I am examining myself and trying to figure out why I am such a pessimistic person. The immediate answer would, of course, be that I have been a depressed person for most of my life, and we are quite prone to pessimism. The slightly less immediate answer would be that I am basically a born cynic, have been since a young age, and believe that some cynical thoughts don’t count as cynical if they are true.
The longer answer is, I am a physician, and physicians are by nature a VERY pessimistic bunch. It’s ground into us early. Before medical school, it’s all about the frantic studying, and a lot of people get culled out applying for medical schools. So you’re not ever sure that you’ll get to go at all, and you have to steel yourself for that possibility.
Before you even START medical school, the pessimists get ahold of you. You are told to read House of God, by Samuel Shem, and this book tells you more than you ever wanted to know about the attitude you’re going to have. I read that book the summer before med school and cried. It’s a must read if you want to understand what your doctor is truly probably thinking, and what they’ve been through.
Then the skull fuckers get a hold of you in med school. Sub-par students try to terrify you into believing you’ll fail. You’re not sure who’s sub-par and who’s not, but once you figure it out you realize that they are the skull fuckers. They approach you before tests, regaling you with tales of how much material they’ve studied and how much territory they’ve covered. This is to trick you and frighten you into believing that you are underprepared. And if they take a test a section ahead of you, they’ll tell you horror stories about how impossible the test was, how you’d might as well give up, so you’ll be so nervous going in that you’ll do much worse. Nothing increases your view of other human beings like these moronic pieces of shit. It goes on constantly.
Once you get into the hospital, as a third year med student, you realize you are the lowest of the low. You are given jobs that not even the nurses or the orderlies will touch. At the VA, if labs were ordered, WE had to go draw them. We had to do our own EKGs and read them. We had to clean out disgusting bedsores and shotgun wounds that nobody else wanted to touch. We were woken up to do a history and physical on a patient (after the residents and the attending had already done one) who was too batshit crazy to communicate orally, and too combative to touch. The residents just laughed when they woke us up.
About this time, you start with the pessimistic magical thinking. This is the polar opposite of magical thinking where you hope for a good outcome. Around this time, you’ve learned that the worst possible thing that can happen probably will. And you’re trained to think that way. You’re paid not to miss the bad things. So you have to look for them everywhere, and expect that the patient will have the worst possible disease, the worst possible complication so that you can quickly detect and treat it when it happens. When it doesn’t happen, so much the better, but you never unlearn that negative point of view. It persistes all the way into private practice.
When you’re on call, you expect the worst. You’re all alone in the middle of the night; it is just the right time for a five hundred pound woman to come in needing an emergency c-section, which you will have to do all by yourself. You lie there in the call room and stare at the ceiling, unable to sleep because you KNOW somewhere out there is that woman with her name on you. You NEVER make plans when you are on call; the simple purchase of a movie ticket will cause a ruptured ectopic pregnancy to show up in the ER before you even get in through the theater doors. Yes, it happened to me. Fortunately they gave us our money back on the tickets. As you get older and older, and less and less optomistic, and have seen some of the truly horrible disasters that can happen in your profession, you just become more and more nervous. Every woman who comes through the door in labor – will this be the baby that dies? That one in over a hundred thousand MOMS that die on you? Every one could be the one. This haunts you so much you begin to lose all perspective.
And things like today can happen to you. The person on call (who is NOT me today – I’m on some time next week) is in charge of all the delivered patients and all the laboring patients, and all the unattached Gyn patients that come through the door. If you’re not on call, you should be immune from having your day yanked out from under you by a wayward patient. But the group across town that we’ve just joined has a rule – we take care of our own Gyn patients EVEN IF WE’RE NOT ON CALL if we’ve operated on them or if they just show up in the ER and say that they are our patient. And that’s what happened to me this morning. My husband and I made dinner plans with friends, which I never ever have time to do (not to mention, I don’t have any friends since I’ve been on call all the time for years) and which I felt perfectly safe doing, because I am not on call. But at 8:15 this morning, the OB/Gyn on call from last night called me and announced that a patient had come in through the ER, with a possible cyst or pelvic infection, she might need surgery, and because she said I was her doctor, she was all mine for the day. WTF? I had to call the nurse taking care of her. I had to order things over the phone. And I had to spend my whole lunch hour over there seeing her. The worst part was, my morning was RUINED. I was CERTAIN that the patient would need surgery this afternoon, because that would be the worst possible outcome for my day. I was CERTAIN I would be missing my dinner fun. Of course, when I went over there to see her at lunch, she wasn’t sick at all and I was able to let her go home. But the morning was spent CERTAIN that my night was ruined. And I was furious. And I still didn’t get any lunch.
So that doctor pessimism has ruined me. It has permeated every aspect of my life. I don’t know how to turn it off. And the magical thinking persists. I feel like, if I don’t think of all the possible bad outcomes, one of them will happen. And if I don’t expect to get my plans ruined – well- that’s when they will be. So this is why I’m taking some time off. I’m going to work as a travel doctor two weeks out of every month, and be off two weeks out of every month, so I can spend some time with the family and break the cycle of constant terror that something awful is going to happen. Not to say I won’t feel that way the two weeks I’m working. But at least I get two weeks free of the terror. And maybe that will be enough for me to turn some things around.