Dear friends— especially my colleagues,
I recently failed a class (I have been working on a PhD in psychology) and found myself immobilized and disengaged from life, personal happiness and joy. I actually didn’t even tell my husband, who is my true confidant of my feeling and thoughts, until the following day. I found myself in that familiar place of guilt and shame. I thought I had transformed a lot of sh*t in my life, so I was actually angry that that sense of shame was right there in my face. I could not believe that my thoughts immediately went to replay what I see as a tragedy in my residency that I think I could have prevented — if only. The familiar visual scenes ran in my head like a projector playing a home movie on the projection screen of my mind. It replays over and over with my mind — still, 25 years later, searching for what I could have done to change the outcome.
A lovely woman and her worried looking husband came to my labor deck (that is what we called the labor and delivery area) pregnant with her fifth child and in active labor. She didn’t speak English. They were recent immigrants to the U.S. from Mexico. She had her previous four children at home, in a dirt floor house in Mexico, with no problems. Her husband (and I) felt reassured that this time his wife and mother of four beautiful children would deliver her fifth baby in the safety of a modern hospital.
Little did we know, at that moment, ultimately, she would not walk out of the hospital. My mind splits between seeing her sweet face and his worried brow, then darts to the scene in the OR. I see myself in the operating room, gowned and in the lights with the blood-tinged gauze in my hand. I am staring at a pink, recently pregnant uterus that is exteriorized. I am watching her uterine incision continue to ooze after closure. I put in a stitch. I wait, then give meds. Put in another stitch. Have my medical student stand there and massage her uterus while I put pressure on the oozing incision. Wait for five minutes. Check again. Oh, it is much better! Just a little ooze in the middle.
My movie cuts to the scene when I am emergently called into the recovery room in the middle of the night because she continues to bleed vaginally. I take one look at all the bloody pads on the floor. I hear myself ask: “Why didn’t you call me earlier?” and “Why would the anesthesiologist continue to give her pressors when her blood pressure was low?”
Why? Why? I look at her frightened face and guess by her color that her hemoglobin is five (usually 12). I am thinking to myself that she’s already dead. She’s already dead. She’s already dead.
And that is where my movie stops to loopback. Back to a mish-mash of smiles, frowns, blood, light, a uterus. In the end, we did all the emergency care for uterine atony, transfused her, tied off vessels and did a hysterectomy. Managed her DIC (non-clotting of her blood). I actually called in her primary resident, my husband (now ex) and let him take over. I had done a cesarean hysterectomy before, so protocol was to “share” with your fellow residents because they were so rare, and it was a skill we needed as obstetricians.
He appears. I don’t even look at him. I give the report, stay until things are in hand and then break scrub. I see and feel myself exhausted and fighting back the tears and nausea.
Cut back to her uterus oozing. Cut back to her pallor. Cut back to her sweet face and her husband’s worried brow. Cut forward to the ICU when we had hoped she would live.
Cut forward to several days later where she died in the ICU. The thought loops starts. In my head 25 years later, I run them over and over. Should I have done a hysterectomy sooner? Should I have done more about that oozing incision? Should I have expected the uterine atony (a uterus that is not contracting to control blood loss after delivery of the infant like normal) to reoccur? Should I have sat at her beside all night? Why didn’t the nurse call me instead of the junior resident and the anesthesiologist? What did I do wrong? I should have predicted, known. She died.
She had four children at home in Mexico. And she died in our hospital, on my watch. Repeat. Repeat visuals. Repeat thoughts. I am definitely a piece of sh*t. Repeat thoughts. Repeat visuals. Yep. I feel guilt — and worse shame.
Now, how did I go from reading an email that I failed a class to feeling like sh*t about a maternal death in residency? What is this? This, my friends, is shame. Shame almost took my life at one point in my career. Shame robbed me of vitality and love for my husband, past and (and apparently) present. Shame broke up my family in the intervening years. Shame re-enforces shame. I had to deal with the shame of my absence with my children and the loss of my marriage. Eventually the loss of love for my career.
Does this sound familiar to you? Do physicians have the same shame as the general public? How does shame affect our health? Is there a way to avoid shame? Can you become shame resilient? Am I the only one that carries such a story?
I do want you all to know that shame is a very familiar brain track (like an 8-track tape, if you know what that is), but not one I am stuck in. The above experience of failing a class turned out to be amazing. I am now appreciative of how far I have come — of what I have learned, through much transformational therapy, mindfulness and coaching work.
I am lucky enough to have a choice in my thoughts and to not disengage. I don’t have to be stuck there. I can put it on speaker-phone with trusted individuals in my life. I can dedicate the work I do now to the memory of my patient and her family. I continue to heal and offer healing.
Life is really an amazing tapestry with short fibers, longer fibers, many colors and most of all — each thread woven to make a perfect whole. It is when we feel stuck that guilt and shame can get the better of us, impacting all areas of our life. I am sharing this very personal story to make a difference with those stuck in the negative talk and the feeling that the core of who we are is not worthy. Enduring shame is associated with depression, anxiety, PTSD and addiction. Shedding light into the dark areas of thoughts we keep secret make a huge difference.
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