Category: Emotion

Categories
Emotion General

A Caution Against the Extinction of Emotion

“Well, you know, I was recently diagnosed with cancer,” my friend said lightly in the middle of a spirited conversation about the merits of eating organic vegetables. She smiled as though she had just mentioned a factoid about organic kale, and not told me something earth-shattering. She continued eating her lunch while I sat there slack-jawed, trying to arrange myself. So consumed was I with the news of the diagnosis, I cannot recall a single other thing that we discussed during that lunch.

Throughout medical school, our professors have often told us to “get comfortable with being uncomfortable.” Diligent student that I am, I believed I had mastered discomfort. I believed that no matter how difficult the patient or awkward the situation, I could muster up some empathy and manage to make that prized human-to-human connection that separates the clinicians from the caretakers.

It’s an illusion to believe that we are comfortable with discomfort if we only ever experience discomfort as physicians. In this unique profession of ours, we are prepared to meet strife and pain on a regular basis. Whether we are delivering bad news or seeing a struggling patient, discomfort is no stranger to us. It is essential, however, that we recognize the power imbalance inherent in these situations. As physicians, we are the ones delivering the bad news or offering advice to our patients. As such, we must come from the position of strength. I have also detected the unspoken expectation that no matter what awaits us when go through the door to see a patient, we must remain unchanged when we come back out the other side. While we empathize with our patients and do our best to help them, ultimately, once we step out of the examining room, that bad test result or unfortunate lifestyle choice is the patient’s emotional burden to carry forward, not ours. In other words, our professional responsibilities call upon us to maintain that misfortune as ‘other.’

Even as a student, I’m already seeing how challenging it can be to disentangle my professional identity from my personal life. In my professional life, I have cultivated a sort of empathetic stoicism that allows me to connect with patients ‘in the moment,’ and then quickly wash my emotions off and redirect my focus toward whatever task comes next. It’s a survival tactic that I suspect many of us have deployed. In our personal (non-professional) relationships, however, our identities as children, siblings, lovers, and friends must come before our identities as doctors. Unfortunately, the more time we spend practicing in our professional roles, the more difficult it seems to transition from professional to personal. In personal relationships, we cannot always anticipate when we’re going to receive news, either good or bad, but when we do, we cannot expect to go through the door and come back out unchanged.

In our professional lives, we’re expected to be compassionate but composed. We’re taught to deliver bad news, perform motivational interviewing, and deal with difficult patients, but I wonder where the line is between beneficial sensitivity training and detrimental emotional taming. Before we walk into an exam room, we read through the patient’s chart so we know what to expect, and this allows us to create a sort of comfortable discomfort to protect ourselves. I would argue that this emotional fortitude is not beneficial to all aspects of our lives. Emotions are sloppy—something  that doctors cannot afford to be—but I worry that if we don’t let our feelings bleed through the lines, emotional composure could pave the way for an extinction of feeling. After having lunch with my friend, I had felt frustrated with myself for being so stunned and scared by her news. I didn’t have the emotional composure that I would have with a patient, but that’s the key difference—loved ones are not patients. It’s a testament to our most intimate relationships to express our genuine feelings however uncomfortable they may be. Perhaps, as physicians, we need to work even harder to stay in touch with these feelings so that we never lose our ability to access them.

Featured image:
Feeling. by Javi Sánchez de la viña

Categories
Emotion General Reflection

What We Carry

I recently stumbled upon an entry on another blogging site I follow, featuring a piece by Pamela Wible, MD. She’s a family physician who recently published Physician Suicide Letters — Answered. She also gave a moving TEDx Talk last year where she spoke about the four hundred physicians (and medical students) who commit suicide each year. She discussed some of the stressors physicians face, like losing income to hospital overhead or working incredibly long hours. Her unhappiness in the field motivated her to start what she calls an Ideal Medical Care practice.

After listening to this talk and looking into ordering her book, ironically, I felt kind of depressed. As a pre-med student, I was always so excited to become a doctor. I think I glorified this career choice for a long time, which isn’t necessarily a bad thing. As I’ve made my way through my first two years of medical school, I’ve experienced some of the heavy burdens that we can endure by choosing this career path. Long hours of studying, high-stakes exams and, ultimately, the responsibility of another human’s life.

