The Physician's personal wall

[EdLongshanks]

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I am meditating on different doctor's personalities and the wall that they put between themselves and the patient. I thought I might solicit you all's opinions on my thoughts.

Let me start with comparing the physician to Jesus (since doctors have a God complex, it seems appropriate). During his year of popularity, Jesus was "thronged" by the crowd of people seeking healing. A woman with endometriosis pressed through the crowd saying, "If I can but touch the hem of his garment I will be healed." When she did so, Jesus "felt that virtue had gone out of him."

A rich young ruler came to Jesus for life advice. Jesus "looking at him, loved him." But the rich young ruler refused his advice and walked away, sorrowful. When he did, a little piece of Jesus went with him.

At times, Jesus went away on a mountain alone to pray. He had to be alone, this is the only time that someone wasn't taking something from him, some advice, some healing, some direction, some salvation.

My wife is working at a nursing home. She has been annoyed at one of her co-workers for some time because she doesn't come to work or do a good job when she is there. This makes my wife's job harder. Recently, my wife found out that her co-worker is being abused. Now, my wife has "looked at her and loved her." Because my wife understands, she can no longer be annoyed and my wife's job is even harder. By really looking at the girl, my wife has now had a piece of virtue flow away from herself.

The doctor is besieged, thronged, with needy people. Unless he puts up a wall, unless he refuses to see anything beyond the physical, his non-divine soul has divine demands placed upon it and he is torn apart. A little piece of him walks out of the office every time a patient leaves and soon there is nothing left.

 

[QofQuimica]

I think regardless of what wall you may have, it's overwhelming sometimes to have so many other people show you what's behind *their* walls.

To extend the wall analogy, I compartmentalize. When I'm at work, I'm thinking about patients' issues, and my personal concerns are mostly put on hold. When I'm not working, I'm thinking about my own life, not about patients.

I reckon Jesus didn't much have the luxury of ever only thinking about himself, even when he was "off-duty."

 

[spiderpete]

Well, I can't speak as a physician yet, but I would liken these types of interactions to chemical reactions. Some require energy input, some give off energy. An exothermic reaction/interaction is where I get something out of it. I like solving problems for people, especially if the problem is interesting or the person is appreciative. I walk away from it feeling energized, happier, ready to do more. On the other hand, putting my time into correcting stupid mistakes or dealing with angry, crappy people sucks the life out of me a little - endothermic. We can only hope that the energy put in will come out one day as improving a life, or keeping the situation from repeating itself, as unlikely as that maybe.

I guess I see a physician's 'wall' as more of a balancing act. You don't have to push people away or close them out if they seem to be stealing your virtue. You just need to balance them with people who feed you more. Does that make any sense? Get out of an environment that is long-term energy drawing, and into one that adds to you.

 

[Prncssbuttercup]

I agree with pete

 

[EdLongshanks]

I guess I see a physician's 'wall' as more of a balancing act. You don't have to push people away or close them out if they seem to be stealing your virtue. You just need to balance them with people who feed you more. Does that make any sense? Get out of an environment that is long-term energy drawing, and into one that adds to you.

Yes, I know that there are energy suckers who must be avoided at all costs.

I think my comments go a level down from this though. A physician, by definition, sees sick people all day long. Humans have a God-given desire to help other humans (ok, maybe God used evolution to create or increase this desire, 'nother discussion). When a non-sociopath comes across another human in need, she will have a adrenaline response causing her to expend energy to help. So a physician, during her early career, will end up as an adrenaline-driven, stressed-out, wreck of humanity. This is the part of "House of God" that I understand - the natural stress of the intern year.

Eventually, the physician learns to NOT expend energy when she sees need, but rather to "in an emergency, the first thing to do is take your own pulse." (I'm quoting from the "House of God" again).

But this method of coping can be bad. It can cause the physician to stand apart from humanity, to not be touched with the feeling of other's infirmities. She can no longer say, "Every man's death diminishes me, for I am involved in mankind." For if every death diminishes her, she will shrink to nothing.

 

[Druggernaut]

I'm also no doctor, but working in the ER, I can tell you that patients have become somewhat dehumanized. They're work now. You go in, work out what has to be done, and do it, just like any job. The challenge, especially when you're working way too many hours and making do with too little sleep, is to remember that they're not just work, they are people. That needle you've got in their arm hurts, the drunk asking for a sandwich really isn't feeling too good (even if he brought it on himself), and the guy you think ought to be able to walk but states the pain is too bad to do so might not just be a wuss. Forget that, and you may find yourself behaving in a way you would've previously found repulsive. For better or worse, people can get used to just about anything.

