As someone trained in Brené Brown’s curriculum for helping professionals, vulnerability is my jam.
As a physician? Not so much.
The COVID-19 pandemic has thrown already burned-out health care providers into the arena with more than just a shortage of equipment. We are now expected to risk our own lives caring for others, which was not part of the original job description. Medical providers are not Marines, nor do we work for the Secret Service; we never signed up to take a bullet for another. Yet, we are asked to “be brave” and show up anyway. And we are doing it.
But not without consequences.
In this time of unprecedented uncertainty, being afraid to show up in a dangerous work environment is understandable. Trusting our intuition to stay home with our families and stay safe has a strong pull on our consciences. We are humans, and we are hardwired to seek safety, first and foremost.
In this context, the motto Show Up, Be Seen, Live Brave™ leaves me asking: “how are we supposed to show up now? What is brave?”
Some of us think brave is being afraid and showing up anyway. But doing what we are told, without having a choice, leads to resentment and, in the worst cases, trauma.
Some may see bravery as going against the herd, speaking up against what others expect, in order to stay within your own integrity. But in medical culture, going against the grain is often met with labels such as “high maintenance” or “difficult.” Or, as in the case of Dr. Ming Lin, an emergency room physician in Washington state, unemployment.
I would argue that both responses are equally moral, justified, and courageous. Each option will also result in some degree of shame. There is no way to “win” under these circumstances, and none of us will come out unscathed. The degree to which we survive this pandemic intact largely depends on the skills each of us have to deal with our own emotions.
There are lots of ideas and definitions about what vulnerability actually is. For me, it really boils down to being willing and able to feel feelings. It’s the emotional experience that we have about uncertainty, risk, and exposing our emotions. We don’t like the feeling because it’s so uncomfortable.
We are well-versed in showing empathy and compassion for patients and their families; however, health care professionals, physicians, in particular, are notoriously unskilled at recognizing our own emotions. Notice I said recognizing. We are quite savvy at managing our emotions and are downright gifted at burying, hiding, avoiding, and denying any socially unacceptable, negative emotions.
To be fair, I want to say, “It’s not your fault!” Contrary to popular belief, emotional intelligence is not in our DNA or something present at birth. It is acquired. It has to be taught, and it has to be learned.
None of us got any formal training on how to deal with our own emotions. Such “soft skills” took a back seat to memorizing facts and executing protocols. Assuming that we arrived in medicine with some degree of emotional intelligence from our upbringing (which is a hefty assumption to make), a life in medicine has trained our own vulnerability right out of us.
It has been my experience as a coach working with physicians that each of us can recall an experience very early in medical training when our innate emotional response to a tragedy in the clinical environment was met with a strong sense of shame; an unspoken message of “you are not allowed to feel that or express that and certainly not here, not now.”
Shame is the mother of all unwanted emotions and brings an overwhelming physiological response that translates into, “I am bad. I do not belong in this environment. I am not worthy of being here.”
Meta-cognition is the way we think about our thoughts. Meta-emotion is the way we feel about our feelings. As health care professionals, we have shame about our feelings. Shame about having feelings and shame about showing feelings. We learned quickly: I don’t have time to feel. I don’t have permission to feel.
As we move from room to room to room, come home exhausted, only to repeat the cycle the next day, unwanted feelings go unaddressed. And the thing is, unprocessed emotion doesn’t go away. It builds up in intensity and ultimately wreaks havoc on our physical and emotional health.
In 2018, The Wall Street Journal reported: “We have an epidemic. Close to 400 physicians a year are committing suicide.” That was two years ago, before the pandemic.
This week, The New York Times printed: “She tried to do her job, and it killed her,” said the father of Dr. Lorna M. Breen, who worked at a Manhattan hospital hit hard by the coronavirus outbreak.
In a 2017 study of 2,800 physician “star performers” by El Aswad, Nadler, and Ghossoub, it was found that high-achiever success is a function of 75 percent emotional intelligence and 25 percent technical competency. We know that sports champions always have a coach to help them with the mental game. As a society at large, we recognize that the stress that comes with being a star performer necessitates emotional assistance.
In the world of medicine, inordinate stress is instead accepted as just part of the job. If you can’t handle the heat, get out of the kitchen — or see a therapist on your own time and dime. I strongly believe that traditional therapy and psychiatry are vital and valuable disciplines — I might not be here without them. But not everyone who needs help living through this crisis (or pre-coronavirus life) is mentally ill or needs a diagnosis in order to qualify for guidance and support. No one should have to go through this pandemic, or life itself, alone. Literally or metaphorically. Not even doctors.
As we wait for scientists to develop a vaccine and improve the reliability of testing, it is a good time to confront the obvious: in order to come out intact, healthy and whole on the other side of this pandemic, we are going to have to build our emotional intelligence and learn how to be vulnerable again.
The only way to heal is to feel.
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