These same stressors can be applied to many other rigorous fields. I’m sure law students spend countless hours reading up on cases. Engineers might make a decision that has a lasting impact on whether someone lives or dies in a car accident. So why does the medical field have such an epidemic of suicide on its hands?

One of the main differences I see between professional fields is the proximity medical providers have to death. I’ve become quite confused on how exactly we are supposed to grieve. Many medical students have heard that in the past you weren’t supposed to show emotion and to separate yourself from death when a patient passes. Obviously, the sentiment has changed and the values we instill in future physicians are different, but I don’t think our coping skills have drastically improved.

As early as the pre-medical years, students in this field encounter death. I worked in a cadaver lab in college where I was intimately exposed to death in a way I had never dealt with before. As first-year medical students, it becomes easy to forget our cadavers are human bodies, and in the clinical years, in the hospital, death is everywhere.

When will we stop to cope? Can we take a week off to grieve when we experience death? Will our superiors understand why we seem “off”? When you deal with death on a frequent basis, it’s easier to forget. We bury the emotions that we carry. However, keeping things in and not going through a proper grieving process can be detrimental to our health and well-being. It’s important for medical providers to understand the weight of death that we carry and its effect on our own mental health.

In my opinion, teaching proper grieving and allowing medical students time to cope would be a useful addition to the medical school curriculum. This might even lower the suicide rates in our field. The things that lead someone to commit suicide are ultimately multi-factorial, but I think this is one way we can try to improve these numbers.

Featured image:
sunrise and silence by x1klima

Categories
Emotion General Lifestyle

Thank you for being a patient: A reflection on gratitude and its place in medicine.

I was walking through Target a few days ago when I noticed a banner had been discarded in a pile of clearance items. “Give Thanks,” it read. Assuming that the banner was a Thanksgiving leftover, I quickly moved along to a different aisle. Later that day, I started thinking about that banner, and its lowly place in the clearance bin. Gratitude has become a seasonal commodity. From November to mid-December, we’re reminded to give thanks, be grateful, and celebrate others through food and gifts. Unfortunately, the half-off banner serves as a reminder that the notion of gratitude can become “out-of-season” as we turn the page on the calendar.

One of my personal rules for daily life is to live each and every day with a grateful heart. I think this idea comes from having practiced yoga for more than a decade, where gratitude is a foundational tenant. At the end of almost every yoga class I have ever attended, both teacher and students bow their heads and say, “‘Namaste.” Namaste is a Sanskrit word which, loosely translated, means ‘the goodness in me honors the goodness in you.’ For me, this sacrosanct moment at the end of class is what makes yoga different from any other activity I have engaged in. As the instructor thanks me for allowing him or her to share the practice of yoga, I can both thank the instructor, as well as take a moment to thank myself for taking the time to do something good for myself. In contrasting my own personal attitude of gratitude with the Hallmark-esque notion that gratitude is a seasonal commodity, I began to wonder what place gratitude might have in the practice of medicine.

In my brief time as a student doctor, I have witnessed patients struggling with complex challenges that I never even considered prior to medical school. It’s true that many patients will visit us when they have a stuffy nose or an itchy rash, but just as important are patients who see us when they are struggling to quit addictions, deal with a major life change, or manage their own healthcare on a limited budget. It is these patients, especially, with whom it is imperative that we as healthcare providers work with to build trusting relationships. I believe that the first step of building such a relationship is an expression of gratitude. I want to thank patients for being brave, for reaching out, and for asking to get help. I want to tell them how very grateful I am that they have respected themselves enough to value their health, and for trusting me, or one of my colleagues, to help them make very important and potentially challenging life changes. Essentially, I want to say Namaste.

As we leave behind the snow-dusted magic of the holiday season, we should not let gratitude melt away like a snowman. Gratitude should be a part of our daily lives and a cornerstone of our medical practice. It only takes a moment to let our patients know how thankful we are for being part of their journey to wellness, but I predict that the impact it has on our physician-patient relationships will be long lasting.