The last time a situation really got to me was during my first year in the ED, as I noticed one couple who really wanted a kid and had done everything right was having a miscarriage and was devastated, while a drunk, drugged out, verbally abusive young lady's spawn was brewing inside her without any sign of distress a few rooms over. Not really a direct patient care thing, but more a reflection on how unfair the world can be. I still feel uncomfortable about some of the situations I'm pulled into, but once it's over, it's over. It's nice when you've done some good and you get a sincere thank you, and it sucks when someone gets bad news or they tell you off, but you shrug it off and move on.

Personally, I find myself more emotionally effected by movies and TV shows than the stuff I encounter at work now.

 

[spiderpete]

Right you are Ed. But I think it boils down to coping or living. There's a ton of angst in the EM docs forum, my predisposition,that seems to scream both ends - some are barely coping, others are like, yeah no problem. There are layers and layers of complexity and you can prelive the profession if you make the time to read thru it all. There are docs there saying that they are being eaten away, that it is time to go. Others say its the best, simply the greatest. The reality is that most docs see the extremes but live in the comfortable middle. I think most of them.

Non trads in particular know doctors who live happy lives. How? Have they built a wall? Or a routine? Or do they do what they do, and have the strength of character to absorb the energy stealers with equanimity? The latter is what I see. Else you bow out, right?

If you are comfortable with who and what you are, shouldn't the virtue stealers just shrug off?

 

[n3xa]

My wife is working at a nursing home. She has been annoyed at one of her co-workers for some time because she doesn't come to work or do a good job when she is there. This makes my wife's job harder.

I've noticed that my expectations and patience for my clients (so far) is different compared to my peers/co-workers.

 

[BPlaysItCool]

Very cool thread topic. Some real thoughtful responses too.

I plan to contruct my wall out of a living matrix. Hopefully with just the right doses of laughter, daydreaming, meditative pauses in secret hopsital spots, appreciation of unresolvable paradox, attitudinal agility, camaraderie, and maybe some group therapy here or with friends.

I think people who build theirs out of need for salvation, curative conclusiveness, victory, power, competition etc. will end up frustrated, depressed or worse.

I think you do just do your best on any given day. And keep and honest reflection of yourself within reach. Maybe you ignore somebody. And then a little flicker of your conscience reaches for cognition and then you go back and do better.

Except for codependence. You must slay that part of yourself. Or you err in the other direction.

Personally I think a Buddhist conception of compassion is far more useful in this setting. Those who insist on working out their own salvation in others are in for a real ride.

 

[kraskadva]

Well, I'm not a physician yet either (just starting down that long road) but my father is, and having watched him for many years, I think having that wall is important. My dad does and doesn't have it. Mostly doesn't...
Does- in that at the end of the day, he isn't sitting around obsessing over individual patients and wondering how they're doing (barring a few, rare cases). After he walks out of an exam room and dictates his notes, he stops thinking about them.
Doesn't- in that when he's in the room with them, it's no holds barred. For example- Mr X comes in with a stomach ache, should be a 10 min visit, but his regular appointment is next week and the lab results are already back, so "while I'm here Doc, can you just refill my meds?" etc., etc. Next thing you know he's been in there 45 min lecturing Mr X on his diet (or maybe just shooting the breeze), and Mr. X is the 4th person this has happened with today, so he's 3 hours behind his schedule already, the nurses are p****d, the patients in the waiting room are p****d, and there's been a drug rep sitting in the kitchen for 2 hours waiting to give their spiel.
However, the nurses are getting paid, so they'll put up with it. The patients may not like waiting, but they know they'll get the same care when it's their turn, so they'll put up with it (most of them know the drill and bring a book). And the drug reps...well, it's their job, and he writes a lot of scripts.
Again and again and again. Then he comes home tired and cranky, because he's given all he has to give for the day- all the virtue has gone out from him🙄- but then he acts like an a** at home, so the family (who are already tired and cranky from their respective daytime activities) gets more tired and more cranky.
(sounds a little bitter, huh 😉 we've mostly worked out our issues, but it's taken years and many screaming fights)

Because of all this, it took me years to realize that I wanted to go into medicine myself. Always found the science of it fascinating, but had no desire for that lifestyle. I still wouldn't touch private practice or IM with ten foot pole, but I have found the other paths/specialties that I can see enjoying for the rest of my life/career.

