Physicians put up walls. But they feel everything.

We sat in the office of the intensive care unit under fluorescent lights, both staring at computer screens covered in vital signs and labs. It was the summer of my second year of residency, and I spent it entirely in the intensive care unit. There were two of us on call at night. Half the nights we would spend shooting the shit about life, and the other half we spent running around trying to pretend like we knew what we were doing. One year as a doctor, and we were the front lines in the ICU with the sickest patients in the hospital. The learning curve is steep, to say the least. I could feel the pressure of that every day. I could also feel myself changing. The soft edges of my personality had ever so slightly started to harden. A change perhaps imperceptible to anyone but me, but I could feel it.

“What do you mean?” he replied.

“Do you think all this stuff we see changes us? Do you think we even feel anything anymore?”

There was a pause in the conversation. We sat there in silence, with no answer to the question, for what seemed like forever. The empty space and inability to answer spoke volumes in and of itself. The silence was finally broken by my all too familiar pager beeping.

“F*ck. It’s a 911.” The pages came across our screen in a type of code to denote how severe the injuries or how sick a trauma patient was. And a 911 code was the most sick and injured type of patient. And that usually meant a night without sleep.

“Maybe it’s just another old lady who fell and hit her head. It’s probably nothing,” he said, and went back to scanning data and numbers on his computer screen.

I grabbed my stack of papers and pagers and started walking the quarter mile down the hospital halls to the emergency department. We never ran to codes, we had to keep our composure. So I walked at brisk pace through the blank white-washed hospital halls, half frustrated that I might be up all night and a half excited by the idea of some good trauma action.

As I walked in the back of the trauma room, all I could see was a street sign post, a stop sign, sticking straight up from where the patient’s gurney would be and a crowd of people. I couldn’t get a good look. Frustrated, I wove my way through the crowd as much as I could until I saw the man lying there exposed, breathing tube in place, paralyzed. My eyes widened as I could finally see the stop sign entering flesh and bone, impaling his left hip. This fell into the category of good trauma action for sure.

The room was a combination of people actually working and spectators gathered to see the exhibition of such a thing. While the workers were circling and buzzing getting the patient ready to go to the operating room, the spectators were spectating. Someone said in the back of the room, “Didn’t he read the sign?” Half the room chuckled, and half the room groaned at the dark and distasteful slant of the joke. The base and sarcastic side of me laughed with the spectators. After all, if I couldn’t laugh in dark times I was never going to survive residency, I told myself. I looked at the patient’s face as he rolled out of the room. Through the breathing tube and blood, I could see he was young. Younger than I expected. But despite the young nature of his face, he had lines around his eyes for days, like he just went through life smiling at the joy of being alive. I wondered if I would ever get lines like that as I watched him roll him out the door to the operating room. I walked back down the white washed halls of the hospital the quarter mile to the ICU and waited.

A couple hours later they brought the patient back to the unit bandaged up, looking clean and almost human again, stop sign removed, and dropped him off in his room for me to take care of.

“You know they say he’s a drummer. Pretty good one I guess. Has a couple kids too. They are young I think.” I heard the nurses in the unit gossiping. I didn’t particularly like knowing more about my patients’ and their life story. It made it more difficult somehow. So I put my head down, tuned out the conversation, went back to pouring over data. We drew labs; we checked vital signs. Everything appeared reassuring. He was going to be ok, and I could feel myself slightly relax.

Thirty minutes later, the nurse called me to his room. His blood pressure had just dropped precipitously. We started rapid infusions of fluid and blood. Something was wrong. I lifted the sheet and looked at his leg. It was purple and blue, cold and lifeless. Something was definitely wrong. I called the resident more senior to me to come and take a look. He raised the sheet, took a quick cursory glance at the leg, didn’t even flinch at the gory appearing nature of the limb, and set the sheet down. He walked swiftly to the desk and made a phone call. I heard him mumble “We need to go back to the operating room” and then “yes” and then a “no.”

