back to the last artist of the night, Dessa. She’s my favorite Twin Cities musician. Dessa has charisma and stage presence coming out of her eyeballs. I would probably enjoy her reading a cereal box on stage. Instead, she shared from her book, expertly using her lyrical gifts, which are simultaneously clever and deep; quick-witted and philosophical. Upon returning home, I couldn’t resist checking out her book from the library to dive deeper. In her book, Dessa wrote about how she was on a train that ran over someone. She discussed how it’s literally not possible to stop a train in the time from seeing someone on the tracks to hitting them. A friend told her that the driver of the train is immediately given a week off and counseling. She noted that seems quite short for a person grappling with feeling and/or being responsible for someone’s death. I suspect we all have a sense that it takes longer than that to recover from a traumatic event, and we really do need and want someone driving a train at their best. 

However, this is in stark contrast to how patient deaths are managed in medicine. There have been times where I have had 5 minutes after a patient's death before I needed to start seeing patients again. As far as I know, I wasn’t directly responsible for these deaths, but there are certainly times when it feels that way. The idea of paid leave and counseling, or someone truly being concerned about one’s long-term ability to continue practicing, feels inconceivable. 

After my most difficult patient death, I was back at work the next day. I didn’t feel like a functional human being for at least 6 to 8 weeks. After 4 weeks of flailing, I went to the Employee Assistance Program counselor. She reminded me of how I would respond to someone else in this situation and that it didn’t closely resemble my internal monologue, but that’s about all the assistance I remember receiving. 

I honestly wonder if someone had offered me a week off to get my head right if I would have taken it. I suspect I wouldn’t have, unless it were mandated. I expected that if everyone else could handle it, then I could too. The idea that none of us were actually handling it wouldn’t occur to me for another 15 years.