After exhaustion

I reflect about doing justice to the patients.  Justice is one of the four tennets of ethical medical practice, and we are all called upon to enthrone it in our practice. Taking a good history, arriving at a diagnosis and administering appropriate treatment are all pillars of this justice in our medical ministration. 

I have every intention of doing justice to them. However, at the fringes of my stamina, when my body is pleading for some sleep, and my brain is running on fumes, if confronted by a problem patient, I find myself baulking. I recognize mistakes made from such non engagement. I am not able to mentally engage, and thereby the potential for missing diagnoses, erroneous prescriptions and and management. What to do in such situations? 

Temporising the situation by returning later to engage may be one coping mechanism, since trying to engage with the patient at that time may be counter productive. Delegating engagement may be another mechanism to cope by requesting some else to engage. A persistant problem in the peripheral hospitals is that there may not be anyone else. Whenever life threatening situations confront, adrenalin kicks in and fuels engagement. However, it is often at the fringe of the urgent that most mistakes are made, when a patient does not demand emergent care, yet is sick enough to warrant concerted attention. And what if I am sick, and not able to engage? The patient does not go away. As time passes, and the fire of  youth is replaced by the tiredness of middle age, one finds the reserves of energy more sparse and complaints from the physical body more frequent. 

After months of running on fumes, the body  and mind reaches a plateau of chronic fatigue, where it runs hollowly on adrenaline and reflexes, and accumulated exhaustion is factored into a continuum of daily habit. Continuing too long in such a state is deleterious for the community, the co workers and the patients one professes to treat. But when there is no one else to step in and provide relief, what does a professional do? Can he just shut the hospital and demand the patients go elsewhere? Can he just stay at home or go away and consign emergencies to a coffin? The  usual option is that the engine keeps running on fumes.

My grace is sufficient for you, my strength made perfect in weakness are words that have meaning for every moment at such times. There is no other mode of survival. I am very thankful for the doctors who have stepped in, for those who have provided relief and for the juniors who have stepped up to contribute to that grace which has been my sufficiency. I also recognise the fringes of that grace which has wrapped around me and paused the flow of patients, permitted uninterrupted sleep for four hours, and flowed over the patients to sustain them. I am grateful for mercy in protecting the patients through times of my failures and mistakes, and for the same grace healing and restoring them. 

Indeed His grace is sufficient, and His strength made perfect in our weakness.