The Chair in the Bathroom

Rachael Zacks, MD, MPH is currently the chief resident at Harvard's Occupational and Environmental Medicine Residency program. She is a proud board-certified internal medicine physician who has spent ... [+]

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Nature is calling. As a new intern in the medical intensive care unit (MICU) my bladder is not yet trained to resist this instinctual human need. The team has been rounding for six hours, discussing the problems and plans for some of the sickest patients in the hospital. But my 6:00 a.m. green tea doesn't care that we are not close to finishing. I've got to go.
The MICU is a polarizing place for many first year residents, commonly called interns. For some personalities it is the holy grail, where the critically ill patients provide opportunities for procedures aplenty. For others it is a place of fear, where patients are too sick to communicate and interactions occur via family meetings and end-of-life discussions. To the public, the MICU is often a cold place full of endless alarms, ill loved ones, and an ever-revolving door of nameless doctors.
I was able to sneak away by sprinting out of a patient's room and making a beeline for the bathroom. There is only one bathroom for staff in the ICU. It's hidden in a back corner, inconspicuous and poorly labeled. Inside was equally plain. No potpourri, sweet-smelling lotion, or hidden bowls of candy brighten the space. There are the essentials: toilet, shower, sink and . . . a chair? I did a double take as I was washing my hands. It was nothing fancy, just a plain brown plastic chair kitty-corner to the toilet. Its seat was well worn and rust tracks marked the broken tile floor beneath its legs. I couldn't help but wonder . . . why was there a chair in the bathroom?
Over the next couple of weeks my time was spent in the chaos of the critical care service. I was learning by doing. See the patients. Check the labs. Talk to the family. Poke the veins. Push the drugs. My life became an endless to-do list interspersed with teaching from residents and fellows. The rhythm was at times comforting. One was too busy to feel the stress, to miss the empty bed at home, or to notice the voicemails from family. I had forgotten about the chair, learned to tolerate the burning from waiting to use the restroom, and was starting to feel the numbness of too little sleep and too much caffeine.
Then she rolled in.
The nurse pushed the gurney down the hall accompanied by an entourage of blinking monitors and hanging drips. I listened to the all-too-familiar story. Young woman, late 20s. Found down at a friend's home. No heartbeat for ten minutes until the paramedics could get her heart started again.
I cringed on the inside. She was my age. No heartbeat meant no oxygen to her brain for ten minutes. Ten minutes is a lifetime to the cells of the brain. I shined a light into her eyes and her pupils did not move. I could feel the black cloud that followed her into the room. I started the mental note in my head . . . concern for brain death, check for signs of brain activity, report to the resident. I had become conditioned to start the checklist. The code bell rang indicating another patient's heart had stopped. We dropped everything and raced down the hall.
The next morning the whole team entered the young woman's room. The family was there—a mother clutching the limp hand of her daughter. The attending immediately went to the bedside. He had heard me give a presentation on the patient before we entered the room. He didn't pause. He turned to the team, checked some signs meant to look for brain activity, and began peppering the medical team with questions.
"Excuse me, sir" the mother interjected.
The attending held up his hand to stop her from speaking. "I have to teach my team. I'll be with you in a minute." 
I felt the atmosphere in the room shatter into a million pieces. The mother's eyes widened, tears pooling. She turned to me, the only face she'd seen before and wailed, "This is my baby! This isn't just a body for you to learn from. This is my baby!" 
The family responded to her despair, curling around her in a protective shield. The attending retreated and we followed. I heard the sister whisper as we left, "Some doctors just don't care anymore."
The air outside the room wasn't any less heavy. The team dispersed and I found myself feeling everything that the hours had numbed. I escaped to the bathroom and collapsed into the chair. I cried. For the girl who had lost a future. For a family who had lost a daughter. For addiction that steals the dreams of the young and old. For training that forces us to pretend we're not human. In that worn and rusted chair I found a space to feel all the emotions that had been weighed down by long shifts, little sleep, and occasional cookie binges.
I left the chair and went back to the family. I held the hand of their daughter and explained everything we were doing. There were opportunities for questions and moments of silence filled with compassion. It wasn't perfect, but it was a start. And for the first time in a long time, I forgot about the checklist. 
The mother hugged me. "I wish we had never met because it would mean she was never here. But since we have, I'm glad it was you." During the hug, I felt myself stiffen for a brief moment. It had been over a month since I'd had compassionate touch from another human being.
The MICU is a hopeful and despairing place, full of miracles and tragedies that often happen within seconds of each other. The pace leaves little time for the luxury of decompressing one's emotions. But that's why we have the chair in the bathroom. That's why every MICU has a chair in the bathroom. I get it now. It's a place where we can reconnect with the empathy we feel for our patients . . . a place to fight the burnout that can keep us distanced and efficient . . . a place to recharge our batteries so that we can continue to try and tip the scales in favor of miracles. It's a place that lets us keep going. Caring for ourselves while we care for our patients is a balance that will take a lifetime to perfect, but I plan to keep on trying. And I'll always know, that chair is waiting if I need it.

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