Why maintaining a distance is necessary for doctors

You would think that for doctors, who work with life and death issues every day, the issues of our own frailties or the tenuous line between health and sickness for our own families would be, if not accentuated, then at least more immediate than to those who, say, do investment banking for a living. But the strange thing is that despite our easy familiarity with human mortality, it is not the case at all that we are able to readily apply these scenarios to ourselves. We see patients who are sick or even dying on a daily basis–sometimes patients who very much remind us of ourselves, our spouses, our parents, our kids. But it’s just a constant stream of other people. And seeing so frequently that it happens to other people, more than anything, starts to make you feel unconsciously like it’s always other people, that it could never happen to you, or to those we love most.

Two years ago, when my husband was hospitalized after an acute bout of viral myocarditis (from which he has since totally recovered), the experience was not so much of concern or apprehension–though, of course, there was plenty of that too–but more than anything a feeling of disorientation. We were in an ICU. It was morning. Morning work rounds were underway, and even through the closed door, I could hear the scrum moving from one bed to another, emitting a low hum of recited numbers and medications and therapies that, even just partially overheard, sounded wholly familiar. But I was inside the patient room now instead of outside like I usually would be, and Joe was lying in the bed beside my chair. The environment was familiar, but the context was completely strange. What was I doing here? Why wasn’t I outside at the nursing station, checking labs, writing orders? Why was Joe wearing a nasal cannula? Why was he the patient? How could this be happening?

Some of the experience of being a doctor involves being close one instant and yet distant the next. It sounds strange, and sometimes patients interpret the emotional boundary as coldness, but in many ways, maintaining a distance is necessary in order for to be able to do the job well. I am warm with patients, as familiar as I need to be, but in my mind, I set up barriers. Sometimes there are things that I don’t want to know. Sometimes there are things that I don’t want to see. Taking care of patients is wonderful, an honor, and yet sometimes, the things we know threaten to tear you up from the inside, in small, insidious ways when you least expect it–like tiny shards of ground glass you didn’t even know you’d swallowed.

Because sometimes things happen and you can’t set up barriers, because they’re too close, or happen too quickly. And that’s when it’s hard. And those are the nights you come home to your family after work and you hug them a little bit tighter, a little bit longer. And your kids think you’re crazy and start running around, shouting about whose turn it is to throw the Frisbee, that they’re ready for their evening snack, and asking if they can watch “Kung Fu Panda” for the umpteenth time because they haven’t watched any TV at all today, not even a single second.

Then they ask you about your day. And that’s when the barrier comes up again, as you force a smile and sneak in another hug before telling them that your day was fine, just fine, thanks for asking.

Michelle Au is an anesthesiologist and author of This Won’t Hurt A Bit (and other white lies): My Education in Medicine and Motherhood. She blogs at This Won’t Hurt at Bit and the underwear drawer.  This article is reprinted with the author’s permission.

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