I'm fine.

It was a hot August day when I went to see April in hospice for the last goodbye. I met her the year before, and immediately knew there was something other-worldly about her. She had a spark in her eyes, unusual for someone in their early 20s, mixed with a sharp wit and an inner knowing that afforded her an uncanny ability to read people. I thought I was well-

versed in that area, but April had me beat by far. We became close quickly, as April shared my impatience with superficial conversation as a colossal waste of time. She preferred nitty gritty “deep shit” as she called it.

Two months after we met, she was diagnosed with cervical cancer. Now it was nine months later and I got a call that it was time to come. I was my practice’s designated “nephrospitalist”, meaning that my responsibilities were all dialysis inpatients at two hospitals, and any new admissions during the day, overnight, and then into the weekend.

Mine was a busy practice, encompassing five dialysis units spread out over a wide geographic area.

My partners couldn’t cover for me while I went to see April, so I snuck away with pager and cell phone at the ready, my husband holding my hand as we walked into April’s room. Many were gathered around her bed. She was unresponsive but we were all talking with each other and with her, sharing anecdotes and jokes and tears. And then she died, and I went back to work.

I had an admission waiting for me in the Emergency Department. The hospital was about a ten-minute drive from the hospice house, and I cried the whole way and pounded the steering wheel with fury at the unfairness of losing a bright, beautiful, funny, smart and engaging 24-year-old to fucking cancer. I parked, took a single deep breath, and walked into the ED.

With the emotional distraction, I apparently forgot to check the status of my make-up in the rearview, so when Jo, a favorite ER nurse, stopped me and asked, Are you okay? I pulled up my best questioning look and said, I’m fine.

She nicely said that my mascara had run a bit, so off I went to spitball- repair that, and then I did my admission. And then there was another admission, and another, and then an unexpected code of a favorite patient that ended in death.

I’m fine.

Throughout the evening, there were admissions and cross cover issues that required in-person attention and even an emergent dialysis. And through it all, and through a tiring call weekend, that door to April’s death and the images of her over her five days in hospice stayed securely nailed shut. I’m fine, uttered day by day, week by week, month by month, year by year, kept it so.

And there were other doors, not just the one hiding April’s death. There was the door of coding and billing frustration. The door of productivity and equity. The door of managing a private practice with employees who were trying themselves to just stay financially afloat while we partners were giving ourselves bonuses and whining when it hadn’t been a financially productive-enough year to do so.

I’m fine.

How many times in a week have you said that to family, friend, or colleague when the reality was that you felt like your insides were ash?

How differently might you feel if you said aloud, I’m not okay? What if I had said to Jo, I’m not okay. My friend April just died and she was only 24 and it sucks pond water. In just two sentences I am vulnerable, yes, but I’m also cracking open a door for connection. I’m honoring the other person with intimacy and trust. I’m not actively seeking any specific response, but I am seeking connection which, again and again, proves itself the only real

balm in trying times.

How differently might my work life have been if I had said to a colleague every now and then, I’m not okay. I need help. Can you cover for me. I am sad. I am tired. I posit that the connection established in those moments of authenticity might be the missing Secret Sauce to abating the epidemic burnout the medical profession is still experiencing based on burn-out indices. (This is in spite of Institutional efforts at “coaching,” so-called.). Yes, of course, elements of reasonable schedule/call/productivity expectations all help, but the bottom line is, we remain disconnected from each other as a profession because we are terrified to be vulnerable in front of each other.

I have a one-woman show that I am performing in various non-traditional venues around the country. We’ve done eight performances to date, and each one has generated a brisk and meaty talk-back after in which audience members share their own vulnerabilities after I’ve spent 50 minutes sharing stories illustrating my own foibles. Our most recent performance was for 36 physicians, all of whom were known to me intimately over various stages of my career. Before we did that performance, I hypothesized that the talk-back for this show, should it even occur, would likely have a very different tenor, and I told my husband that no one in that room would display any vulnerability at all about what the experience of seeing this piece was like for them, personally. While there were comments, they were sparse, and to a person, no one expressed an iota of personal response, personal resonance, or personal story. It was exactly as I expected. And, while interesting to me, this also saddens me because it illustrates the fundamental faultline in our business.

Saying I’m fine shuts the door tightly. Saying I’m not okay opens it. Brene Brown offered this notion.

Try it on.

Jenie