It is a balancing act, as other people have said. The patients do need that compassion- otherwise someone will just build a machine that can do the same thing and make doctors obsolete- but you also have to be a little selfish and hold back, so that at the end of the day you have something left for yourself and your family. I'm sure we've all seen the extremes from both ends, as well as the ones who find their balance. It's a matter of finding your own balance, which many times is easier said than done.

 

[FiremedicMike]

After 11 years of working in a busy urban fire-based EMS 911 system, I can tell you that at least some compartmentalization must occur to remain both emotionally stable in the long run as well as competent in the heat of the moment. If I were to dwell on the tragedy at hand while I'm in the hot seat and supposed to be making decisions, I would be useless. If I were to dwell on the tragedies I've seen over the course of my career, I'd likely be catatonic.


Of course it is somewhat cyclic. As a new medic, I was enamored with the emotions surrounding me. I realized quickly that this wouldn't work, and spent a good deal of effort turning my emotion off completely, becoming almost robotic in my own delivery of care. As I grow older into my career, and embark on my goal of medicine, I realize that I must allow emotion in in limited amounts, otherwise I succumb to general apathy.

This leads to what I feel is an oxymoron of med school admissions, in that you must prove you are a compassionate person to gain admittance, only to spend the rest of your career learning to turn off or ration your compassion for unique cases.

 

[BlestMama]

Well thank God Jesus died for our salvation because none of us are going to get their on own. 😉

I'm really hoping for a half wall. I don't want to be so far removed from my patients that I forget (as another poster said) that they're human, but I also don't want to be totally wiped and have nothing left for my family (or myself) at the end of the day. As with anything in life, it's a balancing act, and I imagine that means we'll be wobbling like crazy when we first get started. This is total speculation as I have absolutely no clinical experience to speak of whatsoever.

 

[FlyLite]

I think the key thing is to figure out what the right thing do is and do it. And sometimes the right thing may be taking a little time for yourself to recharge, and if a wall makes you a better physician, then it needs to be built. I think as long you know you are a caring person but you are putting your feelings on hold in order to do your job...you ought to be able to live with that.

 

[EdLongshanks]

Well, I'm not a physician yet either (just starting down that long road) but my father is, and having watched him for many years, I think having that wall is important. My dad does and doesn't have it. Mostly doesn't...
Does- in that at the end of the day, he isn't sitting around obsessing over individual patients and wondering how they're doing (barring a few, rare cases). After he walks out of an exam room and dictates his notes, he stops thinking about them.
Doesn't- in that when he's in the room with them, it's no holds barred. For example- Mr X comes in with a stomach ache, should be a 10 min visit, but his regular appointment is next week and the lab results are already back, so "while I'm here Doc, can you just refill my meds?" etc., etc. Next thing you know he's been in there 45 min lecturing Mr X on his diet (or maybe just shooting the breeze), and Mr. X is the 4th person this has happened with today, so he's 3 hours behind his schedule already, the nurses are p****d, the patients in the waiting room are p****d, and there's been a drug rep sitting in the kitchen for 2 hours waiting to give their spiel.
However, the nurses are getting paid, so they'll put up with it. The patients may not like waiting, but they know they'll get the same care when it's their turn, so they'll put up with it (most of them know the drill and bring a book). And the drug reps...well, it's their job, and he writes a lot of scripts.
Again and again and again. Then he comes home tired and cranky, because he's given all he has to give for the day- all the virtue has gone out from him🙄- but then he acts like an a** at home, so the family (who are already tired and cranky from their respective daytime activities) gets more tired and more cranky.
(sounds a little bitter, huh 😉 we've mostly worked out our issues, but it's taken years and many screaming fights)

Because of all this, it took me years to realize that I wanted to go into medicine myself. Always found the science of it fascinating, but had no desire for that lifestyle. I still wouldn't touch private practice or IM with ten foot pole, but I have found the other paths/specialties that I can see enjoying for the rest of my life/career.

It is a balancing act, as other people have said. The patients do need that compassion- otherwise someone will just build a machine that can do the same thing and make doctors obsolete- but you also have to be a little selfish and hold back, so that at the end of the day you have something left for yourself and your family. I'm sure we've all seen the extremes from both ends, as well as the ones who find their balance. It's a matter of finding your own balance, which many times is easier said than done.

You are describing what I could very easily become.

