Comfort Zone

Chapter 57

But she didn't bring any cheery balloons to the next hospital visit. Ezzy was in the hospital, too. He'd ended up in the ER after swallowing a large amount of pills, an attempted overdose, "a classic cry for help," he said when he revived. The ER Baker Acted him and he was admitted to the locked med-psych unit for the required 3 days. After that, he'd be free to leave unless his psychiatrist thought he was a danger to himself and took the time to go to court and argue it.

It was now day two, and despite the ethical and legal dictates regarding confidentiality, someone in the unit leaked and word got around. Miriam was hesitant to visit, sure he'd be humiliated, but finally decided to stop by. She was relieved to see his weak smile of welcome when he saw her nervous face peeking in the door.

"So much for confidentiality, right?" Miriam perched on the side of Ezzy's bed, but the words wouldn't come. What do you say to someone who tried to commit suicide?

Her head was bursting with all the inappropriate questions she shouldn't ask, the sentiments she shouldn't voice.

How did you get the pills? Who found you? Why did you decide to do it? You selfish idiot, how dare you? Do you have any idea how everyone who cares about you would feel if you succeeded? The pain you'd put us through?

There was a brief but uncomfortable silence. She could offer to bring him food, try to pretend he was her patient.

"How do you feel?" That was a safe question, she guessed.

"Actually pretty relaxed and rested. I guess the pills aren't completely out of my system. They're taking good care of me, like I'm a VIP. They're still calling me doctor. My mind is still protecting me from what I did and no one's telling me what they're really thinking. All I'm getting is love and concern. You're not going to enlighten me either, I can tell."

"All I'm feeling is love and concern," she lied.

Couldn't you have asked for help? Couldn't we have done something? I remember how depressed you looked in the elevator every time I saw you. The malpractice suit, the yelping. Why didn't we see the signs? You could have died.

Still, how could you do it? How did you get that desperate? Was this the only way you could get free?

Ezzy answered at least some of her silent question, eyes soft and unfocused without his glasses.

"Everyone keeps asking me what tipped me over the edge and I don't even know. I remember working on a prior authorization, thinking how tired I was of having to justify every breath I take. Tired of living in constant fear of the words, 'Doctor, how did you miss that diagnosis?' Tired of seeing everyone getting cynical and bitter, asking why we're all working so hard without satisfying anyone. Squeezing more patients into the day, spending countless hours on computer work.

"I know standardization is supposed to prevent us from forgetting something, and making a mistake and cutting off the wrong leg, but really, doesn't having a list of tasks to check off every day suck out all the joy and creativity? I was just relieved to finish the checklist, jump through the latest hoop, and ace the quality measure. I had no energy left to see my patient. Really see, I mean.

"With all the hassles and mandates, how can anyone in medicine have a healthy, happy, well-balanced life?"

There was silence again, but not uncomfortable, rather an intimate, shared "I don't know."

"Why can't I be like JK was?" Ezzy finally burst out. "Nothing bothered him, everything that happened was a chance for a belly laugh."

Miriam suddenly flashed back to a memory she'd long suppressed. JK, losing his temper, yelling at a nurse, then apologizing wildly and running away. He hadn't seen her, and she'd never mentioned it.

"Even he wasn't made of steel,"' she said.

"Well he's gone anyway, but how do you do it? The hospital nearly killed you. You had a valid excuse to leave and you still came back."

Miriam shook her head.

"Ezzy, all I know is the canned speech we give our patients about balance. Enough sleep. Outside interests. Social support. Exercise. But I don't live any of those things. I don't know how I do whatever it is I do, and frankly," she surprised herself by saying, "I also don't know for how long I can continue doing it.

"But Ezzy," she couldn't resist saying, "couldn't you have found another job, changed fields?" Done anything but this?

Again, he heard some of her silent words with the spoken ones. "I know it doesn't make sense. Logically, why didn't I just leave Miami Health if I was so miserable, find another job? But is it any better anywhere else in medicine? I'm in a good group of decent people.

"I kept telling myself to keep going through the motions. Keep getting that respect and money; what else are you trained for? You don't know how to do anything else. You can't abandon the patients and colleagues who rely on you. Leave them, stop being a doctor, and what would I be? Nothing! All those years of training, what should I do, bag groceries? Pump gas?

"I don't know about you, Miriam, but I still have student loans to pay back. I bought into the whole thing, the house, the car. I'm horrified what I did, but man when I think about the whole situation I almost wish I'd taken more pills!"

An aide came in to refresh Ezzy's water pitcher and take his blood pressure and they fell silent until she left.

My expenses are sky high, too, Miriam thought, even without paying alimony. I don't know what I would do if I left medicine either.

She remembered the Scottie running to its death on Biscayne Boulevard. Maybe it's we who are running toward death, not our patients, she couldn't help thinking.

"Don't think about it now, Ezzy. First you have to heal. Do you have someone to be with after you leave here?"

"I'm going to stay with my sister in Minnesota for a while. The owner of my group just came by, told me I should get the help I need and come back when I was ready. He'd hold my position for me. But is it really just about taking the right happy pills? Changing my attitude?

"Isn't there something inherently wrong with the system, having to live with the constant feeling you can never measure up, you've forgotten something, and if there's a bad outcome your conscience and the lawyers will torture you? It's funny. When you're burnt out, you can't care for your patients, or anyone! But when you have no time to care, that's when you burn out.

"Face it, Miriam, medicine's awful! It's just getting worse, and none of us has the time or energy to fix it!"

Miriam thought back on her week and found it easy to agree.