Lesson from the Wards: Fatigue of unspecified etiology


We were sitting across from one another in my call room when you asked, “how does it feel to spend a month doing what you believe is your calling?” You’ve always been that way – getting straight to the point. Our conversations of substance are why I tell people that you’re one of my residency big sisters. My answer: “I’m tired.” Fatigue of unspecified etiology, likely multifactorial with at least some emotional component.

“Okay so? We came here to work hard. If you want to be hot at this job…if you want to be brilliant at what you do…forget tired. We’re chasing our passion.” You’ve always been that way – dispensing tough love when I want a hug and ice cream. You’re always right.

“And it’s a privilege, I know. I feel an indescribable amount of gratitude to be on this journey,” I said tentatively.

“Residency teaches us to bemoan what makes us good. We gotta snap out of it. Challenges make us better. Sleepless nights mean we are learning. Don’t whine about not being a white cloud. Be grateful.” You answer your ASCOM: someone wants you to push TPA. I answer my ASCOM: someone wants me to assess a kiddo with altered mental status.

I thought about what you said as I spent the rest of my call awake. I thought about what I described as the hardships of this month: the patient turnover, the acuity, the loss of a patient I loved, the painful conversations during which “I’m sorry to tell you, we don’t anticipate a cure” was dropped, the moment when I held the hand of a child soon to pass and she smiled, the moment when a patient having received a diagnosis of lymphoma paged the overnight nurse to ask me to stop by for “girl talk” because she needed a friend (I can’t blame her), and the moment when a patient in excruciating pain pushed her PCA for upwards of 400 times and then reached for my hand and wept.

One of my attendings said it best: “you’re the type of human who feels everything deeply.” I nodded. She was right. It’s why I danced with a patient’s parents when he was approved for an experimental study drug; it’s the same reason why I cried next to them when he coded. It’s the reason why I say nothing when parents yell; it’s the reason why I again say nothing when they apologize in the light of day. It’s the reason why I went to say goodbye to all the patients I cared for before I left the floor. I saved my favorite (and I know I shouldn’t have favorites) patient for last.

“Hi, I just wanted to say goodbye because it’s my last day on the team.” She teared up, her mother teared up, and I (naturally) teared up as well. “I want you both to know
it’s been such a honor to participate in your care and to walk alongside you during this journey.” She reaches out to hug me. She’s an early adolescent with the hopes of becoming a physician. She just finished her first day of chemotherapy. She wept (I can’t blame her) when she received the diagnosis of stage 4 cancer. I wept (can you blame me?) after we told her. “You’re a really good doctor,” she says. She doesn’t know that I’ll replay these words again and again. “You’ll be a good one too.” She beams and I question what I said – there’s a fine balance between being hopeful and ludicrous. Now rested, I think I may have toed the line.

“How many years left in your training?” her mother asked. They wanted all the details: where did I see myself in five years, how did I get here, and how proud is my family? We remained in silence for a few moments before I collected my belongings. “Thank you so much for everything you’ve done for me. I’ll never forget you.” To which her mother followed (in the typical West African fashion) “continue to work hard and make us proud. We will pray for you.”

To the patients who challenged me, thank you. To the patients who encouraged me, thank you. To the patients who became like family to me, I’m forever changed. Thank you.

2 thoughts on “Lesson from the Wards: Fatigue of unspecified etiology

  1. This was beautifully written. I followed your blog a few years ago when my sister was also in Medical School. I wanted some insight into what she might have been dealing with so I could know how best to support her. Like I’ve told her countless of times, YOU are a tool of healing in the hands of the Lord. Thank you for your service to all of (US)💛


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