"Once I was so exhausted that, when taking the babysitter home, I automatically drove to the hospital instead."

One of the worst hardships is having so little time to spend with one’s family. The athlete can shower and go home after the game, but for doctors the working day often has no end. I had to adjust to the idea that being home on a weekend was a bonus, not something I could count on. Moreover, I was suffering from two-way guilt: snatching a few hours felt like stealing time from my patients, while the sixteen-hour days felt like stealing time from my wife and children. I didn’t know how to respond to the guilt or how to unify my life. Many nights I was too tired to enjoy my family after I did get home. Once I was so exhausted that, when taking the babysitter home, I automatically drove to the hospital instead. She probably thought I was kidnapping her.

Even the time I managed to spend at home always seemed to get interrupted. The kids were constantly asking, "Are you on call tonight?" Everyone was nervous when I was on call, sure that the family evening wouldn’t last. For most people the ringing of the telephone is a friendly sound. For us it meant anxiety and separation.

One of a physician’s most unnerving trials is due to the fact that death comes in the middle of the night more often than at any other time, something I now understand. One can’t help but feel a twinge of anger when a patient who has been in a coma for days passes away at 2 A.M., and the doctor and family must be awakened with the news. We think, "Why can’t the dying have a little respect for the living?" Few of us ever mention this hostility. We just feel guilty about it. Then there’s the added burden of having to be cheery and alert in the operating room at 7 A.M., despite family problems and two or three calls in the middle of the night.

On New Year’s Day in 1974, I started keeping a journal. At first it was largely an outlet for my despair. "At times it seems the world is dying of cancer," I wrote one night.

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