When someone asks, “How was your day?”, you probably briefly look back and choose one or two words that summarize your strongest feelings about it. “It was exciting!” or “It was exhausting” or more often, “It was fine”. While this is what we have come to expect in our everyday short-form communication with one another, what we end up doing is burying dozens of other emotions that deserve a mention, too. This got me thinking about examining just one day in my life. I could review any day, but Wednesday got me especially intrigued.

During a 6:30am meeting, I started by feeling tired. 6:30am is just an early time for a meeting, but we do it regularly in surgery so we can get to the OR by 7:30 or 8am. We put in long days. It’s just what we do. Thankfully, we have normalized Zoom meetings in our post-COVID world, so this one had me sitting on the couch in my living room, drinking my coffee. My husband was away on business, so I ensured the kids were awake and moving, on pace for getting to school on time. By 7:10am, still on my meeting, and feeling defensiveabout comments insinuating that I failed to provide clear communication in the care of a patient (when I give you my cell phone number and tell you to call me with any questions, I feel like that’s clear communication, but I digress), then I got a text from my 14-year-old, “I think I missed the bus.” Welcome anxiety. Do I drop off the call, throw on some shoes and drive him to school? Do I stay on the call to defend and clarify my position to the group? I texted back, “You can walk. It’s one mile. Sorry bud.” Hello guilt.

I finished that meeting and jumped on the next, convinced my son would be blazing angry with me by the time he got home in the afternoon. I was distracted by this feeling, something researchers call attention residue. A few minutes later, I got a group text from my boss “Something has come up and (name redacted) won’t be able to come in today to cover her shift. I need volunteers to help cover clinic and the ICU.” Confusion(so what happened?), frustration, and calculated thought came swirling in. Maybe someone else will volunteer first? But if I don’t volunteer then I look like a jerk. But I had planned for two weeks to use this afternoon to work on a big project I have been putting off for lack of a block of time to do it. If I volunteer, I’ll lose that time and I’ll be working on it over the weekend! Indignation! Do I reply to the group or directly to my boss? More anxiety. As I was texting, “I can come in this afternoon” another partner had beat me to it. Relief? Nonetheless, the decision was made to have both of us come in and help. And so that’s what I did.

While getting ready for work, I got a text from a recruiter requesting I consider locum tenens work in Indiana. All sorts of physicians get these requests all the time as locums work skyrocketed during the COVID era. So, this wasn’t unusual. However, filled with anger over the abortion issue, especially in Indiana, where the Attorney General has been vocal and directly attacked a physician by name who was legally doing her job and providing healthcare to a child, I replied to the recruiter, “I don’t have availability and you can take me off your list for any jobs in IN. I wouldn’t consider working in a state whose legislature and attorney general have demonstrated hostility to women and physicians.” The recruiter’s response? “I completely understand that.” As I was driving into the hospital, I thought of my friend back in IN who is a tireless advocate for the work of defending women and public health. I took a screen shot of the text exchange and sent it to him, thanking him for his work and expressing my solidarity. He thanked me and requested permission to tweet about the text but keeping my name anonymous, which of course, I immediately affirmed. The tweet got a lot of traction and generated a discussion about brain drain in Indiana. I monitored the tweet throughout the afternoon. I saw a lot of comments affirming my position, and a few suggesting the text exchange was made up. I felt defensive, angry, anxious, and sad all at once. I wanted to scream back “Don’t call me a liar! Wake up! These abortion bans are hurting women. Why would I practice where the AG will call me out for legally doing my job, to the point of having to hire an attorney and personal security?” I didn’t reply on Twitter, but the fury continued inside of my head and heart.

By now, I was in the clinic, the frustration of losing my afternoon had waned and I just embraced seeing the patients. Each patient had landed in this clinic for a problem that wasn’t life threatening but could be surgically addressed. However, as I dug through their medical records preparing to go into the room and talk with them, I discovered that none of them were good candidates for surgery. One was being worked up for a possible cancer unrelated to the reason he was in my office, another with medical conditions that make her an unsuitable candidate for general anesthesia. My afternoon was filled with long conversations about risks and benefits; the reasons surgery is full of complex decision making; and telling people “No, I’m sorry. Surgery is not for you right now.” It became clear that these patients had seen other doctors, even surgeons, who had suggested they should come to our clinic and “sign up for surgery” but hadn’t done the hard work of explaining things to the patient. Enter exasperation. People who should know better, didn’t know better or didn’t care enough to spend a few minutes with a patient to bring clarity to them. I dutifully, patiently, explained things to each one until the result was “Thanks doc. That makes sense. I have never heard it like that before.” And by the end of the afternoon, I felt proud that I had come in on my day off and made a small difference for the patients and helped out my partners.

However, woven into the time between patients, I was getting texts from my friend in IN who had been contacted by a reporter who wanted to speak with me. Brief excitement was followed by a hiccup of anxiety. I confirmed my availability. These issues are important. But will I regret being vocal about my position? There is risk, for sure, but silence is complicity so I agreed to speak to the reporter.

A few minutes later, a text came in from my oldest son, asking for medical advice as his friend’s grandmother suddenly became ill and was rushed to the ED. The prognosis was poor, how should they proceed? For the next few hours, he peppered me with texts filled with concern, fear, sadness, and confusion on behalf of himself, his friend, and the family. I helped them the best that I could and finally he said, “You know, you deal with these things all the time. You see death every day. But we don’t. And we don’t know how to be logical about these things. So thanks for your help.” It pierced me. He’s right. Many of us in medicine see death and dying every day. Do we become callous? Do we just get really good at compartmentalizing things? Do we care too much? Not enough? Wow. I don’t know. But this is what we do and maybe we don’t reflect on this enough…

Finally, I walked out of the clinic with my boss, sensing his fatigue. We talked a little about how to navigate some issues we are dealing with as a team. I felt compassion for him. Having briefly been in that same leadership position at another institution, I know how it feels to be torn between anger and sadness about issues in a group. I know how it feels to want to just tell people, “Do the right thing. Be kind. Quit being selfish.” But life and leadership are more nuanced than that. It’s hard to lead through challenges, but I affirmed to him I think he’s doing a terrific job!

After that quick chat, I rushed out to my car and drove the 5 min down the road to my therapist’s office. I walked in 2 minutes late, dropped down onto the couch and sighed deeply as he asked me, “How was your day?” “It was a long day. I’m frustrated, but I’m fine.” He paused, he sensed the weight of so much more than “fine” and he said gently, “Can we go back to the part before you said, ‘but I’m fine’ cause there was way more to your day…”

Disclaimer: My viewpoints are not necessarily reflective of my employer, or any local, regional or national organization that I belong to. As a matter of fact, I pretty much just speak for myself. Please keep that in mind.