Emergency physicians have to build emotional walls. Sometimes they break.


We emergency physicians are often thrust into the frontline battles raging in society. The pain, blood, and emotions are so real, so thick and ever present, creating an undertone that is difficult to deny. We walk the corridors of our departments actively involved in life or death, where the span of mere millimeters might as well be miles as we explore wounds, clinical scenarios and presentations. How do we do this on a day-to-day basis? How does active involvement in tragedy and triumph of others become a career? How do we leave the trauma bays, resuscitation rooms and bereavement rooms and continue our lives with families and friends without a shattered, paranoid perspective?

Humans have the innate ability to compartmentalize and depersonalize repeated traumatic events. This process has been studied and replicated in multiple societies during wars, famines or times of extreme social constraints. It is nature’s cloak of protection that shields, compartmentalizes, and protects us, enabling the process to go forth. It’s what ensures steady hands during a thoracotomy or pediatric resuscitation. The cloak of brief depersonalization ensures that lifesaving processes are carried out with meticulous detail while chaos, death and devastating disability encroach furiously. It creates the eye of the storm where the physician, nurse and ED staff can perform.

We have all had those moments where the cloak slips, and depersonalization falls by the wayside — leaving us exposed. Maybe it was the big pink bow on a child being resuscitated or the faded nail polish on a geriatric woman in cardiac arrest. The hint of perfume that brings back childhood memories of neighbors, teachers or lost acquaintances. It’s these moments that follow us to our cars, come us home and rest deep in our souls. I feel that these powerful moments make me a better physician, father, husband, and friend. The cloak is on the floor, the veil is lifted, and two worlds collide, creating a beautiful and perpetual evolution.

As emergency physicians perched on the frontline of life and death, we are the orators of miraculous saves and untimely losses. Not many weeks go by that I’m not walking to the family consultation room with a charge nurse to deliver the news of death. Personally, this is where the cloak is strongest, providing sympathy and compassion but raging a battle against empathy, a battle of preventing us from being in the shoes of others or the other side of the dialogue. But sometimes the battle is lost, and I’m forever grateful.

I recently had a conversation with a father who was forced to face the untimely death of his son — a vivacious child full of potential, love and charisma. His dreams and aspirations were much like those of our children. The tears in the father’s eyes, his devastating silence and his broken embrace evaporated my compartmentalization and cloak. We were two fathers. His steps echoed loudly as we walked the dimly lit corridor to the resuscitation room where the body rested, tubes and IVs long gone. My steps as a father, husband and brother echoed in the steps of his well-worn boots. It was the sound of his boots that followed me to my truck in the misty night air at the end of my evening shift. It was the sound of his boots that followed me home. His echoing footsteps in that corridor followed me up the stairs to my children’s room, where I peered in at my sleeping children.

Subtle glimpses of similarities, the emergence of empathy and beams of light that break through nature’s cloak make me a better physician, father, husband and son. Life is precious and can’t be compartmentalized neatly. Complete compartmentalization is unnatural and impedes patient care and personal growth. I embrace the echo of that father’s boots and the collision of paths while answering my calling to emergency medicine.

Jeffrey McWilliams is an emergency physician who blogs at Advocates Of Excellence.

Image credit: Shutterstock.com


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