‘BRP’

We call it “BRP,” which stands for “brief reactive psychosis.” It happens to the best of us. I first saw it happen to my then roommate, a first-year pediatrics resident at one of the country’s biggest hospitals, an otherwise kind, cheerful girl who would come home daily at 10 p.m., quiet and angry, and who would lie face down on her bed still wearing the day’s clothes and not move for the next six hours. When she did talk to me, she would only talk about how she was on the verge of quitting her job. I would tiptoe around her, knowing that she was going through something I couldn’t understand.

Years later, I understand very clearly. It happens to me, too, with varying degrees of intensity. What we call BRP is actually separate from the medical phenomenon of brief reactive psychosis—rather, it’s a way of putting jokingly into words the indescribable sensation of terror, frustration and hopelessness that intermittently attacks the average medical professional in training. Maybe there’s a corporate counterpart for it that I don’t quite understand, and maybe artists occasionally dump their brushes and works in progress out the window in a fit of anger and despair; I wouldn’t know.

But for us the BRP stories are real, occasionally funny, and always poignant: One doctor reportedly got so fed up with the workload, with the treatment of his superiors, and with the constant demands of his patients that he dropped everything in the middle of the workday, got into his car, and drove all the way to Tagaytay. What he did there I don’t know, but what we do know is that he came back and was forgiven, and it was business as usual after that.

It’s something we often wish we could do. Days off are rare and weekends are a foreign concept, and so often the one thing we want most is to get away for just a day. We feel trapped in the hospital, and this may parallel the way we feel about our profession: We feel trapped by the weight of expectation and by the years we spent investing in a future that sometimes we’re no longer sure we want. We used to have a term for that, too—the med-life crisis. Part of it is the legitimate fear of missing out on life: We look at our friends’ Instagram posts about weekend getaways, family gatherings, and glittering nights out, and we compare these to the humdrum nights we spend asking patients about their last bowel movements. And suddenly we don’t know why we’re still here.

The thing that separates BRP from this daily longing is that it happens when the tiredness and simmering dissatisfaction finally boil over into a mess of bad decisions. In college or in medical school, the consequences are less dire: When you have a BRP you mostly decide to aggressively binge-watch your favorite series despite knowing that you have an exam at 7 a.m. the next day. In training and in practice, suddenly BRP takes on a whole new weight: There are people expecting you to show up, and when you don’t, the rest of the team scramble to pick up the pieces. Maybe it speaks of how undermanned most healthcare teams are. Maybe any one person shouldn’t be indispensable. But the fact remains that when you go away, you mostly decide to come back because you’re needed.

This is okay, because what matters is that you do come back. You get up, you get dressed, and you show up.  Even in a culture that celebrates strength and scoffs at daily failures, where “What doesn’t kill you makes you stronger,” it doesn’t matter if you’re only Neville Longbottom-ing it through every workday.  What matters is that you show up anyway.

In medicine we often feel special, as though our unique work hours and our life-and-death decisions set us apart from any other group of twenty- and thirtysomethings struggling to know what it is they want out of life. The fact remains, though, that no matter our profession, there will always be an inevitable longing for something different, hence the occasional BRP. It isn’t that it happens to the best of us—it happens to all of us, in all professions, in varying degrees. A few of us will quit, and maybe they should. But those of us who stay, I think, should have a renewed commitment in staying.

Terry Pratchett wrote that “personal is not the same as important,” and young doctors are in a unique position to come face to face with this every day: There is evidence to show that we are more tired, more depressed, more sleep-deprived, and more financially challenged than other professionals within our age group, but maybe there are things that matter more than our schedules or our personal comfort. It’s easy to forget the glory of this job. The romance gets lost somewhere in the soaked wound dressings of our patients, in the arguments we have with other tired members of the healthcare team, in the bone-deep weariness of coming home at 2 a.m. and needing to get up four hours later. But—if we can just manage to remember it—maybe there’s still glory in staying. Maybe, when it comes to brief reactive psychosis, what matters is that we keep it brief.  There are patients waiting, and there is much to do.

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kaychuarivera@yahoo.com