Monday, November 19, 2007

When Dreams Become Responsibilities

The last few weeks I've been having the same dream: I am working in the Emergency Room surrounded by patients I can't cure with problems I can't even understand. In the bizarre logic of dreams, my patients seem both real and somehow blurry enough that their illnesses never make sense. These dreams last all night. I awaken, realize I have been dreaming, but cannot shake off the anxieties of the dream; “What would I do if that really happened at the hospital?” (Unable to realize that dreams present problems to which there are no solutions.) I fall back into fitful sleep. My wife says I talk frantically in my sleep. These dreams only come on nights before my shifts at the hospital.

It is interesting that I once would have said it is my “dream” to be a doctor. Although I love my job, my former dreamy idealism has been replaced with heavy duty. Before in residency, I was in a group of many training doctors and was never the one finally responsible for the care I gave. Now as I work 24 hour shifts in this rural Emergency Room, I alone am responsible for the life and safety of every person who enters the doors.

Fortunately in my waking work, even my patients with complex problems eventually make sense to me, and I believe the care I provide really is quite good. People I know occasionally bemoan not reaching ambitious goals they set for themselves. My daydreams are the opposite: I think how nice it might have been if I hadn't passed my medical school entrance exams. I could work a regular job without weary nights, death, suffering, and weighty responsibility. My brother recently left nursing school. He told me, “I like working with people, but if I give the wrong medicine someone might die. I don't think I want a job like that.” A few years ago I would have tried to talk him out of this. Not now.

My wife reminds me that I had similar dreams during my first year of residency. I grew out of them, as I became more confident in my new role. Hopefully I will also grow stronger under the burden of this dream I have chosen for myself—strong enough to carry it's weight with grace and patience.

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