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blow up over some trivial issue, and yell at a tech or staff member, frequently bringing them to tears.
    It was a radical change in his behavior, and we all noticed it.
    “When are you going to talk with Dr. Whipple? He’s really messin’ up.” Amy was not known to mince her words and was obviously concerned about her friend. “Not just here, but at home too. He told me the other night that things were rough with his wife. ‘Difficult,’ I think he said.”
    A few days later, I came in early to relieve him.
    “Let’s go back to the lounge for a few minutes,” I told him. “We need to talk.”
    We spent the next forty-five minutes discussing his recent “difficulties.” At first he was defensive, but gradually he began to listen. We were concerned about him, and wanted him to be happy—at peace. At present, that wasn’t the case, and it was affecting the entire department.
    “Burnout is a common problem among those of us in medicine,” I told him. “Especially ER docs. Long hours, difficult and complex patients, holidays, nights, weekends. And only an infrequent thank-you. You’ve been doing this more than ten years, and that seems to be the breaking point. Somebody either figures out how to carry on in a meaningful, productive way, or they do something different. I think that’s where you are, Darren.”
    He had lowered his head and was silent for a moment.
    “Robert,” he finally said. “This is what I love to do. I’ve just got to get things together. Thanks for talking with me.”
    We discussed counseling, fewer hours, more exercise, more time with his family. He was going to try all those things.
    Every week or so I would ask how he was doing—was he making progress? The answer was always the same: “I’m doing fine.” Finally I stopped asking. I was hopeful this was going to work—hopeful that this would be a turning point for Darren Whipple.
    Apparently it wasn’t.

    “Let’s talk about this ‘answer to prayer’ business, Lori. What exactly do you mean?”
    Virginia glanced at me, adjusted her glasses, and headed for her office.
    “It’s just that I’ve been praying a long time for Dr. Whipple,” Lori began. “He’s such a nice man and a good doctor—I hate to see him so tormented.I think the talk you had with him helped some, but like Virginia said, it didn’t stick. He was better, or seemed to be. But something was simmering just below the surface. There was something in his eyes, some unrest or something. I just sensed he could explode at any minute. He was trying hard, but it was too much for him. And then he did explode.”
    “Explode? What are you talking about?” This was news to me.
    “Ms. Granger made me promise not to say anything to you.” Lori glanced around the department and lowered her voice. “She made Dr. Whipple promise too, and Sharon Mahaffey.”
    “Sharon Mahaffey? What does she have to do with any of this?” Sharon was a veteran ER nurse and worked the night shift.
    “Dr. Whipple blew up at Sharon one night and she went straight to Ms. Granger. She said she didn’t have to take the abuse that Dr. Whipple gave her and would resign from the ER if something didn’t happen.”
    “Why didn’t I hear anything about this?” I shook my head, wondering what planet I had been on.
    “Like I said, Ms. Granger made us all swear to keep it quiet. She wanted to see if Dr. Whipple could change and make things right.”
    She paused and looked at me. “I’m sorry, Dr. Lesslie, if—”
    “No, I understand, Lori. If Virginia wanted to keep this quiet, you were only doing what she asked. But what happened?”
    She shook her head and again glanced around the department.
    “The four of us were in her office and she had Dr. Whipple sit down, right in front of her. She told him that his behavior was unacceptable, that he needed to decide if he wanted to work in this ER or whether he wanted to be a doctor at all. That really got his attention, but he didn’t say