***Alexandra DeFelice is an MS4 at the University of Virginia School of Medicine and plans to go into psychiatry.***

I wrote “Close” (Intima, Spring 2022) after a particularly difficult day on my Family Medicine rotation—a rotation where anything can walk in the door.

Anything can walk in the door, and the vast majority can also walk out.

I walked out every day, too. I walked out after an 8am-5pm shift, a blessing compared to the 0500 rounds of the Surgery rotation or the 13-hour night shifts of the Pediatrics rotation. No matter what walked in the door of that Family Medicine clinic, I had a wealth of time to process it, relatively speaking. That day I describe in “Close,” I was able to think of my family 1,300 miles away and let the isolation crush me, because I had the time. I had the luxury.

In “R&R” by Richard Kravitz (Intima, Spring 2019), he describes condemning a man to spend Christmas in the hospital, only he didn’t realize it was such a sentence at the time. The condemned man didn’t immediately react, but when he was finally crushed by the isolation—“Only later did he pick up the chair and smash it against the floor”—Kravitz was gone:

“By then I was home. I didn’t hear the threats, the crash and shatter. I had turned the heat up, the news on, my mind off. A little R&R.”

Kravitz was able to go home. He had the luxury of time, and it brought him relief.

The condemned man was not able to go home. He had the luxury of time—stuck there in the hospital for all twenty-four hours of December twenty-fifth—and it brought him rage.

On that day of my Family Medicine rotation, I was able to go to my apartment. It’s not actually home (home is 1,300 miles away, dare I say it again, and painfully so), but it was something away—away from the clinic, away from the hospital, away from the patients. I was able to walk out the door. I couldn’t go home, no, but I could get away.

On every rotation, actually, I could get away. The amount of time was variable, but it was guaranteed: There was an approximate time, every day, when I knew I could leave. Leave and have the luxury of some amount of time away.

My patients have the luxury of time, too—time to lay in bed, await that elusive point when they get to leave, (wonder if they will even be able to walk out the door). But they don’t get to go home.

They don’t even get to get away.

And Kravitz takes that contrast a step further. He points out not only that the patient stayed in the hospital while Kravitz went home, but he recognizes a tension between the two:

“I could go home he’d accused me.”

I wonder how many patients make that (true) accusation, whether the provider realizes it or not. I wonder how many patients feel rage in their luxury of time—how many chairs are smashed against the floor each Christmas? How many patients would smash a chair against the floor if only they weren’t so weak, so sick, so bedridden? How many patients have smashed that chair in their mind, in their heart, in their silence?

And how many times have I walked out the door, gotten away, and not looked back?

In medicine, time is precious. Sparse and fleeting. Short and limited. The shifts are long but the hours pass by oh-so-quickly. It’s exhausting and frustrating and often overwhelming, maybe it even feels like a condemnation when things are particularly chaotic. Having time is a luxury.

But so is walking away.

Alexandra DeFelice lives in Falls Church, VA with her fiancé. She is an MS4 at the University of Virginia School of Medicine and plans to go into psychiatry.