Not phased by tragedy anymore?

[TheComebacKid]

One of the things that has been weighing on my mind is how "numb" I've become to the horrible things we see in our profession.

A few weeks ago I was part of managing a horrible pediatric cardiac arrest in a 2 year old that was very likely secondary to abuse. I still have the images of a pleading mother picking up her dead limp child in her arms and screaming at the top of her lungs.

But the thing that really is getting to me is how much it ISN'T getting to me. I've seen so many horrible things in the short time I've gone through residency that I feel like it doesn't really phase me anymore. Some people would argue that it's a good thing that you aren't affected by these horrible images as it allows you to stay level headed and take care of other patients in the department and get them all the care they need.

I would argue that on shift negative emotion, i.e crying, discussing your feelings etc is not good for patient care and ultimately compromises your ability to do your job. But I think at some point when you go home, it should "hit you" and should feel something. Our job is one that involves emotions and honestly I don't know how you can do good work if you don't feel that pain and sadness sometimes. How can you be motivated to work hard to save a life when you don't feel the pain that is associated with the tragic and sudden loss of life?

I'm concerned because I feel like I'm just heartless and I can't process these feelings anymore. It has never really "hit me". Maybe it's because I don't have kids? On some level I feel bad for what happened, but I don't feel AS bad as I thought I should feel. I WANTED to feel more, but I couldn't. I picked up Taco Bell on the way home from work like it was an ordinary day. I went to work the next day like nothing happened. It feels almost like I'm the one who has a sickness because I can't experience the very basic of these human emotions anymore.

End rant. Thanks for listening.

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[dchristismi]

Ok, here's my take, as an EM/Hospice physician who does death Every. Single. Day. now.

I think there are all sorts of little things that "get" to us, but not necessarily what you might think. Your baby the other day - came in basically dead, right? Perhaps this is callous as well, but people who come in dead are a LOT different that people we talk to, interact with, who THEN crash and die in front of us. I've wondered the same thing about pedi codes and ultimately, that's what I came up with... because I felt the same way, especially if the kid was basically already dead.

I had a case that really screwed me up which was the opposite. A young person, (who was technically a grown up, but had the body habitus and mental status of a kid due to a genetic syndrome) who I managed to stabilize, talk to and was a lovely, lovely kiddo. With loving, attentive parents. Who ultimately crashed, burned and died in the helicopter en route to the mecca.
This happened probably 5 years ago, and I remember it like it was yesterday. I am absolutely scarred from it. And while there were some really heartbreaking elements of this case, I am certain that I reacted to it so strongly because he was not only alive, he was talking, joking, smiling (albeit hypoxic as hell even on the bipap.) He was excited about the aeromed pin they gave him. And I intubated him, and he never woke up again.

If your kid was dead on arrival, (or perhaps had weak vitals and never gained responsiveness) it likely isn't going to affect you the same way. You're going to work him regardless - I always would... but it's not the same. And I've wondered the same thing about myself with pedi codes especially - why am I not sad? Oh, I'm sad, but not in a "my world has been wrenched apart" way. If everything got to you, you absolutely wouldn't be an effective EM physician.

I truly doubt you're heartless. Exhausted, overworked, stressed? Absolutely.
This is hard, hard work, make no mistake. And as hard as you're working, those emotions get shoved down. I think you're perfectly normal.

 

[austintr]

I was basically this same way (and still am to an extent) from working in EMS and then later doing transplant stuff. When I started med school I went to the student counseling center to try and see what I could do to become human again.

Though the counseling was pretty much a waste of time, the PsyD did give me one useful but of advice: we see empathy as a "switch" a lot, and when we do that it's easy to say when the switch is off, we're protected. And when the switch is on, we feel things and are vulnerable. But if you try real hard, you can maybe turn that switch into a dial. I don't know what the hell she meant by it, but it at least sounds reasonable.

 

[LChristmas]

I've had similar thoughts even just rotating through the department on auditions. Thinking, "Man, this is horrid. I should feel something, but what should I feel? I should probably feel sad or something like that." Intellectually, I know I should feel something because it's legitimately the worst day of many people's lives, but I was just numb to it. There wasn't that gut feeling of emotion that I was expecting. I'm still trying to process my way through (as an MS4) how this is going to work out during my career.

Do I look on the positive side that, well at least we sustained "life" long enough to keep their organs alive? I dunno. Does anyone?

 

[GeneralVeers]

I don't feel anything while at work. I don't want to take my work home from me. When I'm off shift, I generally don't think about the horrible things I"ve had to do/see in the preceding days, nor would I want to.

 

[Angry Birds]

Your job is to save life and limb. Do this and you have discharged your duty. You don't get extra points for shedding tears or feeling bad.

 

[EsTxDr]

Your job is to save life and limb. Do this and you have discharged your duty. You don't get extra points for shedding tears or feeling bad.

I dont know, empathy can change an experience for a hurting family member or patient. Maybe as life changing or impacting as the tragedy is to us. That might be construed as extra points by some.

Recently had an aortic dissection go south quickly ... very quickly. I had been very frustrated by the patient and had to repeatedly talk him out of leaving ama, etc, during a very busy shift. I did, in all of that, get him a phone and let him speak to his daughter from out of town. She looked me in the eyes later and thanked me for giving her the last conversation with her dad. They had been somewhat estranged and had reconciled to some degree in her mind on that phone call. Had I not allowed myself to feel something that might not have happened.

