It’s been a while.

Academic medicine makes life a divided attention task. To say nothing of having these small people at home who want such luxuries as regular bathing and food.

In the last few weeks I’ve been doing all the stuff I’m supposed to be doing – data for a study just came in that I’m slogging through, a paper I gave up for dead may see the light of day, and various people who have been sorely deceived into thinking I know something asked me to give a few talks which I’ve been piecing together. All that has kept me away from you lovely folk.

I think I also took a bit of a knock a couple of months back. The way things work at my institution I am on service, meaning running an inpatient team, for one month rotations. We had a rough month.

It’s an addiction treatment service and because of the high volume it can be flukey. Some months you get a run of people who are sick as the devil, sometimes you get some who are sweet and grateful, sometimes you get people who are just mad at the world. Once a mood is set in the group, it can be infectious. A few patients who are experienced and wise in the ways of recovery can pull the whole group back from the various crevasses of self-pity, other-blaming, and shame that can poison the air. Then again, sometimes a few charismatic troublemakers can derail the whole train.

That month we had a remarkable run of people bailing out early, with no rhyme nor reason I could see. The fundamental principle I run the unit by is that people who don’t get into treatment don’t do well; so right from the jump I’m talking to everybody about what they’re going to do when they get out. Our whole team works every minute to set up that next step and help people make it to there.

Yet, you will sometimes have the one who thanks you profusely and talks about what a wonderful job you did; then tells the cab driver after discharge she was forced to go to treatment and asks to be dropped off at some corner. Or the young one who starts out on day one talking about how she can’t keep living this way, and walks out two days later saying she can’t imagine ever going a day without getting high.

I know such things happen. I know there will be bad months.

At the same time, I think you always have to ask yourself if there is something more you can do. That is the question that helps you find ways to make the system better, to help more people, to work smarter.

The other edge of that sword is that the answer is always yes. You could have said this instead of that. You could have seen the problem a day earlier. Maybe it would have worked, maybe not.

Maybe it would have.

Sometimes I need a little time to recharge from all the maybe it would haves.

So, I’m recharging.

I’ll come back. I always do.

Keep going, friends, and so will I.