This is an article I wrote for my medical school publication after a particularly difficult call that K went on. It took us a couple of weeks to fully recover from the damage it caused to his psyche.
What is your job as a doctor? Is it to know anatomy, biochemistry, pathology and pharmacology? Sure. However, it is more than just that, we share a very unique burden with law enforcement and other emergency personnel. Except for a small number of specialties, you will often be treating patients when they are very ill. It is our job to treat a whole person; part of that burden is treating their emotions. Unfortunately, when you are dealing with the most painful aspects of the human condition it is hard not to let it affect you personally.
Medical school attracts highly motivated, type A personalities who are used to being a person who is depended upon. Medical training also seems to impress upon students a somewhat casual approach to death and pain, beginning with cadaver dissection and moving on through clinical rotations. During the clinical years a student or resident can feel like showing any perceived weakness might hurt their grade or change how they are viewed by their mentors. Much of this problem comes from pride; the culture of physicians includes the ability to be a casual observer of these most difficult parts of life.
Home life may not be much improvement, especially if one does not have a good support system or someone else who can empathize at home. Often times it is even suggested to emergency responders not to “bring work home” with them. So imagine this scenario: you have just worked a twelve hour shift of dealing with other people’s pain, you know you have no one you can talk to about it and you know that when you leave work you have people who are depending on you to complete your responsibilities at home; it is easy to see why there is such a high prevalence of drug and alcohol abuse amongst physicians and other emergency personnel.
It is incredibly important, in my opinion, to learn early in a career how to debrief effectively. It is inevitable that at some point you will see a patient that will trouble you. They will remind you of your mother, your children, a painful situation in your past, or you may have a patient die and feel like it was your fault; something will get into your head. It is our job to be able to compartmentalize our emotions to effectively take care of our job and treat the patient at that moment. However, leaving your emotions compartmentalized will effect all of your personal relationships and in the long run is detrimental to your entire life and leads to burnout.
So who rescues the rescuers? We all do, it is our responsibility as a community to be able to recognize the signs of someone having a difficult time and to be available for them. It is our job to support the members of our teams and realize that everyone will eventually have a problem like this. It is also our job to be open enough to recognize these feelings in ourselves and seek out help instead of letting them fester because we are no use to anyone if we are broken.
“Physician, help yourself: thus you help your patient too” – Nietzsche
