And the (heart)beat goes on.

How do you sit on the edge of a bed, look into eyes and hold a hand without getting pulled into someone's world? How can you meet the parents and the fiancee and even the folks from the "church home" without somehow folding a piece of yourself into the story they all tell? How do you do all of these things and then, when the calendar turns over into a new month, just walk away?

This is what it kind of feels like to be an inpatient hospital physician sometimes during the time we are scheduled to be on the wards. We arrive all bright-eyed and bushy-tailed. We work shoulder to shoulder with our residents and nurses or, if it isn't a resident teaching service, with the countless other people who aren't residents and students but who are integral to hospital care. We high five in hallways, chuckle on rounds, and break bread together. We dissect clinical conundrums and process adverse outcomes over the course of two to four weeks. The time we are slated to be "on service."

Yep.

That all leads to some bonding. And much like a boot camp or a pledge period of sorts, you gel, yes. But simultaneously some part of you is cheering when you reach the finish line. A piece of your time handed back to you, life finally back in your grasp.

But.

As bittersweet as that might be, it doesn't compare to how it feels to leave the patients. You get so invested in them. For some, you feel like the loved one who rustles them awake on the first day of school and the next door neighbor who stops by after school. You are the one often ushering them into a new normal--this life after a diagnosis has been rendered. Your words and the cadence with which you speak them play like a broken record in their heads and you search to make sure they are more melody than cacophony.

And . . .  you worry about them. On your drive home. In the cafeteria. During journal club sessions. And whatever else you are doing. You pull up papers from the New England Journal of Medicine on your smartphone and read them while waiting for elevators in an attempt to find answers. The answers to, first, what the new normal even is and second, what to do about it. You see your consultant friends in the hallways and exchange both pleasantries and cutting edge thoughts gleaned from those articles that required your reading glasses to see.

You do all of this. For a finite period of time, you do.

And then it ends.

The clock strikes six P.M. on a weekday afternoon. The calendar tells it in big block letters. It is a new month, a new block, a new group of doctors. Your time is up. You are free to leave.

Woo hoo?

So invested, you type up some list of your patients with probably more detail than is even desired, but you do. And this person who doesn't know and love them like you do listens to you droning on and on and they politely nod and say, "Uh huh. Uh huh. Got it." And partly they say that because they are getting it. But also because they know that you need to honor your patients through this exchange.

I go to their bedsides and tell them. "You will see some new faces tomorrow," I say. And their eyes always widen when I do. Some because they are confused by the process. Other more seasoned patients because, though familiar with how the hospital teams turn over, they are simply sorry to see you go.

And a lot of the times, I feel the exact same way. Like I've somehow betrayed them.

I said good bye to a man last week who'd received some very bad news. And I saw him right before that bad news was final and then the page turned and it was August 1. Life started happening and I got busy with all of the things that had been on my back burner while on service so, despite my intention to do so, I didn't get upstairs to see him the following day. Yes, I was technically "off service" but still. I wanted to see him and look into his eyes and hold his hand. I did.

He left the hospital before I could. Yeah.

There is this thing we talk about called "transition of care." Where we hand our patients over to one another at the close of a scheduled time caring for them. The key is that we don't want any balls to get dropped or wheels to be reinvented so it is critical that this happens. And that part, I have figured out. But what I still struggle with is how how to transition the caring. Is there a way to communicate to someone the things that don't make it into the chart? How special this woman is to her grandson or how cherished this man is to his little boy? Should I assume that the next doctor will find this out on their own or should that, too, be typed into my little sign out sheet?

"Loves oranges but peak season peaches are his favorite."
"Has seen every single episode of Seinfeld and can quote them all."
"Says that the Maury Povich show is her guilty pleasure."
"Played center field for the Atlanta Black Crackers in the Negro League."
"Was a back up dancer for M.C. Hammer."

Some part of me doesn't want the ball to get dropped on all of that either.

So my point? I don't know what it is. I guess I'm just thinking about all of this over my coffee this morning. And even though I'm no longer the attending of record, my heart is still rounding every single day.

Yeah.

***
Happy Monday.