“Package him up.” That was all he said to me as he glided out of the intensive care unit, white coat flapping behind him. I sat on the red biohazard bin in the corner of the patient’s room waiting for the operating room team to come get him. My knee jiggled up and down at a rapid pace nervously. I stared at the monitor above the patient’s bed watching the green, blue and red tracings carefully. I only had to keep him alive a little longer, and then they would take over. Empty blood packages sat on the ground next to me in a pile, each one life saving for about fifteen minutes, then we had to give another one.

After what felt like forever, the operating room team finally came and rolled him out the door. I was relieved. Without responsibility for the moment, I could feel the adrenaline that had been pumping through me slowly dissipate. The bedside nurse put her arm around me and gave me a hug, like we had survived something together. It was now 5 a.m. My shift was almost over, and I had survived.

We all sat in the office and laughed about the night. I was recounting the story of the stop sign to my co-residents with wide eyes when the phone rang fifteen minutes later. “We are bringing him back. There’s nothing else we can do. Call the family.” Click. I could feel my heart sink to a low pit in my stomach. I did not understand. How could we not save him? We could fix anything right? What do you mean call the family? There was no opportunity for questions or explanation; this was an order. I walked over to the nurse and said “He’s coming back. We are done, I guess.” A look of sadness and horror came over her face. I could feel my face and tone of voice were both blank, like those white washed walls of the hospital, absent of emotion or feeling.

I dialed the number to the patient’s mother. And then his sister. I could hear myself speaking but did not connect with the words. They felt empty and flat. I could hear myself saying the preselected script “There is nothing else we can do” and “I’m so sorry.” I tried to remain detached. I needed to keep up that wall. I went about the motions of notifying the family that their loved one was about to die, because we, as doctors, could do no more for his injuries. Because sometimes even surgeons cannot fix wounds inflicted. It felt like I was moving in slow motion. The rest of the ICU was going about their business, ramping up for the day, and I sat in the office making phone calls in an isolated and muted bubble.

We kept him alive until the family could gather at the patient’s bedside. About fifteen people came, one or two at a time. I watched as they walked by the resident office, eyes directed to the floor, filled with grief, anger, and disbelief. They all huddled around his bed. Some held his hand. Some touched his face with care. Others stood with a distance in the corner of the room. I watched from outside, exhausted and spent, each moment passing I could feel myself become softer. I could feel the walls crack.

I was about to leave when the sister of my patient came out of the room and asked to talk to the doctor who took care of her brother. The nurse directed her towards me. I stood there in the hallway, exposed to the rest of the care takers in the unit. The other residents, nurses and surgeons saw her walking towards me, and I could feel their eyes on us as the conversation unfolded. I grew tense, trying to hold on to my last ounce of composure and fortitude. I had to keep it together. I did not want to be called soft. Tears streaming down her face, she looked me straight in the eyes and said, “I know you did everything you could do.”

That one sentence disarmed me in a way I didn’t know I could be anymore. I cried with her, for the impending pain and loss of her brother. I sobbed in front of my peers, mentors and staff. She gave me a huge hug and then invited me into the room to be with the family while her brother died. I couldn’t do it. I said thank you and goodbye and rapidly walked out of the unit. I went home to my small and cozy apartment, bloodshot eyes and stuffy nose and slept for what felt like days. When I woke up, I felt strong again. The walls were patched and repaired, and I was ready for another night in the ICU.

So, I guess the answer is, we always feel. We feel everything. Maybe we just put up walls to make it easier. We leave our emotions trapped and hidden below a strong exterior so we can remain professional. Sometimes our feelings are deflected with sarcasm or a poorly placed joke. But now and then, those walls crack, and we show our true feelings. Feelings we weren’t sure we even had anymore.

Caitlin Smith is a surgical resident who blogs at Education of a Knife.

Image credit: Shutterstock.com

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