Critical Care

“I imagine I’ll cry all the way there, and all the way back,” my unsentimental patient, Ruby, a critical care doctor, tells me. Ruby had just had a baby, and her Department Chair was calling her back from maternity leave to supervise physicians managing the devastating COVID-19 crisis overwhelming her hospital.

“You don’t become an ICU doc if you don’t like intense situations,” Ruby says, sounding more like the Ruby I’d come to know. Ruby has begun to mourn ungrieved losses she had never dared immerse herself in, afraid of drowning in her sorrow. Her mother died soon after the birth of her firstborn, life and death tragically entangled, and her big sister died soon after, leaving a hole in Ruby’s heart. But Ruby, the dedicated, brilliant intensive care doc, kept on moving forward, taking care of others, a pillar of strength and resilience, echoing Harris’ (2009) notion of omnipotence as a melancholic defense against mourning.

“I don’t worry about getting sick myself,” Ruby tells me. And yet. There are cracks in this narrative. “But what if I get sick and spread it to my kids. Part of me thinks I should live separately from them while I’m working in the ICU. But I don’t think I could survive without seeing my babies.”

There are no good choices here. Ruby doesn’t have the luxury of choice. Her chairman made it clear that she’s desperately needed at the hospital, and Ruby is tortured. “I feel like different parts of me are at odds with each other. I feel so guilty leaving my babies, but also guilty not being in the hospital. This is the kind of medicine I love, what I was trained to do. I’m needed there. Part of me is even excited to go back.”

Then, a sudden shift. “But Lauren, I’m so immersed in being a mommy. I can’t imagine not having Derek’s newborn smell with me all the time.” Ruby starts to cry. “I’m nursing him right now. This is so stressful.”

I’m aware of powerful self-state shifts in me throughout this session: fear, concern, envy, compassion, shame, vulnerability