IT'S after midnight, and I've finished my moonlighting shift in the ER. It's quiet outside, a little too quiet. Where is that white noise when you need it?
After a day that should have been spent in jogging shoes rather than wingtips, it's nice to get home and slow down.
Yet, strangely, I feel like that merry-go-round scene from Alfred Hitchcock's "Strangers on a Train": the one where the bad guy has hopped on the ride at the carnival, and a policeman takes a potshot at him -- and the wayward bullet strikes the ride operator, who slumps over dead against the control lever, the weight of his body pushing it to full tilt and the doomed merry-go-round picks up speed, lots of speed.
Now there's chaos: screaming kids, flailing limbs, two guys fighting under a plastic horse's hooves. Whump, thump, whump!
My day was a lot like that.
Eventually, someone gets to the brake, and the merry-go-round goes from flat-out to a dead stop in a few seconds. Disaster. Plastic horses, bodies and brass poles fly.
Lesson: You can't come to a screeching halt after a day spent at breakneck speed.
Unwind. Breathe. Meditate. Eat. Yes, eat. I like that one the best.
Boy, were there some sick people tonight. I hope I did OK by them. I seem to recall cases of congestive heart failure, a kidney infection and an elderly woman who ran out of her antipsychotic medication. And that's just the tip of the iceberg. There were many more, but by now my mind is so foggy I can't think straight.
It feels good to be in a position to help. Yet I'm absolutely, thoroughly, completely exhausted and enervated from a long day that began way too early.
Well then, why am I sitting up writing all this down instead of racing off to bed? Remember the merry-go-round? I am so tired that I'm beyond sleepy: glazed eyes, achy feet, a jillion thoughts in my head, running through the day's patients over and over again. Wondering, always wondering: Did I do OK today? Did I miss anything important? Did I get scammed by the usual-suspect drug-seekers? Did I give the right medicine? I hold my head and wonder when these thoughts will stop.
Over in the corner is the sorriest houseplant I have ever seen. It's a ficus that I bought to make my drab living room a little homier. It was beautiful in the store: bushy, verdant, even sensuous with its intertwined trunks. Now it looks like a stand-in for the tree on "A Charlie Brown Christmas," more twigs than leaves.
Is it a metaphor for my life in medicine? Get a hold of something or someone and try to nurse it along to keep it healthy, or at least slow the dying process? Even after all is said and done, some people die despite my best efforts.
I look at the few remaining leaves on the tree, and I see the faces of today's patients: the boy with the earache, the woman with the yeast infection, the banker with the migraine (geez, I hope it wasn't meningitis), the window washer with the backache and the 6-foot-10-inch monster with a gash in his hand from punching a mirror.
Hold on to your stalks nice and tight, little leaves! Don't let go! I'll take care of you! Which one will be on the floor tomorrow, shriveled, crinkly and brown? None, I hope.
I hope I am a better doctor than gardener.
The merry-go-round slides to a gentle halt. . . . And now, time for bed.
Steve Dudley is a family physician in Seattle.
In Practice allows doctors, nurses and others working in the health/medical field to share stories or points of view about their work -- and the lessons they've learned from it. Submissions should be 750 words or fewer and are subject to editing.