I’ve been conceptualizing this for several years now – ideas about what I would like to do with perspectives from my long-time practice as a physician and those always developing as a psychotherapist. I love both; each brings a unique skill set and way of being in the world, and I am well-immersed in the confusions one has for the other. I am an adult therapist with a deep love for the interpersonal expressed in my work with individuals and couples, integrating my understanding of neurobiological substrates that interact with the environment to make the changing and growing “who” of us.
As an anesthesiologist immersed in physiology and pharmacology, med/med interactions, and how to integrate these into the behavior of illnesses of the physical body while being subject to the physical stress of surgery – the heart in failure struggles under the best of circumstances, and now we are going to expose it to a surge of sympathetics; these kidneys don’t make pee, so I am, for a time, responsible for fluid and electrolyte balance. I replace blood lost, navigate coagulation parameters – some say this is easy. Some say being a therapist requires little in the way of effort or training. Neither, of course, is true, especially if one is a serious clinician. I am certainly that in spades.
So, what does it mean that “they get to tell their story, and this is healing”? For emotional insight, I lean into Gregory Orr’s devastating memoir, first picked up to better understand his poetry. He describes with excruciating reality the impact of having to hold your story in isolation. His grief and shame are palpable, leaping off the page into our own consciousness. We shudder with him, want to disappear into the floorboards, want to run from his described experiences. At times, it is almost too much to bear. Mind and body shrink in response to the emotional fallout of a tragedy. But especially a tragedy we are unable to share with others.
We develop unshared beliefs about ourselves that directly impact the direction and experience of our lives and relationships. If in childhood, those perspectives are necessarily distorted by that developmentally egocentric perspective: it was my fault and therefore I am bad. So, to witness is also to transform underlying beliefs, or sometimes to facilitate acceptance in all of their shuddering horror. It is to be with, to understand, to comfort, to expand access and acceptability to our darker sides, to those sides which we all carry. It is to come to terms with, find peace, and, ultimately, access to a fuller range of emotion, sometimes, to shed depression or chronic anxiety. The physiology of feeling, right-brain attunement, the importance of this, such a different set of parameters compared to wheeling a patient back to the operating room.
To hold the direct responsibility for someone’s death is an agony impossible to imagine without having had some direct experience. Physicians understand this in an alternate context – I was here to help and heal, and instead, my treatment led to death or disfigurement. This is a reality every physician is required to accept, overtly or subconsciously, along with the solemn oath we all take upon graduation. My personal decision to become a doctor was directly tied to this responsibility – if I am the cause of someone’s morbidity mortality, as we say in medicine, I don’t want that to be because I carried out someone else’s orders. Denial plays an enormous role in much of the work of physicians. Denial that complications can occur in my hands, as long as I am careful, meticulous, hyper-vigilant. It is among the greater challenges physicians navigate, directly or indirectly, over the course of a career.
That bad things can happen directly due to our hand is not the only denial in action. Grief is also given short shrift. We see this in our callous descriptions of tragedy with no connection to the impact on a person. We see this in callous responses to pleas for help: “You’re an alcoholic, you aren’t getting treated anyway, so just forget about it,” “he’s a methhead, a loser, a waste of our time.” These kinds of interactions can be pathognomonic for burnout, but they can also result from consistent exposure to meanness and tragedy with no outlet for processing, being witnessed, comforted, heard, and understood. It takes a deliberate approach to navigate this with some sense of equilibrium.
As in all aspects of life, we cannot deny one emotion selectively without impacting the experience and meaningfulness of all, including peace and joy. Much of medicine ignores, denies, or represses the intensity of feeling to which this career exposes us, and as a result, also denies the intimate relationship between our minds and our bodies. This can be described in neurobiological terms today, but it is too easy to intellectualize a predominantly emotional conversation. And physicians are not the only bearers of the fallout of denying emotion. Orr’s shame was physical, painful. And, of course, it takes a poet to help us understand the power of witness.
This is our best training for becoming therapists, for understanding what it is we are doing in the therapy office, beyond just being another profound empathy with someone’s questioning self. We need compelling learning to be able and willing to tolerate the worlds that we are privileged to enter and be part of, so that we can witness, while also helping to unravel those implicit assumptions, rooted in the early development of the brain, our mind, and body.
Maire Daugharty is an anesthesiologist.