"I Can't Do This" — And Other Lies Your Brain Tells You
I. Can't. Do. This.
That thought echoed through my brain multiple times a day last week — when caring for patients, when talking with families, when rounding with colleagues, when teaching, when writing notes, when walking to my car at the end of the day, and marinating on the prospect of coming back the next morning. A mantra I never chose but somehow kept reciting.
I missed writing last week. For the first time since September 2023. Was I on some luxurious vacation? Oh, lovely friends, no, no, I wasn't. I was having one of the worst weeks on service I've had in my 13 years of being an attending physician.
For those who are local, you may have heard what was going on. For those of you who aren't, I will not recount the details and horror-purge my mental and emotional state onto you. What I will do is reflect on that mantra.
So, that's got to be super comforting for anybody who's worked with me, learned from me, or had me care for their critically ill child. Surely the last thing you'd want out of somebody who does what I do is them feeling... what was I feeling? Inept? Unprepared? Dread? Panic?
Here's the thing. I tried putting it in a Thought Model — if you're not familiar, it's a framework for tracing how a single thought can create a cascade of feelings, actions, and results — but I couldn't make it work. That's a first, because the Model always works. What it told me is that "I can't do this," while it was clearly showing up in my conscious mind, probably wasn't the thought driving my actual behavior. Because if it were, the model would look something like this:
C: Objectively awful week on service
T: "I can't do this."
F: Inept, unprepared, dread, panic
A: Shut down, put off making patient care decisions, forgo teaching, "forget" to give feedback, ruminate on all the ways I'm a bad academic physician
R: Slide into burnout while finishing the week — or, worst case, call in back-up, turn in my notice, and start looking for a job that doesn't involve life and death consequences.
But those weren't my actions. Hence, those weren't my results. I didn't shut down, I engaged. I taught, and I gave feedback. I'm not burned out; I could go in and do some shifts now without a whole lot of inner drama about it.
So what was the thought actually running the show?
"Yep, this is awful — and we're doing it anyway."
Sit with that for a second. It's not inspiring. It's not, "This job is amazing and everything I always wanted to do with my life." No rainbows. No butterflies. No unicorns. Just a quiet, no-frills acceptance of reality. And a decision to stay in it anyway. And I want to be clear: this isn't toxic resilience. It's not white-knuckling through or stuffing everything down. The “how” of that thought mattered just as much as the thought itself.
When I think about what I was actually feeling last week, I felt focused. There was no time for unnecessary dramatics because appropriate dramatics were all around and needed my attention. I teared up with families during every single family meeting and end-of-life situation I was in, no pathological compartmentalizing. No telling myself I was a bad doctor, because I was on the schedule, and it was my literal job to be there and take care of the patients that day. And my result? I came out of that objectively awful week generally unscathed. I was sad. I was tired. But I was okay.
So the next time you catch yourself saying, "I can't do this," just take a beat and look at what you're actively doing. Chances are, it's "this" — the very thing you're telling yourself you can't do.
Whatever your "this" is — a census with lots of morbidity and mortality, a schedule that's massively overbooked, a board exam that's already been failed once, a child having her third temper tantrum of the day (I see you, you amazing parent physicians out there) — if you're in it, you are doing it. "This" is not always calm. It's not always organized. It's not always easy.
That doesn't mean you can't do it. Because, lovely friend, you are.