 

[BPlaysItCool]

Well thank God Jesus died for our salvation because none of us are going to get their on own. 😉

(No. He died for your salvation. To me. He threatened Roman authority and suffered for it. The sermon on the Mount and some other things have survived past the death of a wandering dervish. Your public service announcement is irrelevant unless your making the case of the Serenity
Prayer)

Law2Doc recently gave an excellent depiction of this fundamental tension by describing the intern's life in the House of God thread.

Walls appear necessary by consensus and common sense. Now, this other notion Ed is raising. The detraction of virtue. To me. This is the factor that varies. And is determinant in the quality of experience in healthcare and presumably medicine.

 

[EdLongshanks]

(No. He died for your salvation. To me. He threatened Roman authority and suffered for it. The sermon on the Mount and some other things have survived past the death of a wandering dervish. Your public service announcement is irrelevant unless your making the case of the Serenity
Prayer)

Law2Doc recently gave an excellent depiction of this fundamental tension by describing the intern's life in the House of God thread.

Walls appear necessary by consensus and common sense. Now, this other notion Ed is raising. The detraction of virtue. To me. This is the factor that varies. And is determinant in the quality of experience in healthcare and presumably medicine.

I'm sorry if my Jesus references appeared to bring in religion. That wasn't my intention. I was speaking of Jesus as a healer and people's response to him. The story of the woman with the "issue of blood" is one of the best pictures of the limitations of the healer. That's why I used it, not in order to make any religious points.

 

[BPlaysItCool]

I'm sorry if my Jesus references appeared to bring in religion. That wasn't my intention. I was speaking of Jesus as a healer and people's response to him. The story of the woman with the "issue of blood" is one of the best pictures of the limitations of the healer. That's why I used it, not in order to make any religious points.

Ed, I'm with you. You're on a roll lately. I'm enjoying the discussion. Let's not derail. I don't like mind control tactics in the form of blank staements and regretted entangleing myself in combatting them. (not enough apprarently)

 

[BlestMama]

Wow, a mind control tactic? That was not my intent at all. In fact it was a joke in response to your earlier statement:

I think people who build theirs out of need for salvation...will end up frustrated, depressed or worse.

I admit I have a strange sense of humor, but I was actually agreeing with you in that people seeking salvation through helping others will only end up unhappy in the end. My personal belief is that helping others should be done out of a genuine desire to help regardless of what it can do for you.

 

[jd221b]

I think we are all unique and have certain skill sets we are born with. We tend to enjoy what we are naturally good at and are thus re-energized by it. Many of us have overcome some of our weaknesses through shear effort. While this is necessary and admirable, if we spend our days performing activities, tasks, analysis, interactions, and procedures that we are not naturally wired for then we will burn out and find necessary a much thicker wall to cope with the drain. Of course we will all have tasks in our day that tend to be natural weakness. I think the trick is to find a specialty/career that minimizes the work that we do that is outside of our skill set.

I’ll use myself for example. I am pretty God-awful at certain types of organization/administration. Because of this I should never have my own PC practice where I’m in charge of the business administration. Getting better at it through training and practice and good discipline helps me manage the administrative burden that comes with just about any job. But it should always be viewed as a necessary evil for me and kept at minimal levels if possible.

All of this is fairly obvious, but we all tend to want to challenge ourselves and not accept our weaknesses. This puts us in a bad place. What is not as obvious is that the reverse is also true. If we have skills inside of us that are not being used either vocationally or avocationally, then we tend to grow frustrated and will again burn out. This is a lot less likely to take shape in a physician, since it tends to challenge a wide variety of skills. Of course there are a few ways it can happen such as someone with exceptional skill at working with their hands going in to Radiology, but they could just take up woodworking as a hobby and be okay.

In general this aspect of it is a huge advantage we have over the traditional student. Most of us have a generally good idea through life experience of our strengths and weaknesses. I’ve gone through testing myself that has given me an added level of confidence to reinforce what I’ve gathered from life experience.

IMHO getting in to the right career is the first and foremost aspect of minimizing the need for a wall. But after all is said and done and you know your in the right career, you still have to have a wall to buffer the daily inundation of emotionally traumatic events. Some are better than others at this, but nobody can take it day in and day out without some degree of a wall. I think letting the wall down in off hours and processing will preserve a great deal of the humanity.

If you haven’t already, check out this thread for some perspective:

http://forums.studentdoctor.net/showthread.php?t=154841

 

[BPlaysItCool]

Wow, a mind control tactic? That was not my intent at all. In fact it was a joke in response to your earlier statement:



I admit I have a strange sense of humor, but I was actually agreeing with you in that people seeking salvation through helping others will only end up unhappy in the end. My personal belief is that helping others should be done out of a genuine desire to help regardless of what it can do for you.

