Book in Progress

Chapter X: Insults and Injuries

I read through the medical journals over and over. The information was not sticking. The feedback from my wife and Dr. Goodfellow had struck me to my core. My memory was injured, my emotions were erratic, my reasoning was not cohesive at times, and my writing style and voice were less than high school level. My pride in my ability to apply logic, reasoning, creativity, and critical thinking was damaged. Were these attributes ever going to return?

My memory before the injury was pristine, but my memories after the injury were fragmented and blurred. The incomplete anterograde amnesia was a personal nightmare.

My Grandmother was one of the most brilliant and caring people that I had ever known. She had married my Grandfather, a World War II bomber turned apple farmer, with some consternation of her father, a musician turned physician during the Great Depression. My Great-grandfather and I had many similarities, we played the same instrument, we were the only two to become physicians (Osteopathic physicians at that), and we both loved Japanese architecture. He had died from testicular cancer years before his daughter began to have lapses of memory. By her 70s, the annual family letters seemed to serve as memory aids rather than updates. She had been able to care for all of her affairs even after my Grandfather died of throat cancer up until she was found wandering the streets confused. Late-onset Alzheimer’s disease, the loss of memory and autonomy was found to be genetic. I carried that gene and had feared the disease ever since.  I missed her and miss her every day. Eventually, her disease turned fatal, losing the drive to eat over time. And, seemingly at her own will, she said goodbye while closing her eyes for the last time in my Aunt’s arms.

I remember the day my Aunt and my Grandmother had lowered my medical school ropes over my shoulders. The pride in their eyes. The 26-year path completed and a reflection of my Great-Grandfather in me. I remembered it all in such detail, like a movie in my mind complemented by the emotions, scents, and peripheral happenings immediately available. Reliving those moments was easy and it would have been easy to live there. Like a high-school football star in his 30’s, I could just live in what I had done and who I had been. It would have been so much easier.

I had relied on myself in the past to help me. I had created an avatar in my mind that was everything that I wanted to be in profession, virtue, character, and wisdom to guide me throughout my adult life. He had stopped me when my frustration had started to bubble to the surface, he had helped me craft my words to deliver the intended point, he had shown me the path to being a physician. He was now silent.

In Dr. Goodfellow’s, the realization coming to me too as we discussed my conduct. The weeks prior had been pock-marked by frustration and outbursts. Our medical system was in its infancy, but at least before the injury, I could compensate for these shortcomings to a degree. Now, I needed my support staff to provide much more support. I didn’t have the bandwidth to do it all on my own anymore. I had allowed my frustration to come out as a raised voice, “just get the labs, do your job so that I can do mine.” This was too much and it had forced informal counseling with the recommendation for the Employee Assistance Program for counseling.

“I am worried about you,” he said with great care. “You haven’t been yourself the last few months.”

“I absolutely agree with you,” I said, looking at his face in frustration. My mind wishing that my leader had been there to guide the clinic. Instead, he continued to do hospitalist work with the hospitalists. I would have normally kept my retort to, “I have been struggling since my injury. I wish you had been in the clinic to lead us. I have not been able to manage the way that I used to. I am unable to lead in my current state, I need to just be an employee.”

Unfortunately, I blurted “I am just an employee. This is crazy. I can’t do this anymore.”

“We are both just employees,” he said reassuringly, oblivious to my inner turmoil and prison. “But we are leaders all of the time. I think it is best if you were to engage in the Employee Assistance Program for counseling. Happiness comes from within.”

In my mind, “Thank you, I need someone to help me out of this abyss. I can’t imagine that I can continue doing labor and delivery call. The stress is overwhelming currently. I am not able to think as clearly as I used to and would hate for any children to suffer due to my shortcomings.”

My mouth reported, “I can’t do labor and delivery anymore. Remove obstetrics from my credentials, contract, and privileges.” My face was momentarily stunned by my comment. Knowing that this would make our attempts to form a residency more complicated, I still knew that it was the right thing to do. I didn’t know when I would be able to be the man and physician that I had been before. My face became resolute. My subconscious was still functional, it seemed. Aware enough to realize that I was a liability to this program as well as my future medical career if I continued to take risks.

“I am sorry to hear that, we will work on the paperwork.” The pain in his voice as he turned to the administrator that I hadn’t even realized was witnessing our conversation. To this day, I couldn’t remember her name. I know that she never really did anything of significance. Maybe that is why I failed to acknowledge her presence. She was the sunspot on my arm, never really doing anything, never really appreciated. She just was.

When I told Dr. Este about my conversation with Dr. Goodfellow and the unremarkable administrator, she replied “let me know how it goes. I have been thinking about working with them. This place is terrible.”

I had failed to recognize that my colleague was in pain. How long had this been happening? Was it before or after my injury?

“Dr. Este,” raising my head from my shame, “how are you doing?”