 

Featured image:
The Stethoscope by Alex Proimos

Categories
Clinical Emotion Lifestyle Narrative

A letter from a patient with anorexia nervosa

Dear Doctor,

What I need from you is validation that what I am experiencing is real; recognize this is more than just a burden for me.

At first it was a rush. The best feeling I’d ever had. I was getting compliments, attention, and my jeans felt wonderfully loose.  But it didn’t take long until it became everything; an obsession.  My eating disorder (ED) has become all I think about.  Every second of every day is consumed with what I eat, what I avoid, how I can avoid it, when I will exercise and for how long. I can’t escape.  Even if I actually wanted to gain weight back, it’s not that easy.

I know you might understand, but at least acknowledge that it’s not about the food. The truth is, when you say it’s about the food, it’s more tangible, easier to categorize, like a patient with a broken wrist.  People think that if I “just eat a sandwich” I will be fine, but this is far from accurate.

Sometimes ED hints at me, other times it screams. Either way, ED is a part of my life; it is a part of who I am right now. I have a deep connection to this diagnosis. Because of this, I will defend and validate ED, and conjure any excuse to hold on to this relationship just a little longer. For patients like me, ED becomes another member of the family, the third wheel in a relationship, or even another personality who needs attention.

I still struggle often, but I have good days too.  I am not just another girl with anorexia.  I’m a young woman who never takes life too seriously, loves road trips and playing the piano, and who fights back against anorexia every single day.  I know it’s your mission, but you cannot fix me. Only I can do that and I am going to need your support.

So right now, take a seat on my rollercoaster, listen to me, and let’s get to the end of this ride.

Sincerely,

Your ED patient

 

* Inspired by a loved one

Featured image:
Anorexia. by Mary Lock

 

Categories
Emotion Reflection

The Power Of Crying

Last week, we started a class called “Death and Dying” (doesn’t it sound fun?).  Jokes aside, this class is a valuable component of the medical school curriculum. Physicians deal with death on a regular basis—some every day, and others every hour. During one of our discussions about a patient, a small tear rolled down my cheek. I quickly wiped it away in embarrassment, pinched myself to “get my act together,” and hoped no one had seen. Later that day, I wondered what would have happened if another student had seen me almost cry? Would their opinion of me change?

I am a “crier.” Not when I am faced with my own struggles, but when those I love go through happy or sad times, that’s when the waterworks kick in. This has me worried. I know that crying is seen as a sign of weakness. Some would even call it unprofessional, and I can’t blame them. Our profession teaches us to set personal and emotional problems aside. But what happens when our profession is the cause of these emotions?

A recent discussion we had in class answered my questions. It turns out that crying is okay. Of course, this does not mean we should break down every time a patient has to spend an extra day in the ED, but it does mean we can be vulnerable in a highly professional setting. One of the pediatric oncologists shared a special patient experience with us. She had always shied away from crying in front of her patients. However, one day after a family had received especially disheartening news, she unintentionally teared up in the clinic room. This was well received by the patient’s family—the patient’s mother told her, “It let me know you cared.” From that point on, the physician’s relationship with the family was altered—an unbreakable, unspeakable bond was formed.

This alleviated a few of my fears concerning the display of raw emotion. We are in a profession where humans care for other humans. It is natural to cry. In fact, we become physicians because we deeply care and love others. Showing this empathy is not a sign of weakness—it is a sign of power.

Yet, there are some important points to remember about crying. Though releasing a few tears is okay, you cannot become a mascara-stained mess.

  1. Your tears have to come naturally. These tears are symbols of your love and devotion. They signify your raw, genuine emotion. Don’t cry to make yourself closer to a family.
  2. You still need to be strong for your patients and their families. You want to be able to process and deliver information to them in a calm, collected way.
  3. You do not want to cry and then have your patients feel they have to comfort you. You are their robust pillar of support! They should be leaning on you for guidance and comfort—not the other way around.
All in all, I am happy to have realized that watery eyes in the clinic will not make me a pariah. Crying, like all aspects of medicine, has to be motivated by your candid empathy. Only then can it be powerful.
Featured image:
A Single Tear by Lauren C