****. My bad. Still not over getting kicked out of bible study for asking too many questions.

Now back to our regularly scheduled program...

 

[Torr]

Then he comes home tired and cranky, because he's given all he has to give for the day- all the virtue has gone out from him🙄- but then he acts like an a** at home, so the family (who are already tired and cranky from their respective daytime activities) gets more tired and more cranky.
(sounds a little bitter, huh 😉 we've mostly worked out our issues, but it's taken years and many screaming fights)

I just want to point out that if you were to read this snippet out of context, it could easily be applied to a profession outside of medicine. We all give some of ourselves to our patients, our businesses, our children, our sports teams....

Really no one else in my family is in medicine or science and this scenario plays out all the time.

I agree with the earlier point that although I might be losing some part of myself to my patients I'm also constantly finding ways to recharge myself.

Walls are inevitable but it's a balancing act. I don't wanna wake up as some old doc, completely sealed off from the world.

 

[EdLongshanks]

I think we are all unique and have certain skill sets we are born with. We tend to enjoy what we are naturally good at and are thus re-energized by it. Many of us have overcome some of our weaknesses through shear effort. While this is necessary and admirable, if we spend our days performing activities, tasks, analysis, interactions, and procedures that we are not naturally wired for then we will burn out and find necessary a much thicker wall to cope with the drain. Of course we will all have tasks in our day that tend to be natural weakness. I think the trick is to find a specialty/career that minimizes the work that we do that is outside of our skill set.

I’ll use myself for example. I am pretty God-awful at certain types of organization/administration. Because of this I should never have my own PC practice where I’m in charge of the business administration. Getting better at it through training and practice and good discipline helps me manage the administrative burden that comes with just about any job. But it should always be viewed as a necessary evil for me and kept at minimal levels if possible.

All of this is fairly obvious, but we all tend to want to challenge ourselves and not accept our weaknesses. This puts us in a bad place. What is not as obvious is that the reverse is also true. If we have skills inside of us that are not being used either vocationally or avocationally, then we tend to grow frustrated and will again burn out. This is a lot less likely to take shape in a physician, since it tends to challenge a wide variety of skills. Of course there are a few ways it can happen such as someone with exceptional skill at working with their hands going in to Radiology, but they could just take up woodworking as a hobby and be okay.

In general this aspect of it is a huge advantage we have over the traditional student. Most of us have a generally good idea through life experience of our strengths and weaknesses. I’ve gone through testing myself that has given me an added level of confidence to reinforce what I’ve gathered from life experience.

IMHO getting in to the right career is the first and foremost aspect of minimizing the need for a wall. But after all is said and done and you know your in the right career, you still have to have a wall to buffer the daily inundation of emotionally traumatic events. Some are better than others at this, but nobody can take it day in and day out without some degree of a wall. I think letting the wall down in off hours and processing will preserve a great deal of the humanity.

If you haven’t already, check out this thread for some perspective:

http://forums.studentdoctor.net/showthread.php?t=154841

JD, that is a great link and an interesting idea. We are recharged by doing what we love. There are times that we helplessly watch terrible things happen. This is a terrible energy drain. We just have to choose a specialty in which we find joyful experiences common enough to balance.

Even working with addicts in an urban setting can be joyful, if the rare success charges us up enough. We must find the niche in which we fit.

 

[jd221b]

That was my favorite thread when I first came to SDN. For several days I would read a few of the posts and cry, then come back for more. It brought back a lot of memories of when I worked in the ED. Ten years after the fact I remember some of the episodes like they were yesterday. There was the 9 year old girl that drowned. Performing compressions on her I sure as hell didn't have much of a wall. Yeah there was enough wall to function, but I was hoping and praying like she was my daughter. I think the physician must have felt the same because we went for 45 minutes before he called it. Then holding the mother to the floor while she tried to overpower the 4 of us that were trying to keep her from slamming her head in to the floor in a desperate attempt to end her life.

That thread helped me see that inside, the physicians were going through the same thing I was. That pain, as horrible as it was, is something I miss. It just seemed right for me to be there doing something. The extremes of life's emotions feel oddly at home to me. If I end up back in the ED, I know I'll come home some days and feel like I got punched in the gut. On those days I'll hold those that I love a little closer and try to process it all. Maybe I'll come back to SDN and offload when my wife is tired of hearing about it, or maybe just call a friend. I'm pretty confident that I won't lose my humanity based on my experiences. But there will be a wall, and it will get knocked down.