But let me clarify I probably did those things out of guilt for actually not feeling much during that shift. Its a battle for me, I want to feel and I dont want to all at the same time.

 

[Birdstrike]

Just look at what you said, @TheComebacKid

"I feel nothing, but..."

I still have the images of a pleading mother picking up her dead limp child in her arms and screaming at the top of her lungs.

I still have the images of a pleading mother picking up her dead limp child in her arms and screaming at the top of her lungs.

I still have the images of a pleading mother picking up her dead limp child in her arms and screaming at the top of her lungs.

I still have the images of a pleading mother picking up her dead limp child in her arms and screaming at the top of her lungs.

I still have the images of a pleading mother picking up her dead limp child in her arms and screaming at the top of her lungs.

I still have the images of a pleading mother picking up her dead limp child in her arms and screaming at the top of her lungs.

I still have the images of a pleading mother picking up her dead limp child in her arms and screaming at the top of her lungs.

I still have the images of a pleading mother picking up her dead limp child in her arms and screaming at the top of her lungs.

You "still have the images."

Why?

If you're unaffected, pathologically so, what need is there to "keep the images"?

Just think about that for a minute.

What need is there, for a robotic, unfeeling brain to hold on to the images of a terrified, heartbroken mother, hopelessly holding her floppy lifeless child, screaming in pleading agony, while you helplessly watch, unable to do what you want to do, which is to use your training, skills and experience to raise that child up, and make him, her full of life and to light up her mother's world again?

There is no need to "keep those images," accept...

To feel.

There is no other reason, whatsoever. If not for the act of feeling. There is no purposeful reason for a brain to hold on to those images, still. Otherwise, they're just a burden, needless baggage. But you do feel. And you did come to this forum to post about those "those images." Similarly, an unfeeling robot, incapable of human emotion would find no need to come to this forum and start a thread about "those images" which "don't bother you." Neither would an emotionless robot, incapable of being bothered by a mother's tragedy, tears and cries, find any use for being bothered that he's not bothered, by such an unforgettable event. Because they do bother you.

So, I would propose that you have been affected by this case, and others like it, but you're simply not stopping long enough to feel it. But if you do, it just might hit you when you least expect it. Like most of us, you're probably burying the scars because the other option, feeling raw emotion and breaking down, stopping in your tracks, becoming too overwhelmed to do your job, or to get through your day, is just not an option.

If, on the other hand, you're truly unable to be unaffected by these emotional traumas, then I'd count yourself as very fortunate. But probabilities being what they are, you're more likely just telling yourself you don't feel these things, but in reality, you're just locking them away in a brain-vault to be felt later. Because that's what most of us do. If you "still have the images of the pleading mother" taking up any space in your head at all, then I'd propose that you are far from pathologically unable to feel normal human emotion. In fact it's the exact opposite. You're entirely "human." And you are feeling it. And you will feel it.

Eventually.

Somehow.

In some way.

The strangest thing about it, is that sometimes when we're "feeling" these things, we don't even know it.

 

[enalli]

Even if you actually don't feel anything (doubt it), don't beat yourself up over it. As long as you remember you are dealing with real humans and try to do what's right for them, then you are doing a service to mankind. Shaming yourself (or letting yourself be shamed) about your feelings is adding an unnecessary stress to an already stressful career.

 

[Mighty Mouse]

I think you do feel something. We all feel something. But we have a very weird job. There's a thin line we walk between caring and coping. I pronounced someone once, and 10 seconds later walked into another patient's room and was like, "Hi, I'm Dr. MightyMouse." Inside, I thought to myself, this is so friggin weird and pathologic.

But its not. Some of the numbness is autoprotection. Some of it is the repetition of what we see. It is what we do. It is what we signed up for.

But you're not alone. We've all done it. We've all felt it. We're all here with you.

There is no "one way" to feel though. There is no "normal" way to feel. You are you, and you do you. Don't hold yourself up to some expectation of what you should be doing or feeling. Its not reasonable.

 

[Redrox]

I don't feel anything while at work. I don't want to take my work home from me. When I'm off shift, I generally don't think about the horrible things I"ve had to do/see in the preceding days, nor would I want to.

I get internally exasperated when new acquaintances or friends ask that often question

"So what's the most messed up or crazy thing you've seen ?"

Dude, we eatin dinner and you dont wanna know and I'd rather not think about the most recent xyz.

But yeah, I generally dont think about the bad cases or many cases at all off the job.

I remember funny things patients say or nurse hijinks or that surgeon who was an ahole if anything.

Will say to the original poster, yeah we all have that disconnect from time to time. I went something like 7-10 shifts straight telling someone they had cancer every day, feeling like shouldnt this be emotionally crippling to me or something but not really no.

Surreal breaking that kinda news and stepping next door to make jokes about a bead in some kids ear 5 minutes later but our jobs just kinda weird like that.

Dont get me wrong, I get crushed sometimes hearing results on the phone or realizing another doctor has missed a diagnosis or I missed something and gotta eat some crow but the moment passes and kids got beads in their ears that need to be debeaded which is totally a word.

 

[GaBulldog]

Ran the airway on a beautiful little girl with a GSW to the head last night. Sent her to the OR, went back to my other patients and came home and slept like a baby. I'm also a little surprised it hasn't "hit me" yet. Everyone processes grief and stress differently. Just because you're not a sobbing mess over your patients doesn't make you a bad or defective person.