Savoring Water Chestnuts

Hunched over her walker, she gazed upon the water chestnuts with a curious wistfulness that made me wonder what moment from her past she was accessing through the salad bar. The weathered creases of her leathery skin betrayed a faint smile as she added her fingerprints to many others on the gleaming tongs. One by one, she painstakingly created a circle of water chestnuts on top of her salad, putting one back, only to reclaim it moments later to place in the center of her creation.

I lift my sparkling water and cardboard container from the counter behind her and briskly circle to the other side of the salad bar. I am not angry, I am busy. I am not impatient, I am important. She couldn’t help it; we were simply two physical beings moving in opposing directions. Her pace appeared dictated by a past that pulled and anchored her, while mine was controlled by a future that pumped adrenaline and cortisol into quickly moving hands. Two tongs of lettuce mix, one tong of spinach, a snatch of carrots, two tomatoes, four cucumbers, a spoonful of feta, a few peppers, yay olives, balsamic, a heavy pour of sesame sticks, a shake of dried cranberries and I snap the box closed, balancing my drink on top so as to leave a free hand for a dark chocolate square. My mind is on the three new interns that I am in charge of, what my teaching points will be for this afternoon, the orders that I need to make sure were placed correctly, the infant in G302 that isn’t gaining weight.

I am jarred from this familiar space of future action, when, beyond my hand reaching dutifully for one fork and two napkins, I catch sight of one of my interns, Adam, sitting at a cafeteria table. He is slowly chewing a small bite from a large salad, gazing out the window at the sweltering Appalachian summer. His contemplative gaze reminds me of the old woman who had just slowed me down at the salad bar.

Had my muscles not been so tight from chronic clenching, my jaw would have dropped. I stare in disbelief for several more seconds before turning to speed walk back to the pediatric floor.

I can’t recall the last time that I ate a meal without chewing and clicking, swallowing while typing. Early on in my training, one of my senior residents described another resident who took a lunch break every day. The awe in her voice helped me to realize that this was not within the accepted norm. What I internalized was: when the work is finished, you can sit down to eat.

The problem is, in medicine, the work is never finished.

Upon reaching the pediatric floor, I sit down at my computer station, taking a giant bite of salad as my fingers perform the series of clicks and passwords stored within their muscle memory. One by one, I open the patient charts of the kids that Adam cared for this morning. My suspicion is confirmed, only one of the four notes appears to be complete. The work is not finished.

I begin to ponder how to broach the subject to him. I play with phrases in my head.

“Adam, what I’m worried about, is that taking a break for lunch before notes are finished could lead to you feeling overwhelmed if we get a lot of new admissions in the afternoon.” But maybe I should play on his guilt and sense of responsibility to the team:

“If you fall behind on your work then your cointerns will have to pick up the slack.” Or perhaps guilt is too harsh when what I’m really trying to do is in his best interest:

“Look, I’m only saying something to save someone from yelling at you down the road, but no one really takes breaks if you still have work to be done.” Better yet, I can frame it as a necessary evil of our training:

“I know it’s not right, but…”

I catch myself.

If I know it’s not right, then why am I perpetuating it? Am I saving him from future pain? Am I protecting the rest of the team? I wish the system wasn’t as it is, but my job is to help the new interns learn how to survive. Sometimes surviving means putting your own needs second, third, fifteenth.

Is a gentle indoctrination even more insidious than a harsh one?

The line between perpetuating a malignant culture and helping a new intern to survive is so fine that it often disappears. The truth is, if someone takes a break while others are working, the team suffers. If you fall behind on documentation, then even the simplest request from a patient feels overwhelming. If you call in sick, one of your exhausted cointerns gets called in to cover your shift. In a system where everyone is drowning, if you pause to pull yourself from the water and breath, your peers will have one less body to cling to. This is how we justify the perpetuation of institutional and organizational structures that transform compassionate, bright, and persistent idealists into exhausted, disillusioned, and disempowered physicians who crave nothing more than a semblance of normalcy, time for family, and work-life balance—let alone a transformation of our training culture.

If I want change, I must guard myself from the constant comparison of my own past suffering to the status quo of current trainees. I must catch myself when I want to say “We didn’t have duty hours when I was in residency.” I must stop myself when I feel the urge to one-up the intern’s miserable experience by describing my own worst night on call.

Rather than saying, “That’s just the way it is,” I plan to try on “That’s the way it has been.” What if instead of an indoctrination into “the rules of the system,” Adam gets to eat a seated lunch, finishes his notes when he returns, and has a smooth afternoon full of valuable learning and compassion for patients?

When Adam returns to the call room, behind his glasses, his eyes look tired and more than a few days of unshaved whiskers scatter his cheeks. I catch myself thinking, “Why are you tired? You just took a luxurious lunch break.” But in his exhaustion, I catch a glimpse of my own.

My mind returns to the smile of the old woman at the salad bar, affording herself the time to ponder and reflect, and her meticulous indulgence in creating balanced patterns in her salad. I turn from my computer to face Adam, choosing to relinquish the numerous justifications for the indoctrination that I had considered. Instead, I say:

“I saw you having a salad, I’m really glad you’re eating healthy. Did you try the water chestnuts?”