 

[EdLongshanks]

I can't help but quote from my new favorite doctor book "Blue Collar Blue Scrubs" by Michael Collins. Right after I started this thread I began reading the book and the author is saying everything that I am trying to say in this thread. I just read this quote a couple of minutes ago.

"I'm starting to see that the very act of trying exacts a terrible psychic cost. It's hard to pour yourself into a struggle, lose that struggle, and still come out emotionally unbloodied. Maybe that's one of the things we have to learn in medical school: how to become pragmatic without becoming cynical."

 

[n3xa]

Hot Lights, Cold Steel is also a good read.

 

[EdLongshanks]

Hot Lights, Cold Steel is also a good read.

I just started it.

 

[jd221b]

"I'm starting to see that the very act of trying exacts a terrible psychic cost. It's hard to pour yourself into a struggle, lose that struggle, and still come out emotionally unbloodied. Maybe that's one of the things we have to learn in medical school: how to become pragmatic without becoming cynical."

Good quote.

I'd like to add what is probably a very obvious point. Training and protocols offer the most natural and effective wall. I was exposed to and participated in many gut wrenching as well as gruesome situations in the ED. I didn't know how well my training insulated me until several years after leaving it. I was driving with my family on a road near my house when we came upon a motorcycle accident. There was a body on the ground and it was obvious that it had been there for five minutes or more. I performed compression only CPR because his face was a bloody mess and I didn't have a barrier. I paid a much higher psychic cost for trying in that case than I ever did in the ED. I believe the reason is that I was only 80% confident that I was doing everything right because it had been years since I had had CPR training. I also didn't have the team around me to give me the confidence that everything that could be done was being done.

Experience, protocol, and training take a lot of the trauma out of trauma. I'm sure that something like an emotionally charged terminal cancer diagnosis works the same way. Knowing what to say and how to say it takes the edge off of a terrible task.

The psychic cost is still there, but it certainly takes the edge off.

 

[EdLongshanks]

Good quote.

I'd like to add what is probably a very obvious point. Training and protocols offer the most natural and effective wall. I was exposed to and participated in many gut wrenching as well as gruesome situations in the ED.

I watched Forrest Gump last night and I have to mention my favorite quote from the movie. It comes in the scene where Jenny is angrily throwing rocks at the house where her father abused her.

"Sometimes," Forrest says, "there just aren't enough rocks."

 

[spicedmanna]

The problem with walls is that, given enough stress, they will break and come tumbling down, and the stress can come from either side of the wall. It's an archaic strategy, which, admittedly, will work most of the time, but all choices have consequences. The big consequence with putting up walls, is that you are bottling up your feelings and placing yourself at a distance that others have to traverse to get to you. And it takes you away from being fully present in the moment. It's hard to control as well, where you place those walls. Pretty soon, you may end up just walling everything. Bottled up feelings, in my experience, tend to come out in unpredictable ways, some of which may not be too friendly to yourself or others. As one of my colleagues, a psychologist, likes to say, withholding ultimately leads to withdrawing. This much is certain.

We have an inherently difficult job, full of potential for emotional pain. You do get used to it over time and you will develop your own strategy for handling it. It is possible to not have a wall, feel everything, and still function optimally, but it takes practice, which some aren't willing to do. I tend to let things through, but don't let them impact the task at hand. Sometimes, you have to take a few deep breaths to stay present. I like this strategy better because my patients feel me there, with them, and this is a form of healing that has been very underrated. Believe it or not, and whether they overtly realize it or not, patients demand your presence. If you put a wall there, you are denying them that part of doctoring. It's like anything that we do, when you first start the enormity of it all can seem overwhelming, but as you get more exposure, you learn how to navigate through the mire. You become a great explorer in those deep emotional realms. The funny thing is that patients tend not to remember what you did for them as much as how you did it, the care in which you took to really be there for them. Patients don't just come to you with their medical emergency, they also bring with them their deep psychological and spiritual wounds, and they are often connected.

The one wall I do have is that I do not let my feelings interfere with my objectivity, if they are not aligned. When something has to be done, based on my CLINICAL judgment, I will align with that. We have a very critical job to do and it is that job that takes precedence and what we are committed to. We do it because it is the greater good. I will take a deep breath and do what is necessary. Again, this takes practice and becomes significantly easier with time, although there is always that new thing that throws you temporarily off balance. I cannot provide a guideline for this, because it requires you to make your own. And you will.

