This morning I left the hospital after a particularly busy 24 hour shift and contemplated both my day and my life choices. The past few weeks have been particularly nerve-wracking, and with every passing day I am becoming acutely aware of the fact that it is possible to dream of something, work hard for it, and arrive at your dream only to realize it is all smoke and mirrors.

I love what I do. I frankly still cannot think of doing anything else with my life, even on the days and nights when deriving joy from the job seems really hard to do. Nothing beats comforting a person in a difficult situation, doing your utmost to get them from the point of sickness into health. In the intensive care unit, where the journey from the one to the other is fraught with setbacks and obstacles, sometimes one’s only contribution is words of comfort for family members, or listening to a patient describe a glamping trip they are looking to with their children.

A few weeks ago, for the better part of one week, I observed a young lady keep her mother company as she slowly slipped away from the world of the living. The patient had been the subject of a series of unfortunate medical events, and I imagined the daughter almost permanent fixture in various hospital wards for most of her adult life. Every day, through the transparent double doors of the patient’s room, I observed this young woman, whose face had both the glow of youth and the creases of wisdom beyond their years. I never interacted with her, but would observe as she listened to the attendings, taking in the various positive and negative updates about her mother’s health.

I was both heartbroken for and in awe of her. She would come in early in the morning, sit by the bedside, sometimes holding her mother’s hand, other times talking to her. She took every piece of news gracefully, and from what I gleaned, asked insightful questions about her mother’s prognosis. I thought of her often as I went about my day. I imagined her not a day over twenty-seven. She always came alone, which made me wonder if there was a significant other, friends, coworkers who could be there for her. I wondered about her life outside of the hospital walls. Who did this young lady, carrying this huge responsibility, have to unburden herself to? What did she do to wind down? How did she cope with this?

There is a saying that goes “no parent should ever have to outlive their child.” In the natural order of things, it is easy to to think this phrase reasonable. We are born, we live, we procreate, and our progeny are expected to see us off. Which does beg the question: What is the proper age for a child to lose a parent? I can tell you for myself, even at this age, that if a week goes by without my communicating with my mother I get antsy. My father is not the easiest man to get along with, and even then I cannot imagine waking up to a world without him in it. I could not begin to imagine what this young lady could be going through.

The patient was transitioned to comfort care and eventually passed away peacefully, surrounded by family. That was the last I saw of the young lady, but she has been on my mind since then. I hope she is surrounded by love, family and friendship in this time of unthinkable grief.

This young lady, together with a few other patients and specific events have caused me to struggle quite a bit mentally these past few weeks. Last Tuesday, I woke up with the feeling of a dark cloud settling over my brain. By the time I arrived at the hospital that morning I knew the day would go south. The dark clouds rolling in the brain did not clear. I participated in a unsuccessful code event, and had a patient crash who was luckily restored. These only served to sink me further into the depths of melancholy. The next day my attending commented that I looked as though I was “dead inside,” which was an apt summation of how I felt.

I knew what was happening. I was reaching the point of burnout. This happens every few months or so, where my body and mind, repeatedly being put through intense mental and physical exertion, decide entirely on their own that they have had enough. It starts with the tingle behind the eyes, then the dark clouds in the brain, and then the leadenness of the arms and legs. My body proceeds to light up, all nerve endings on fire, and at that point I know it is rest or nothing else. I bore the various phases of this recurrent, painful process throughout the week, and finally experienced the internal fire throughout my shift yesterday. I willed myself to make it to evening, and then collapsed on the call room mattress for a mercifully uninterrupted three hours of sleep.

That is the fascinating thing about the body-it will tell you when it is not right. Usually the trick is to listen and pay attention. My sister and I are currently sorrowfully marveling at the story of a young gentleman who, after being involved in a back-to-back motor vehicle and bike accident, his family elected to defer taking him to the hospital for thorough check-up. After a few weeks of persistent headaches and jaw pains, he was taken for an procedure to repair his fractured jaw, only to have profuse epistaxis a few hours postop from which he was unable to be resuscitated. In the full context of the story there are a number of understandable reasons why treatment was deferred initially, why thorough scans were not performed prior to surgery, and so on and so forth. The point of the story, though, is that we need to pay more attention to the signals that our brains and bodies send us, even when those signals seem overblown.

I have always struggled with anxiety. I am an overthinker, and every waking minute of my life is spent pondering where I am lacking in life, and how I need to improve. I scrutinize and microanalyze every little move by everyone, and am overly critical of myself. As you have probably surmised, that is a horrible mental position to be in when your chosen profession is one of high stress and constantly evolving situations that do not always turn out for the better. For a while now I have dealt with my body being in sustained fight or flight response, always feeling as though I was being chased. For the past few months I have run the gambit of mental exhaustion, and this week was my brain and body finally breaking through the stays that had managed to hold me back all this time.

Watching that young lady bear that unimaginable burden with such grace, knowing there was not much I or anyone could do for her broke me. The patient I performed chest compressions on who did not make it broke me. The patient who constantly reminds us their life is at the mercy of a fickle heart and hanging on by the strength of intermittent Atropine shots broke me. My brain, my body, my mind are at their elastic limits. And we all know what happens when anything is stretched past its elastic limit.

So this week, I made a decision to do something for myself. I needed to stop feeling like the lion is always at my heels. I knew I needed to regulate my nervous system. I called my doctor. “I have struggled with this for some time, and I think I need help.” We had a lengthy conversation, and I was started on medication. Next week I begin the quest for a suitable therapist. Because the elastic limit is a limit for a reason, and it can only go so far.