I ran my first half marathon earlier this week. The training program I used actually capped at 12 miles, so the race itself was the first time I had ever run 13 consecutive miles.

The temperature was an uncomfortable 14 degrees (Fahrenheit) at the start of the race. About an hour later, the digital thermometer atop the CNN building informed me that the temperature had risen to a balmy 15 degrees.

Though not in pain, I was feeling tired and uncomfortable during the last mile of the race. My legs were weary from carrying me two revolutions around Central Park. It was with impatience that I pushed myself across the finish line. I had run the 13.1 miles in about two hours and three minutes.

Not bad, considering that my primary goal was to complete the race.

My legs ached for the next two days. Yesterday, the surfaces of the sidewalks were glistening with snow that was solidifying into ice. I cautiously ran the same two city blocks multiple times at a ginger pace.

Today, I returned to my usual training route along the river.

The crew that runs along the river differs from the crew that runs around Central Park. Speedy people run around Central Park. Speedy people who look like they’re exerting no effort. Speedy people wearing designer running gear who look like they’re exerting no effort. Speedy people wearing designer running gear and look like models who look like they’re exerting no effort.

I’ve labelled those speedy young women “gazelles”. They’re the fine specimens who wear a size two or size zero. Their long blonde or brunette hair is neatly tied back away from their symmetric, oval-shaped faces. They are svelte with pert breasts and toned butts. Their running suits are fitted and each piece is the same shade of black. They run in packs and, while I slog along in my mismatched running clothes, they scamper past with ease and chatter without a hint of breathlessness.

Anyway.

The crew that runs along the river consists primarily of solitary individuals. Maybe a dozen of us are out there in the evening after work. We’re all running alone, together. Many of us are women, though there are a few guys mixed in. We’re at various levels of fitness: Some of them are gazelles (or the male equivalent); some are just starting out (and they are the most inspiring). Most of us are somewhere in between.

I took it easy this evening. My legs have finally stopped aching and my ankles don’t feel as wobbly. My eyes took in the twinkling city lights and my mind wandered over the first few pages of Kabat-Zinn’s Wherever You Go, There You Are.

This is it, I thought to myself. And isn’t it amazing? And sad?

I’ve read that book at least twice. I restarted it again for the third time today on the bus ride home.

I’ve been struggling with work.

This is my seventh consecutive month of performing inpatient psychiatric consults. I don’t know if the patient mix has actually shifted that much recently, but the recent consults seem to have featured people who are significantly ill. Not only do their diagnoses suggest difficult times ahead—HIV, cancer, surgical complications—but they have looked really sick.

People aren’t great at predicting who will die and who will not simply by looking at them, but when people look sick, its disheartening. Their bodies and behaviors grotesquely illustrate the struggle between health and disease.

And some of these patients are not merely physically ill. Lately, several of the patients I have seen have been psychiatrically unwell: no one can make sense of their speech, they have threatened and made gestures to kill people, their arguments, though passionate, have no basis in reality…

… and they have tuberculosis, a new lung mass, or are about to undergo surgery for significant medical conditions.

And while we are all trying to take care of the patients, people become frustrated with their efforts. Nurses have felt unsafe and unsupported by administration and some resident physicians. Medical and surgical staff have felt stymied in their efforts to provide appropriate care. Sometimes, that frustration is transformed into anger and is directed at the consultant.

The wonderful thing about working at the interface is that you can potentially help a lot of people. The frustrating thing about working at the interface is that people can potentially push everything onto you.

If I really think about it, if I really allow myself to both intellectually and emotionally consider what I experience and witness, I want to cry and throw up.

The suffering is terrible. It’s heart wrenching.

We all want to help people. Sometimes, especially in those “in between” moments, when we’re all waiting for the biopsy results, when we’re waiting for the infection to clear, when we’re waiting for the surgery, the most helpful thing we can do is be with people.

And it is so difficult to be with people who are suffering like that.

And not just patients—staff are suffering, too. Everyone feels overworked and underappreciated. They’re doing the best they can and are trying to protect themselves from the horrific suffering going on around them, too.

While I am undoubtedly learning a lot about consult-liaison psychiatry in this fellowship, I have also learned that I don’t think I can do this kind of work on a daily basis for the rest of my career. Maybe under different circumstances I would not find it this draining. Currently, though, my own empathy reserves are taxed. I can’t be with patients as much as I would like because I am expending a lot of energy to protect myself.

I don’t like that.

What does this have to do with running along the river?

Maybe it is a physical manifestation of my flight away from work. I have the good fortune of leaving the hospital at the end of the day; I can run away from the horrors and suffering within. It is my opportunity to be alone, to go at my own pace, to enjoy the freedom that comes with taking off the pager. I can remember that not all people are sick, dying, psychotic, dysphoric… suffering.

Running along the river reminds me that there are things that continue on even though life continuously ends: The river continues to flow past; the now leafless trees will blossom again soon; the setting sun will rise again in the morning.

When I run, I hear and feel my breathing. And my breaths serve as an anchor for mindfulness.

The extra energy I use to protect myself is the extra energy I use to avoid being present. Lately, at work, I have not wished to be present: I don’t want to be aware of all of this suffering. Nobody wants to be aware of it.

The thing is, though, if I am not aware then, I won’t be aware for other things. If I am not mindful of my experiences in the hospital, I won’t be mindful of my experiences outside of the hospital. And that means I’ll be missing out on life, with all of its tragedies, joys, miracles, and routines.

I feel disappointment upon this realization that, in more judgmental terms, I’m not “strong” enough to handle inpatient psychiatric consult work. Perhaps, if I am more kind to myself, I could say that this work is not a complementary match for my personality. And it is better to recognize this now and make appropriate changes than to go on, blindly, wondering why I feel so tired and numb at the end of the day and so anxious at the beginning.

Wait for me, will you? I, and you, will know that I am feeling more settled when I resume writing on a regular basis.