If you’re falling apart, should you still perform the pancreas biopsy?


Many radiologists choose the specialty because they don’t like interacting with sick people. As a highly sensitive person, I went into radiology to distance myself from patient suffering, as a means of self-protection. Radiology has allowed me to compartmentalize, sort of.

It allowed me to have three healthy babies: one in residency, one at the end of fellowship, and one two years into private practice. I went back to work after six weeks of maternity leave each time. Somehow, I was able to read cases, use the breast pump, do a biopsy, pump, pound fluids, stay late, maybe nurse the baby once before bed, and once before work the next day.  This was also possible thanks to a committed spouse equally invested in family life.

I had three kids under the age of 6. I was doing it all, but I was feeling very fragile, sleep-deprived, and hijacked by postpartum hormones; an imposter on the verge of getting discovered. One day, after using the breast pump, I returned to read a few MRI cases before doing a CT-guided biopsy of the pancreas on a woman with probable pancreatic cancer. A colleague’s unexpected entrance interrupted my focus. He closed the door behind him. My heart started pounding because a) I was on a tight schedule; and, b) a closed door in this setting implied something serious to me. He wanted to let me know that his college roommate, an orthopedist in town, had called to express his annoyance that I had described abnormal signal in the subscapularis tendon; he didn’t want me to read his cases anymore because he said the subscapularis tendon only rarely experiences pathology.

I like to think that under normal circumstances, I would have summoned my knowledge and expertise; I had just reviewed an article about the frequency of underdiagnosed subscapularis tears missed with an anterior arthroscopic approach. But this was not a normal circumstance for me. I was compromised.

I now know that the complaint was a “trigger” for me; the emotional response that followed was out of proportion to the inciting event. I completely lost it, crying uncontrollably. The patient with the pancreatic mass was waiting to be consented. I viewed myself as an observer: the news, the seriousness with which the news was delivered, the fact that I was crying at work, the discrepancy between the legitimate seriousness of the pancreatic mass and my trivial upset over a difference of opinion. It was all devastating to me. I didn’t know how to right myself. The patient was waiting. I couldn’t do it. I couldn’t pull myself together quickly. The shame was overwhelming: I am bad. I don’t belong here. I am not worthy of this job.

I asked another partner to perform the biopsy, left the hospital, and drove 5 minutes to another colleague’s house whom I considered a friend. She wasn’t working that day. I wanted her to help me get a grip. When I arrived at her door, she looked at me with a blank stare and offered no consolation. As I sat on her couch, telling her I felt like I was falling apart, she responded, “Well, clearly, you’re having a nervous breakdown.” I suddenly realized: This was a mistake. I shouldn’t have come here. I snapped out of my emotional frenzy, stood up, and returned to work.

Let me pause:  How are you feeling in this moment? Are you having any visceral responses to my story? Are you feeling squeamish? Queasy? Maybe my story makes you cringe? Maybe even just reading my story fills you with shame for me? Sometimes just hearing about others’ vulnerabilities and shame is too much.

I was gone for less than 30 minutes. The pancreatic mass had been biopsied.

My partners were not empathetic.

No one said a word to me the rest of the day. I stayed late and completed my work. No one called me at home to see if I was okay. Silence is the worst because it allows us to make up our own stories and further injure ourselves.

The next day, I was back in the reading room. The head of the group called me to tell me that I needed to promise an event like this would never happen again. I reminded him that it had never happened before, was unplanned, and was not part of my future plans. I made my promise.

I recognize now that my colleagues were not equipped to deal with my vulnerability. I thought doctors were born with skills of compassion and empathy. But no one in my group had the skills to comfort me.

Had anyone been concerned about my well-being, this story wouldn’t be one that shaped my professional trajectory. But that’s not what happened.

These are the moments that, when left unresolved, send us into our lives searching desperately for belonging. I settled instead for trying to fit in.

I stayed in that job for another 12 years, becoming a robot, keeping my real self in check.

It has been 15 years since this incident. I am able to share my stories comfortably now, even the ugly, fall-down moments, because I have built up shame-resilience with Brené Brown’s curriculum for helping professionals. I shudder to think where I’d be if I hadn’t taken action to heal myself on my own behalf.

What is the point of this story?

  1. Doctors shouldn’t have babies.
  2. Doctors should bottle-feed instead of breast-feed.
  3. Doctors should receive more than six weeks of maternity leave.
  4. Doctors should receive formal empathy and compassion training.

Maybe there is more than one right answer.

Did I pick the wrong specialty for me? Perhaps. I made the decision that seemed best for me with the information I had at the time. As it turns out, you can try to take the emotions out of your circumstances, but you can’t take the emotions out of yourself.

Was it unprofessional for me to leave the hospital in the middle of a workday? Yes.

Was it a mistake? I’m not sure.

Would it have been wiser to go ahead and biopsy the patient’s pancreas?

Tracey O’Connell is a radiologist and physician coach. She can be reached at her self-titled site, Tracey O’Connell, M.D.

Image credit: Shutterstock.com


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