About bringing work home: it happens. I try and try to separate them, but haven't had much success here. When I leave after a long day, I still have thoughts about, "oh, did I do this for this patient; did I check this or that; I wonder how he or she is doing; should I have ordered this or that, etc?" It's because you care...deeply. You can alleviate some of this by being organized and making checklists, keeping on top of things. You try to do things the same way so that you can follow the progression and rest on the fact that, yes, you did it just as you've always done it, for patient X. Still, though, you will have lingering thoughts. You get used to it, though, and with time, it won't bug you as much. It's hard, though, after a long day or during a day off, you are confronted with some random person, family, friend, or patient that will still try to elicit the doctor in you, when you are technically "off-duty." I have always erred on the side of helping, but this just makes them want more. At some point, you just have to draw the line and tell them to make an appointment, that it can't be handled this way, for yours and their benefit.

It is critically important that you have someone you can talk freely with about all the stresses behind medicine. You have to get it all out, or it will haunt you and affect how you work and live. You need to do it on a regular basis. Some people call this venting. I support this method.

Also, develop the ability to see the humor, or lighter side, in life and work, where appropriate. This keeps you sane.

 

[BPlaysItCool]

Man. Great posts.

I went back and read that EM thread that jd linked. And simultaneously put EM further into my probably not category.

As Ed (Forrest) says. Just not enough rocks. I don't think I want to go through that. Funny thing. I think my walls have developed chronic leakage as I've gotten older. Things that happened to the "other people" in my younger days have too many relational inroads to my own life now.

I don't think I want to deliver stillborn fetuses and see vehicular trauma. I'd be a mess. Training protocols or not. Too many restless ghosts to contend with.

I think my interest in psychiatry has a better intelectual interest without me feeling dragged down. I have strong walls of sanity. I literally cannot, although I've tried with various modalities, threaten my sense of my own sanity.

Maybe field choice is more important than we realize in this balancing act.

 

[spicedmanna]

Maybe field choice is more important than we realize in this balancing act.

Agreed.

 

[EdLongshanks]

The problem with walls is that, given enough stress, they will break and come tumbling down, and the stress can come from either side of the wall. It's an archaic strategy, which, admittedly, will work most of the time, but all choices have consequences. The big consequence with putting up walls, is that you are bottling up your feelings and placing yourself at a distance that others have to traverse to get to you. And it takes you away from being fully present in the moment. It's hard to control as well, where you place those walls. Pretty soon, you may end up just walling everything. Bottled up feelings, in my experience, tend to come out in unpredictable ways, some of which may not be too friendly to yourself or others. As one of my colleagues, a psychologist, likes to say, withholding ultimately leads to withdrawing. This much is certain.

We have an inherently difficult job, full of potential for emotional pain. You do get used to it over time and you will develop your own strategy for handling it. It is possible to not have a wall, feel everything, and still function optimally, but it takes practice, which some aren't willing to do. I tend to let things through, but don't let them impact the task at hand. Sometimes, you have to take a few deep breaths to stay present. I like this strategy better because my patients feel me there, with them, and this is a form of healing that has been very underrated. Believe it or not, and whether they overtly realize it or not, patients demand your presence. If you put a wall there, you are denying them that part of doctoring. It's like anything that we do, when you first start the enormity of it all can seem overwhelming, but as you get more exposure, you learn how to navigate through the mire. You become a great explorer in those deep emotional realms. The funny thing is that patients tend not to remember what you did for them as much as how you did it, the care in which you took to really be there for them. Patients don't just come to you with their medical emergency, they also bring with them their deep psychological and spiritual wounds, and they are often connected.

The one wall I do have is that I do not let my feelings interfere with my objectivity, if they are not aligned. When something has to be done, based on my CLINICAL judgment, I will align with that. We have a very critical job to do and it is that job that takes precedence and what we are committed to. We do it because it is the greater good. I will take a deep breath and do what is necessary. Again, this takes practice and becomes significantly easier with time, although there is always that new thing that throws you temporarily off balance. I cannot provide a guideline for this, because it requires you to make your own. And you will.

