A Lit Match Away from Internal Combustion

I’d forgotten this night.

My plane touched down in Denver a little past ten, a direct flight from Orange County. I’d watched Southwest’s in-flight entertainment for the duration, seeking decompression. My day had been a long one. Leaving for vacation was always difficult, but this day was particularly arduous. With five minutes to spare, I’d narrowly boarded my flight. The patient calls, messages, and refill requests were ceaseless. But I got the work done. All the loose ends were tied. I was on vacation now.

Or so I thought.

Buzz. Buzz. Buzz.

In the ten seconds after switching off airplane mode, my phone ignited with texts and voicemails:

Dr. Fightmaster, we need you to resend the prescription to the pharmacy. They’re waiting on you.

Dr. Fightmaster, the orders you submitted for Ms. Jones didn’t include the appropriate diagnosis. Can you resubmit? The patient can’t be admitted until you resend the order.

Dr. Fightmaster, we’re still waiting on you. Do we need to call the attending physician?

If it weren’t for the strangers next to me, all waiting to deboard, all excited for their trip to the mountains, all enthusiastic in a way that I could no longer comprehend, I would have yelled, “Fuck!!!” at the top of my lungs. Instead, I yelled “Fuck” at the top of my thoughts, then called back the nurses from my seat. By the time I’d exited the tarmac and boarded Denver International Airport’s underground train for baggage claim, I was no closer to resolving the issues. Apparently, I was the only person who could fix them. And they had to be fixed now. By computer.

My dad was waiting outside baggage claim in a rental car, having arrived before me, for our vacation together. In our first thirty minutes of driving, I spoke with the pharmacist, talked a co-resident into fixing the orders, and averted any calls to attending physicians. The issues were fixed. But I was livid. I detested my job. I loathed its intrusion into my vacation. I hated myself, for allowing this to be my life.

I was a lit match away from internal combustion.

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Two weeks ago, my dad and I were talking on the phone when he mentioned this very night. “Ryan, that night was when I got it,” he said. “It took you the rest of the trip to get back to the Ryan I knew. That’s when I understood.”

Since that night in early third year of residency, I hadn’t thought about it since. It was just another resentment filled night in a long string of bitter years. I find it sad now how accustomed I was to that feeling.

Even still, most of my days in the hospital were good days. You don’t do something for eight years without good days. Those good days convinced me to stick it out, to look around the next promising corner of the next academic year. And as I’ve written, it wasn’t without meaning. Taking care of patients was an absolute privilege and highlight of my life.   

But the good days deceive. Bad days tell the truth.

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When shit would hit the fan—which it does in every job, everywhere—I resented it. To survive, I needed conditions to be perfect. Because my soul wasn’t staked inside the job, I received limited returns on my time; thus, when extra effort and suffering were required, it mandated I dig into my reserves. Though, I had nothing bigger than myself to draw upon. I only had obligation, and when obligation meets adversity, resentment results. It wasn’t medicine’s fault either. I watched plenty of my colleagues navigate the difficult days without divebombing into darkness.

Presently, in my post-medicine existence as a writer and furniture company owner, yesterday was a difficult day. My plans failed to materialize. A client backed out. The to-do list went by unaccounted. I missed my revenue projection for April. Shit hit the fan.

Unlike my years in residency where a single bad day absorbed the days after, this bad day was not a referendum on who I was. It was a speedbump. It was a difficult day, yes, but the hard held lessons. Come late evening, as I sat talking with my wife on our porch, listening to the hum of the emerging summer insects, I knew things would be okay. Tomorrow would be a new day, offering another chance to play the game. There was no resentment, there was no hating my job. Life was what it was. It was just a hard day. I could own it, learn from it, and move on past it.

When adversity strikes—because it will, even after we’ve decided to go live a life we love— watch the stories you tell yourself. How dark does the spiral go? Does resentment follow? Is your tone self-loathing? Is the day end-all-be-all? Or is the day held with perspective? Can you learn from it? Can it just be a bad day?

Those answers illuminate the truth. They always did for me, and I expect they won’t ever stop.

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(Photo Caption: in Colorado, on that trip with my Dad, lost in a purgatory, trying to find my way out.)