Tuesday, April 29, 2008

Irregularly Irregular

The "irregularly irregular" rhythm of atrial fibrillation is one of the most common abnormal rhythms of the heart. Caused by the erratic firing of the cardiac conduction system and unpredictable patterns of capture, the heart rate and rhythm is disorganized and difficult (or next to impossible) to tame. The beat may be fast or slow but always characterized by its own whimsical pattern, totally indifferent to consistency. This particular heart rhythm stands as a metaphor for life in general and the practice of medicine in specific. Predictably unpredictable.

This has certainly exemplified my experience with Medicine and I'm routinely reminded whenever I live through another four day tour of duty as the on-call physician. Friday night and Saturday were a breeze with long times of quiet, work that flowed in an orderly sequence, and a clear sense of planning, purpose and outcome. Sunday was the polar opposite; hellish, disorganized and punctuated by three separate trips back into the hospital. There appears to be no pattern and no way to predict much like this "irregularly irregular" heart rhythm. This weekend might have been insanely busy from start to finish or could have been the reverse, or some combination of the two. The day of the week, the time of the day, the month of the year matter little. There simply is no predicting although some people attribute the variability to cycles of the moon. I do not agree. Cyclical oscillations would impose a pattern on this energetic giant and that's simply not the case.

Recovering today from my four days and nights "on", I'm emotionally tired, cranky, and frustrated by the reoccurring realization that when things go smoothly in medicine, that's the miracle. It does happen. Sometimes. The norm is so much less glitzy than a scene from "ER" or "Grey's Anatomy". A TV show depicting the plodding struggle of a large land turtle making its way through wet sand (or jello) would be a more accurate depiction of what it feels like to function in the trenches. No one would want to watch this sort of medical drama and who could blame them? There is often little that is really exciting. Usually it is the hum drum punctuated by moments of adrenalin rush and extreme sadness as we struggle to understand, intervene, perhaps fix things before they go seriously awry. This is likely NOT a comforting thought to readers and I must emphasize that these are my feelings, honed by 30 years in the profession.

The amusing part of life in Medicine (suspect it is true for all professions but would love to know) is that just when you think you've seen or heard it all, every possible combination of insanities, you have not. Hear me again: have not. Another scenario breaks on to the scene carrying a new twist unlike anything experienced before. I have several examples from this past weekend alone. I will never get to the end of SNAFU and FUBAR. I suppose the beauty of this "irregularly irregular" pattern of permutations and combinations is in warding off boredom and a sense of complacency. The undertow lurks just beneath the surface ripple.

Attempting to tame the beast who will not be tamed, I become evermore frustrated. Ironically, the patience for the irregularly irregular beat shrinks with each passing year. I truly believe that the new, younger generation of doctors are better equipped to accept the constant chaos. I used to go with the flow and ride that wave with more grace and agility once upon a time. Where the youthful frenzy and enthusiasm for the ride went, I know not. I am no longer willing or able (as we often say in this field) to "bend over and spread 'em."

I'm drawn in by The Great Gatsby quote, the final line of the book when Fitzgerald writes; "so we beat on, boats against the current, borne back ceaselessly into the past". This desperate attempt to control that which cannot be controlled, a super heroic effort to fight the undertow beneath the wave is an exercise in futility. I realize from a deep place of knowing that my time and efforts in this most noble of professions draw to a close.

1 comment:

  1. Dear Kate,

    This is a beautifully written and provocative post.

    What do you think is the difference between physicians who lose patience for the atrial fib of life with each passing year in the trenches of modern medicine and those who continue to bob and weave, enjoying the challenges until they are old and gray?

    With hope, Wendy


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