Gross Emotions

Here’s a true story from the Operating Room:

Surgeon: “Intern, what is the story behind this patient?”

Resident Intern: “Patient is a 51 year old female with breast lump on the left side, and 17 out of 20 lymph nodes positive for cancer.”

Surgeon (speaking in a rather ‘as a matter of fact’ tone): “Oh, she’s F_ _ _’d.”

Resident Intern: shocked, frozen and unable to respond.

'How do some physicians become so stoic?' I was once asked by a frustrated student. In one of my recent posts, Breaking Up is Hard to Do, I wrote about feeling sad in regards to saying goodbye to my patients, despite this unsettling feeling that somehow I was not “supposed to” allow myself to feel.

It wasn’t until one of my favorite physician bloggers, Dr. Synonymous, wrote a comment in response that made me think about why I felt that I was not supposed to get attached to my patients. This is what he said:

“Dr JAT, You KNOW you don't believe the above comment about "refrain from getting attached". In family medicine, We are SUPPOSED TO GET ATTACHED to our patients. That is the definition of compassion. That is what separates our specialty from many others."

Family physicians are stereotyped for being a rather pleasant, friendly, and compassionate bunch (in general). But there is still this underlying unspoken culture amongst some physicians (not all) across all specialties, including primary care, that perhaps frown upon the notion of allowing yourself to express emotions in your practice.

However, it is often necessary for physicians to build this rather concrete wall around their true feelings as a coping mechanism, in order to be able to function optimally in their careers. Because truly, after seeing patient after patient, if you allow yourself to feel too much it can wear you down in a big way.

Imagine this: you are a physician with approximately twenty patient encounters a day. Several of those twenty are very ill or dying. A couple of others are with major depression entrenched in helplessness, and perhaps contemplating suicide. And then another one or two who get angry at you for not prescribing them the medication that is driving their addiction. Several may be frustratingly non-compliant, and don’t take their medications like you prescribed, and now their health is deteriorating irreversibly as a result. Then, there are a few more that really make your heart sink, because frankly, they are the nicest people you have ever met, and there is something very serious going on with their health, and it is so unfair.

Now multiply that by a minimum of 5 days a week, 52 weeks a year, which comes to 260 days a year.  This gives perspective as to why some physicians may appear to be stoic on the outside.  It’s about survival of the fittest in this profession.  Because how else can we function otherwise?

When were we all first taught of this unspoken ideology encouraging us not to feel? Is it passed down from generation to generation as a culture while in training?  While contemplating Dr. Synonymous’ remarks, I can recall as far back as my Gross Anatomy class. I remember in the very beginning of the course, my small group was forced to confront our first real deceased human being lying before us. He was so real. He had a tattoo on his arm, with presumably his significant others’ name on it, and many surgical scars. Who was he? How did he pass and leave this world? Who did he leave behind? We all contemplated the answers to these mysterious questions while we respectfully dissected our cadaver as a team.

When the course commenced, we had a sort of a required "support group," in which all medical students were randomly assigned to a small group with an instructor, in order to discuss how we are dealing with actually knifing through deceased human flesh.

I remember the instructor asking, “What are your thoughts on dealing with this issue?” I was relieved to hear this question, because I had heard some students discuss their struggles (whether it was spiritual, religious, or personal) with the challenge of a face-to-face encounter with a body that was once alive. However, when we went around the room, no one voiced their thoughts. No one spoke. I knew that even though several had shared those difficulties with me in private, they were perhaps afraid to voice their emotions in an atmosphere where “sharing your feelings” is not encouraged. How can you blame them?

Finally, there was one student whose words I will never forget. He expressed that he personally tried to view the cadaver as an “object” and that it was only when he looked at his cadaver’s hands that it seemed so “real” to him. “You do a lot with your hands,” he stated. He too was struggling to feel.

But there is something about going through the medical school and residency training process that begins to harden your soul, in preparation for protection against the potentially emotion-draining life as a physician. Is it a bad thing? I don’t think so. Perhaps it is a necessary, hardening process to experience in order to survive mentally.

At the same time, however, I think it is very important to maintain compassion. There has to be some balance. It’s a primal instinct to want to be loved and cared for, and physicians who are able to feel and convey this compassion may have much more influence over their patients’ health. And it ultimately makes us much better physicians if we just allow ourselves to feel once in a while.