Speediness, swiftness, rapidity, haste, hustle…. common buzzwords in an intensive care unit. A patient’s heart rate is 200 beats per minute. Ignored for a few seconds, this racing heart may degenerate into a rhythm that fails to pump blood into vital organs, leading to strokes, cardiac arrest, renal failure, and all manner of catastrophe. One must act reflexively, there is no time to deliberate, contemplate, think. Every delayed second, may cost a patient organ function, long term disability or even death.
So how does one function in such an environment, when one loses their physical ability to move from one critical situation to the next with speed? I never considered this fundamental question prior to my knee surgery. As a physician, I was trained to deal with all manner of illness, infirmary, disease in others. To survive the grueling training spanning eleven years, from medical school, residency, and fellowship, I became adept at ignoring my physical and emotional needs. Medical training is all consuming and ‘survival of the fittest’ is no cliché. It starts with the long hours, prior to ‘work hour restrictions’, up to thirty-six hours at a stretch, the luxury of ‘golden weekends’ where it was ‘normal’ to get only one full weekend off in a month, toxic attendings’ grilling trainees during rounds, without any constructive feedback, no breaks to eat, drink, use the facilities. If you had the misfortune of falling ill yourself during training, it was expected that you would continue to work. The only acceptable reason to call in sick was if you were on your own deathbed.
So, when I had a much-needed knee surgery, as in intensive care attending during a global pandemic, and recovery did not go as planned, I was in uncharted territory. The six-week FMLA allowed me enough respite to gain the ability to hobble around on a cane for short distances. My first day back in the ICU was fraught with challenge and uncertainly. I felt lost and adrift, like a sailor marooned on a desert island, possessing the essential skills to perform the task, but the lacking in necessary equipment. Hospitals are notoriously large, with long meandering corridors, stairwells, wards spaced out seemingly randomly as far away from each other as possible.
The ICU was located on the second and fifth floors, in separate wings of the hospital. The pandemic ensured that both ICUs were full. COVID had inundated our lives, both personal and professional. Our normal census had routinely doubled. The infection control measures needed to safely see these patients meant that it took longer to interview and examine these patients. The careful donning, doffing, disinfection afterwards added five to ten minutes to each patient visit. How would I finish seeing all my patients with the added challenge of my lack of speed?
The thought of getting though the day with a cane, lead to a sleepless night. How would I manage the pain and stiffness, would my leg give out with the exertion, would I be taken seriously by the staff, would they trust me to manage a full ICU with the most critically ill, when I was visibly infirm? I felt relieved that most of my patients were in a coma, and hospital policy did not allow visitors during COVID, hence could not see my disability. I lacked compassion and empathy for myself, someone who had endured a major physical challenge. I was unable to advocate for myself. My surgeon had evaluated me the week prior to my return to work and expressed a vague doubt about my returning to work. I had immediately shut him down, saying, ‘I have to go back to work’. If I had simply extended FMLA, my workplace would have approved it. However, the thought of going through the convoluted disability process seemed unimaginably tedious, the guilt of abandoning my colleagues during a pandemic consumed me and I felt compelled to return.
The day started like any other, the sunrise painted the sky in all hues of sepia, red, orange, yellow and golden. The parking lot was empty, and I was glad to nab the premium spot near the entrance. I grimaced against the pain of extending my knee to stand up after the long drive to work. The knee brace was tight but kept the joint stable as I shifted my weight into the cane.
The walk to the hospital seemed impossible. A concrete walkway required my complete attention, my eyes scanning for pebbles and trip hazards. A fall this soon after surgery would be a major set-back. As I approach the sliding glass doors, I scrambled to anchor my cane on the ground, shift my weight onto it and scanned my badge for entry into the hospital. I was aware of the line forming behind me, of employees trying to make it on time for their shift. I was making them late, and the awareness made me perspire, I was embarrassed, self-conscious.
As I stumbled into my office, I was relieved to see the motorized scooter that I had ‘borrowed’ from the hospital physical therapy department. This had been my ‘lifeline’. It allowed me to zip though the long hallways with speed, in fact my team had a hard time keeping up with me. It gave me the ability to meander from room to room during team rounds, stopping outside each room as each member of the team discussed and gave their input. These rounds spanned more than hour and without my scooter, I would not have been able to walk and stand for such a long stretch. I responded to pages and arrived at critically ill patient rooms faster than anyone expected. I was able to overcome my physical disability and perform my job to the best of my ability. The scooter liberated me from my own worst enemy, my self-doubt and insecurities.
The ICU has always been a close-knit team. The physicians, nurses, pharmacists, nursing assistants, seamlessly performed their tasks in unison. We navigated the unrelating stress of being a witness to death, defeat, grief with good humor, camaraderie, and teamwork. This wonderful staff presented me with laminated ‘plates’ for my scooter, which read ‘Catch ME if you ‘KHAN’!. I was proud to display my personalized ‘plates’ on my scooter. They elicited laughs from friends and strangers alike and broke the ice in tense situations. I thoroughly enjoyed my three weeks on the scooter. I was able to regain my self-confidence, my body healed, and I learned self-compassion. For the first time in my career, I had implemented the spirit of the ancient adage ‘Physician Heal Thyself’.