Am I the cold and detached physician?

It’s 9:30 a.m. on a Wednesday, I get on the elevator, and I hear a man in his 40s, having a conversation on his cell. He says: “He had a brain bleed yesterday, and they had to put a breathing tube in, they don’t know how much damage his brain has suffered at this point.” He gets off on the adult ICU floor. I quickly think “that sucks” and carry on.

A little bit later that day, as if the theme for the day was brain injury, I walk by a woman standing on the street. She speaks on her cell phone and says: “There was a blood clot that went to his head, and now they are trying to bust it, I’m not sure what’s going to happen.” I glance at her, think “that’s not good” and move along.

Reflecting on my day

That night, as I thought about my day, I contemplated how often I hear people complain about physicians being cold and removed. I analyzed my own reaction to the two strangers I overheard that day. The language I heard is such an integral part of my everyday vocabulary. I honestly didn’t think too much about it.

Then I thought, was it that I really did not care? Is it that the system, with the ever-growing workload and the rising demands, has jaded me to the point that I’m truly “cold and removed?” I took a trip down memory lane and looked back on my journey as a physician.

The young physician

When I first started training, every child that died, every family that suffered, it was personal.

I remember calling my dad during the early days of my pediatric ICU training. One of my patients, whom I had been caring for during many months, died. I was upset and crying. Each death was an emotional drain.

Emotional evolution

As time went by, I went through an emotional evolution.

During my last year of ICU training, I volunteered at a hospital in Tanzania for a month. As in most developing countries, death in children happens much more frequently. They don’t have the technology, money or resources that we have in the U.S. While in my home hospital we had one to two deaths per month, in the hospital in Mwanza, they had six to eight deaths per day.

This was inconceivable and outrageous to me. At the same time, it opened my eyes to a different reality. Their grief reaction and their perspective on death and dying was unlike ours. Naturally, parents grieved the loss of their child. However, the grief seemed shorter-lived and less extreme. It seemed death was not such an unexpected event. It was very much a part of life.

I was finally able to internalize that. Yes, losing a patient is terrible, but sooner or later death comes for all. Sometimes, even if you do everything, you still can’t save someone. To be honest, after doing this job for many years now, occasionally, death is a kinder alternative for the patient and the family. It is easy for us to forget it because we have so many life-sustaining and prolonging interventions available.

So, my outlook changed. I finally understood that to be able to do my job and to do it well, I could not be led purely by emotions.

Walking in someone else’s shoes

Being led by logic may not seem great for some, but picture this:

Imagine you are a physician and you are trying to resuscitate a patient, but you are so upset that you are unable to think logically.

I don’t think this is the kind of doctor you or anybody would want.

What I look for in a physician is someone who is able to take a step back and unemotionally BUT compassionately (one doesn’t preclude the other), tell you the facts and information, so that you and your family can make decisions.

Once I saw the kind of physician that I wanted for myself, I had a clear picture of what I needed to become: levelheaded, cool in a crisis, even when everything around you falls apart — while at the same time being compassionate to the suffering of fellow human beings, but emotionally neutral (as much as you can). This, of course, is no easy feat, but it is possible.

So, are we cold and detached?

Big nope. Now, when I hear this, I have to disagree. There are some docs that, due to their formation and experiences, actually fit this description. However, this is the exception, not the rule.

Think about the life of a physician, from medical school to being a fully “grown” practicing physician.

Think of all the patients they have lost along the way. All the tears shed. The sleepless nights spent at the bedside of what was undoubtedly a lost battle.

Imagine how that doctor could survive if they continued to feel and suffer throughout their career as they did when they lost that first patient.

It is simply not humanly possible. Personally, I would have left long ago.

Pressing reset

After my daughter was born and I went back to work, I had to take a step back. Suddenly, every baby reminded me of her. Again, it was hard separating from emotions. I would lock myself in the office and cry, not infrequently, during her first year of life.

Then I evoked Africa, I remembered that death is natural and normal. That life comes with joy and suffering, and part of my job is to help families and patients navigate during one of those suffering moments. This is an honor, and not something to be muddled by my own emotional distress.

I was there to help that patient and provide a service to the best of my abilities. Logic needs to rule.

Interesting and right that the place of origin of our life as humans is the place that taught me about its conclusion.

Michelle Ramirez is a pediatric intensive care physician.

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