I sometimes have trouble telling the trouble between, of all things, anxiety and professionalism.
This is what I think about, when I've woken up from sleep at 1:00 a.m., thinking about a patient's incision, or an antibiotic choice, or an adverse event.
It's where computer records are both a blessing and a curse. A blessing, because I can go to the computer, and log on, and read her chart, and reassure myself. A curse, because, God help me, why is this what I'm doing at 1:00 a.m? I sometimes mourn the space/time limitations of paper. Ah, technology: insert grumble here.
To the best of my (layperson) understanding, anxiety is a form of worry. But worry is normal, and often functional - it's how and why we plan, and get things done, and look both ways before crossing the street. So anxiety, I guess, is mutated worry, worry that's been exposed to some sort of radioactive accident and becomes pathologic, because it is unleashed always and indiscriminately, about events that are unlikely to transpire and about which you can often do nothing.
But what's professionalism, really? Here, I'm not referring to the wearing of a spotless white coat, or punctilious documentation, but to carefulness. Caution. Wanting to do the right thing, and wanting to do it enough that you don't miss anything. So you assess, and you re-assess. And if you're doing something really important, then you think and rethink, and sometimes rethink your rethoughts.
And at what point, then, do you find yourself checking lab values at 1:00 a.m. on your vacation?
I used to think this made me a better doctor - that I cared enough that there was no time too sacred to be visited by the clinical, that there was no space where I was truly free from the decisions I had made and the patients that I had cared for. Not one of those callous doctors, not me. Now, I'm not so sure. It's rare that I remember something truly important, and even rarer that it's something that couldn't have waited until the morning. So this level of care, well, when is it just that other variety of worry, gently glowing in the dark?
A very wise therapist once told me that anxiety is really fear for yourself, that it's not really about someone else. Being a frequently anxious person, I've had opportunities to reflect on this. When I'm anxious about my kids, is that really fear of what will become of me if something happens to them? Somewhere there's a dividing line between worry, which can be focused outward, and anxiety, which is self-centered. I'm sorry to say I've got plenty of both...
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