Sunday, February 12, 2006

Responsibility and Attachment

The weekend has delivered a satisfactory feeling of letting go of the vicissitudes and challenges of work. Patients still cross my mind at most any time of day---the middle of the night being the worst, of course. Luckily the hours of lost sleep while ruminating over patients are relatively minimal. I wish I could say the same for the hours of stress.

I sometimes wonder what it would be like to have a job wherein the end of the day actually ends the sense of responsibility engendered by that job. Who can claim to really let it all go when they punch that clock or close that office door? Writers? Teachers? Clerks? Lawyers? Cab drivers? Chefs? Dishwashers? Scientists? It's clear that as the level of responsiblity and "ownership" of a job increases, the power of that job to bleed into one's private and personal life grows. Clearly there are jobs where it must be relatively easy to walk out that door and not give it another thought until the next morning at nine, but it's been years since I had one of those and I sometimes long for that ease of detachment.

For better or for worse, my job is about building relationships, and when relationships are encouraged to grow, attachment and caring also bloom. I'm sure that most people would agree that when one's work involves others' health, well-being, and perhaps actual survival, it's pretty damned difficult to detach oneself from the proceedings. When a patient is failing; when addiction takes hold anew; when death seems more imminent; when failure of the system seems to mean certain death or loss for a family or individual---those are just some of the moments when one's psyche cannot easily let go. From a Buddhist perspective, detachment from outcome is recommended and encouraged, but I cannot help but sometimes feel twinges of pain at the most inopportune moments of personal and private time.

Someone called me the other day to say that her electricity and gas were being turned off. What could I do? She may have AIDS, but the apartment she's staying in---and the bills for all of the utilities---are in someone else's name. I couldn't write a letter of medical necessity for that reason. I did have a wholly unreasonable mental image of her and her two children and dog coming to stay at my house for a while but I disabused myself of that image quickly. How many times have I toyed with the notion of bringing a patient home for a weekend? More times than I would like to admit, honestly. (I actually understand that one of my previous coworkers actually did just that a few years ago---now that's bringing your work home!)

Sunday evenings often bring a sense of foreboding, the deep knowing that at 8:30am, the pager will begin to buzz, the cell-phone ring, the list of unfinished tasks and demands quickly mounting. There is a melancholy sweetness to the length of the evening and my desire to lengthen it, to trick my mind that the hours are moving more slowly than they really are. As bedtime approaches, I feel a tightening somewhere deep inside me, a gearing up, getting ready for the fray. It's so difficult to let go of this state of relative detachment that the weekend has allowed to occur. Can I manage to be a witness to my day and its stressors without actually inhabiting them? Can I ride the waves but not be pulled under? That is the ubiquitous challenge, the constant emotional task at hand, the test of one's mettle. Whether I am up to the task is not only a day to day challenge, or even an hour to hour challenge. Every moment is an opportunity, and my desire is to seize those moments as often as I can. It's a matter of survival.

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