The Black Cloud

#Microburn in Medicine

In medicine, there’s that buzzword always ringing in the air (or being treated with FREE TEAM PIZZA!) — “burnout”. I assure you all I’m not going to define, nor write any more about physician burnout anytime soon.

However, I would like to introduce a new term that hopefully goes viral and subsequently leads to my book deal. This new word is….microburn. And don’t you dare hyphenate it.

Examples of microburns in my daily practice as an ER doctor might best explain this psychological breakthrough - with a caveat though: I feel like microburns need to be obvious enough to a non-medical person for it to catch on? That is, I sometimes feel that non-medical people just don’t “get it” and in the process of explaining why a situation is bad you’ve now lost the thread of the importance underlying it all. 

Or perhaps a microburn should be more of a vibes based “I know it when I see it” phenomenon and impossible to ever easily define?

I lean towards option 1 and present the following recent small thermal injuries to my soul.

__________

1. Being called a “black cloud” by essentially everyone else working in the hospital while you are already getting your face kicked in by number of patients to be seen. There’s lack of time to think while making snap (potentially life and death) decisions yet someone from the C-suite or a radiology department can pop his/her head in and comment “felt that black cloud walking in today”… Now given the name of this website there might be more to unpack in a future post.

2. The 25–40 year old “psych” patient who has been in and out of group homes, family residences, ERs, psych facilities, and after his most recent discharge was staying at a men’s shelter. He gets dumped off at the ER by his family on a random Tuesday morning - they do not stick around or answer their phones after said drive and drop - because why would they?
   
   Given this patients’ schizophrenia and his medications and likely the presence of some intellectual disability it is very hard to converse or get super deep. Through his crying, his snotty nose, and anxious stuttering he is quite clear and consistent “I need a group home” and “please group home” as he knows the alternatives are back to the street given his family or inpatient psychiatric hospital.
   
   I also know I quite literally have nothing to offer him aside from a temporarily stable 4 walls with a roof and an open door being monitored 24/7 by a stranger sitting there as safety attendant. But he is getting fed, medicated, and (hopefully) feeling safe. I know how fleetingly temporary his stay will be based upon the turning wheels of what the psychiatrist and case manager say over the next 24 hours.
   
   At the end of my shift I leave, he stays - tomorrow when I return I wonder if he leaves (at my click of the discharge button) while I stay to see the next patient who’s already been waiting…