I stand in a pasture while a small herd of unbroken horses waits to be released from the adjacent arena. My back is to them, and the sun feels warm and familiar, comforting. At odds is the growing sense of anxiety tightening my chest, restricting my breathing. This is part of an exercise to bring me into the moment.
"What do you hear?" he asks. "How many sounds can you distinguish?" The truth is I can’t distinguish much beyond my pounding heart and the rushing pulsation of blood in my ears.
"Notice each sense within you. Use your eyes to see without focus, your ears to separate each sound. Feel your body and where you are carrying the emotion. Breathe in all of the smells. Feel the vibrations in your body."
And out they thunder. I hear the hoofbeats grow louder, the nostrils snort, a squawking blackbird, the thwapping of a helicopter’s rotor against the crisp mountain air. I smell the sweet, earthy scent of manure. I feel the ground tremble. My knees tense and I dig my boots into the bumpy dirt. The horses streak past me, hurdling to some undetermined destination. A cloud of dirt kicks up and hits my back. And it’s over that fast. The horses are already munching grass lazily, while my heart continues to hammer inside my chest.
"What did you observe in yourself? What do you observe in them right now?" he asks. I dissect all the details, carefully cataloging them. I am certain of my answers. I have to be certain: I am an emergency physician.
"These are judgments, not observations," he offers softly. "Try again."
For months, we continue this work. Work. In some ways it seems like play, in others it is real work. And it is necessary. I am numb. Fifteen years as a doctor in a busy ER have left me disconnected from myself and others. I thought that was the only way to successfully compartmentalize the raw suffering I see daily. What I’m only now realizing is that I don’t leave this feeling of disconnect in the ER; I take it with me wherever I go. While it has protected me from profound sadness, it has kept me at arm’s reach from profound joy and love as well. I never saw that the tender empathy and compassion I offered patients and their families left me guarded and empty outside of the hospital.
I walk into the arena and stand quietly. The big, brown, retired racehorse lifts his head, and his ears twitch toward me. He listens intently and tries to assess my intent. I approach steadily, and he turns from me. I feel a flash of rejection, even anger, but I have learned to quiet myself. I observe him again, more clearly this time. Observations, not judgments, I remind myself.
The weight is off his rear leg, and I think he is relaxed. His ears are forward but turn quickly toward the sound of a nearby mare. His coat is caked with dried mud about the withers. I touch him. His muscles quiver, his head bolts upward with his athletic strength, and he walks away. And it is then that I see it: He limps on that back leg.
I feel a rush of recognition of his silent suffering. Suddenly, my heart feels tenderness for him. And as soon as I do, he turns back toward me.
I hear the ambulance bay doors open and feel a blast of dry winter air hit me. I shiver in my thin scrubs. The fireman is balanced on the gurney doing CPR as a paramedic is bagging the patient. Following them is a young woman, aged in this tragic moment of what she has witnessed. My eyes glance at the atomic clock on the wall, precise to the second. It is the last few minutes of Christmas Eve. It is the last few minutes of his life.
I take a deep breath, and in an instant I am able to pause and acknowledge the suffering. In this painful moment, I realize that I never stopped loving what I did. I just stopped loving who I was.
By: Susan Ryan, DO
Dr. Ryan is an emergency room physician at Rose Medical Center in Denver, Colo. She received her medical degree from The College of Osteopathic Medicine of the Pacific in Pomona, Calif. She completed a residency in Family Medicine and a Sports Medicine Fellowship and is board certified in both. She has served as a team physician for collegiate, Olympic and professional athletes in a multitude of sports. She actively teaches residents and medical students while practicing Emergency Medicine. She has contributed a chapter to The Encyclopedia of Sports Medicine: Women in Sport as well as written numerous articles and given lectures about exercise and medicine.