About bringing work home: it happens. I try and try to separate them, but haven't had much success here. When I leave after a long day, I still have thoughts about, "oh, did I do this for this patient; did I check this or that; I wonder how he or she is doing; should I have ordered this or that, etc?" It's because you care...deeply. You can alleviate some of this by being organized and making checklists, keeping on top of things. You try to do things the same way so that you can follow the progression and rest on the fact that, yes, you did it just as you've always done it, for patient X. Still, though, you will have lingering thoughts. You get used to it, though, and with time, it won't bug you as much. It's hard, though, after a long day or during a day off, you are confronted with some random person, family, friend, or patient that will still try to elicit the doctor in you, when you are technically "off-duty." I have always erred on the side of helping, but this just makes them want more. At some point, you just have to draw the line and tell them to make an appointment, that it can't be handled this way, for yours and their benefit.

It is critically important that you have someone you can talk freely with about all the stresses behind medicine. You have to get it all out, or it will haunt you and affect how you work and live. You need to do it on a regular basis. Some people call this venting. I support this method.

Also, develop the ability to see the humor, or lighter side, in life and work, where appropriate. This keeps you sane.

If this were facebook, I would click "like". This is the kind of physician that I want to be.

 

[spicedmanna]

I don't think I want to deliver stillborn fetuses and see vehicular trauma. I'd be a mess. Training protocols or not. Too many restless ghosts to contend with.

Don't sell yourself short, B. You'd be surprised at what you can handle when you are faced with it and have no choice but to respond. There's that ominous pause, but then your instincts and training simply take over, and as if a blur, your hands move as if guided by some mysterious force, not your own. You somehow do what needs to be done, what wants to happen. And, then, there you are, in the midst of utter chaos, doing what you thought you'd never be able to do. Yes, we are all messes at first. We are all the same, in that respect. It may not be perfect, not nearly, but at the end no body cares. They just care you were there, the seemingly calm in the storm, holding their hand, there with them doing the best that you can, straight from your heart. Inside, your heart is racing, your mind filled with this or that, uncertainty, shaking, body swimming in all sorts of feelings. Strangely, you also feel elated, so in the moment. You see this person, this patient, in front of you, looking through to your soul, reaching out, trusting you. You are the face they see and will remember. With practice, the mess becomes a symphony, and you hold the baton with care and love. They have no idea what you went through to get there. This is all of us. This is the process.

You don't know until you are actually faced with it, so don't try to decide just yet.

 

[jd221b]

👍 more later

Don't sell yourself short, B. You'd be surprised at what you can handle when you are faced with it and have no choice but to respond. There's that ominous pause, but then your instincts and training simply take over, and as if a blur, your hands move as if guided by some mysterious force, not your own. You somehow do what needs to be done, what wants to happen. And, then, there you are, in the midst of utter chaos, doing what you thought you'd never be able to do. Yes, we are all messes at first. We are all the same, in that respect. It may not be perfect, not nearly, but at the end no body cares. They just care you were there, the seemingly calm in the storm, holding their hand, there with them doing the best that you can, straight from your heart. Inside, your heart is racing, your mind filled with this or that, uncertainty, shaking, body swimming in all sorts of feelings. Strangely, you also feel elated, so in the moment. You see this person, this patient, in front of you, looking through to your soul, reaching out, trusting you. You are the face they see and will remember. With practice, the mess becomes a symphony, and you hold the baton with care and love. They have no idea what you went through to get there. This is all of us. This is the process.

You don't know until you are actually faced with it, so don't try to decide just yet.

 

[jd221b]

If this were facebook, I would click "like". This is the kind of physician that I want to be.

That's what 👍 is for.

 

[jd221b]

I had some personal demons that I was scared to death to face when I first went to the ED. Spiced manna is right that you figure out a way to get through it. After the first couple of times your personal connection to the tragedy serve only to reinforce your heartfelt drive to do everything you can. Yes it still hurts but not as much as you think. Personally it helped me deal with buried feelings. Since those days I've held my own stillborn child in my hands. I'm not looking forward to reliving that, but I know I can get through it.

I think that everyone can get through it with the caveat that they must be the type that has the courage to push through instead of shrinking back. Of course if you don't possess that courage then you don't belong in medical school.

It may be silly, but I think one way to gauge how you'll respond in the face of trauma is how do you respond to gut wrenching movies like Saving Private Ryan. Personally, I'm mesmerized by the drama and the trauma and have no desire to turn away. I feel it deeply and it makes me feel alive. There's a deep pain and a deep catharsis.

Then there's my older brother who was watching The Passion in the theatre. On one of the particularly bloody scenes he had to excuse himself. He went to the bathroom and was at the urinal doing his thing when the next thing you know, he woke up on the floor having pissed all over himself when he passed out.