The functional and professional necessity of detachment

There’s an intersection in Boston outside one of my favorite places to eat. At the corner of two bustling streets is a white bike, chained in place, surrounded by flowers. In loving memory.

***

One evening earlier this month, I was riding the ‘T,’ Boston’s streetcar system, when our train suddenly stopped.

There were the usual sights and sounds of delayed passengers: people fiddled with cell phones, glanced at watches, tapped feet impatiently. Outside, the flashing of police cars lit the night. “Maybe we should catch a taxi,” my friend said, and I agreed. We asked the driver to please open the train doors.

“Can’t go anywhere yet,” he said. “See that dead body?”

“What?”

The few of us near enough to hear him went to the window. Motionless on the pavement was a human-size lump, covered with a white sheet. Next to it, a mangled bicycle. Wheels facing up. Tires and handlebars twisted. Around them, cops were talking. Or were they? It was hard to tell.

Mostly I noticed the way they were standing. In a circle, surrounding the sheet. This was not an unusual occurrence to them, and it showed on their expressionless faces. They were doing their job, and I’m sure they were doing it well.

I’m not sure why their lack of open emotion surprised me. But it did.

***

At the beginning of first year, we were asked to reflect on several aspects of becoming a physician. One of our prompts said this: “Doctors must simultaneously care deeply about their patients and yet maintain detachment. In what ways is detachment a positive, and in what ways can it be a negative, in the doctor-patient relationship?”

“I understand that as a physician, I will be immersed in people’s lives to the point that I will feel closely invested in their outcomes,” I wrote. “While I am concerned about confusing a patient for a host of disease, I also recognize the value of keeping some distance to allow for logical processing of medical issues…”

The person on the bicycle that night was not my patient. I know my feeling of connection is not rational; that it was provoked not by any meaningful relationship, but by the arbitrary circumstances of a T ride through Boston one evening. That people pass away all the time. Almost two per second, I read somewhere. I don’t have the capacity to mourn them all. That’s the right of parents and children, spouses and siblings, other relatives, friends, neighbors, coworkers, religious leaders, caregivers. The rest of us can feel horror, remorse, sympathy – but can a stranger truly mourn?

A bit of detachment is a functional and professional necessity. But it’s hard. For days, I Googled the name of the intersection and “bike crash,” waiting for the media to confer a face, a name, and an existence to what lay beneath the white sheet. I needed to know that a person, not just a body, was there. A person with a life, a personality, stories, friends, memories. In some way, it felt disrespectful not to know.

Maybe I felt that way because of how instantaneously a person becomes a body becomes a statistic. I thought of the graph they’ve shown us in medical school on the most common causes of mortality in the United States. A bar for heart disease. A bar for cancer. Followed by the third biggest cause of deaths in the US: accidents. The person on the bike couldn’t fade into that. Not yet.

Sometime while we were on that train, a bus was traveling in one direction, and a bicycle was traveling in another. Sometime while we were on that same train, everything was fine. Then: a blip in the universe, and something awful and irreversible.

I can’t help but feel that there’s something deeply flawed with a world that can take a person’s life without even giving her time to process it.

“I do not want to let the heartache that comes from one unfortunate outcome become such an overwhelming emotional drain that it detracts from my ability to care for others.”

I know I can’t mourn everyone. I know, especially, that I don’t have the right to mourn the woman on the bicycle. To write about her. I never knew her, while others did. Others loved her.

I am so, so sorry for your loss.

***

The train eventually started moving again, and my friend and I sat in silence. Talking about the details of our days so soon after seeing what we did felt wrong. I alternated between looking out the window and at my feet. Partially I was looking away to hide my wet eyes.

“Do you think you’ll ever become desensitized?” he asked me after a while.

“I don’t know. I guess I have to, a little bit.” I said. “But I’m not sure I want to.”

Ilana Yurkiewicz is a medical student who blogs at Unofficial Prognosis.

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  • Jennifer :D

    Thank you so much for this. My mother was killed a year ago today by a careless driver surfing the web on her smart phone. The newspapers referred to her as “the jogger.” I know there are always people who care, whether or not they ever met the nameless victim. Your beautiful article will resonate with countless others, whether or not they choose to comment.

    • http://twitter.com/ilanayurkiewicz Ilana Yurkiewicz

      Jennifer, I am very sorry for your loss and your experience surrounding it. I cannot imagine what you went through. Please know that the simple terms the newspapers might use to refer to a person are not what everyone else, including strangers, use to think about her. Thank you for reading and leaving your thoughts. Best wishes,
      Ilana

  • Kathy Nieder

    Desensitized a little? Maybe. But if that the sadness ever goes completely away when you lose a patient–that’s when it’s time to find a new profession.

  • http://twitter.com/GoldCareInMed The Gold Foundation

    We are moved by this very honest response to the dilema of balancing your humanism and your need for a certain amount of professional distance. While you question whether as a stranger you can truly mourn the death of the person you witnessed, it is clear that your compassion for those who truly can mourn is in tact. The humanistic attributes of integrity, excellence, compassion, altruism, respect, empathy, and service are what we believe make for an exemplary physician. Sounds like you on the right track.

    • http://twitter.com/ilanayurkiewicz Ilana Yurkiewicz

      Thank you for your comments and kind words. This meant a lot to me.

  • http://twitter.com/leejcaroll carol levy

    I was on a train when it hit someone. The person died. They had us wait, on the train, until the coroner came to take away the body. I was amazed at 2 things. I saw almost no emotion from the other riders. They went back to their computers, reading the newspaper, talking as though nothing had happened. And when I asked a conductor would they get a new driver. He said No, the driver was used to it.

    • http://twitter.com/ilanayurkiewicz Ilana Yurkiewicz

      Carol, that sounds like an utterly horrendous experience, and I’m sorry it happened. I wonder if perhaps some of the passengers who appeared to be doing normal things (eg reading a newspaper) were in fact reflecting on what had happened? Maybe I’m naive, and I do trust your instincts. But I have wondered about the different ways people grapple with sadness. Perhaps for some, sadness can be there without outward expressiveness. Or, maybe the full realization of what happened can hit them later. In any case, the conductor’s response sounds appalling.

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