A long time ago, when I was interning in an emergency department, several ambulances arrived at once from the site of a bombing. They unloaded three victims plus a mass of assorted limbs. As I placed an endotracheal tube in one patient, the awfulness suddenly hit me: These people had probably been sitting peacefully at home only a half-hour earlier, and now they were a mass of gore. Overwhelmed, I froze for a moment. Then I thought, “Dude, this is why you’re here. It’s not about you. Get to work.” And I did.
This scene remains with me decades later. I’m not alone, though. All docs have witnessed the unspeakable, yet even today there’s hardly any mechanism for processing our emotions except the professional subtext which says, “Shake it off.” Get back to work, put it behind you, get a grip, toughen up.
That advice is as cruel as it is useless, since it prescribes deliberate ignorance as a coping strategy. A member of a cancer support group once said, “Buried feelings are always buried alive.” Indeed, that’s precisely the source of PTSD, or post-traumatic stress disorder.
We usually associate PTSD with soldiers and veterans. Certainly, they experience trauma, but there’s plenty of trauma elsewhere, too. Civilians who have been assaulted and abused can suffer it, too. And it’s not uncommon in medical patients.
Imagine being suddenly diagnosed with, say, cancer. Just hearing the C-word, your world becomes so much confetti tossed into the air. You feel frightened, anxious, lonely, and more. There’s no time to sort these feelings out, though, because you need immediate treatment. So you get treated, are finally in remission, and you get much of your life back. But friends say, “How come you have these mood swings? Your cancer’s history now, isn’t it?” Well, the cancer may be, but your buried feelings are clawing their way to the surface.
We docs live with a similar threat. By definition, we work with people who are hurting. We wade in suffering for a living. We see more than our share of tragedy and horror, and we’ve been taught to suck it up, shake it off.
I once facilitated a support group for doctors, believe it or not. Every session was dominated not by the grief endemic to our work, but by frantic concern that no one outside the group learns who was in it. For a doctor to admit any vulnerability was taboo. This is garishly ineffectual armor, but I don’t think it’s changed much. Today’s doctors complain more than ever about the tribulations of practice, and many are depressed and suicidal, but too few take the first step toward treatment, simply admitting that they hurt.
Jeff Kane is a physician and is the author of Healing Healthcare: How Doctors and Patients Can Heal Our Sick System.
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