M

y husband, Peter, texted me one afternoon: His father was violently ill and had been rushed to the hospital. The doctors thought he might have a kidney stone, a painful, but fairly common, ailment that often resolves itself.

I didn’t think much of it —  I talked to my father-in-law, we laughed about drinking more water, and, as I was at work, I moved on to my next patient.

What I didn’t know right away was how concerned my husband was — the image of his father in pain led to several worried phone calls throughout the day.

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That night, after dinner, he wanted to call his parents one more time.

“Again?” I said, and asked if his condition had deteriorated.

My husband’s eyes got really wide. “No, but he’s really sick! He was vomiting and was in so much pain.”

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What I said next was awful and dismissive, and I knew it the second it left my mouth. My words broke a fundamental promise I made to myself in my first year of medical school to treat my patients, in their illness, their fear, and their pain, as people first.

“Yeah, but he’s gonna be fine,” I said. “It’s just a kidney stone.”

Just a kidney stone.

Anatole Broyard, a former New York Times editor, encapsulated this feeling: “To most physicians, my illness is a routine incident in their rounds, while for me it’s the crisis of my life. I would feel better if I had a doctor who, at least, perceived this incongruity.”

That is what I had set out to do, but barely six years into this profession, I’m learning that it’s all too easy to become desensitized to the experience of illness.

When did I lose sight of that person behind the sickness?

When I first started medical school I used to panic at the sight of my patients in excruciating pain — a little boy in a sickle cell crisis, for example — but over time I learned to maintain a level head and approach the problems they faced with reason rather than emotion. Experience was my biggest teacher. Most of the time, we could treat pain. We could bring relief.

In my time in medicine, I’ve seen many patients with kidney stones. Whether in the outpatient clinic, emergency department, or the operating room, with appropriate medical care, they all ended up being fine.

I realized that my repeated exposure to patients with kidney stones rendered it an ordinary part of my experience. But, the fact that this illness is now so ordinary for me really undermines how extraordinary these conditions can be for the patients. And their families.

I quickly apologized to my husband. “I’m sorry, I’ve seen so many patients with kidney stones, that I don’t get worked up about it anymore.”

“But I haven’t,” he replied.

My ordinary. His extraordinary.

Someone once told me that as a first-year medical student you think like a patient, but as you progress through your training, your language, logic, and priorities begin to align with your fellow doctors. On one hand I was proud of my indoctrination — I was thinking like a doctor. But on the other hand I was worried that I’d evolved too far past acknowledging, and to a degree, internalizing, the emotions that define the crushing weight of a medical crisis.

I’ve lost five patients in the past few years, all under sudden and tragic circumstances. I cried about the first three deaths, as I genuinely felt shaken by the loss of these people. Perhaps too much. Now I’m afraid the pendulum has swung so far in the other direction that I don’t feel enough. I know it’s sad that two more people died, but I can’t seem to feel any sort of sadness.

I have broken the promise I made to myself as the idealistic medical student, but I’m wondering if it’s one of the ways I’m learning to manage my actual work as a doctor, one of the ways I’m actually becoming a doctor. This isn’t about losing empathy. I feel for my patients. I am with them. But now, there is a little distance.

This slight deadening inside, is it what I was asking for? Is this an ultimate sign of competency?

I recently read an article about post-traumatic growth — it’s what happens when people overcome a significant challenge and rise to a higher level of functioning. I thought about the calm that recently washed over me as I felt the muffled popping of a man’s ribs succumbing to the force of my chest compressions during CPR. He died, but my team congratulated and thanked me for my competence during the emergency situation.

It felt strange, being congratulated for feeling nothing, or at least whatever defined my post-traumatic growth. I was keenly aware and slightly worried by the absence of emotion. Whatever I was doing, it allowed me to get up and go to work every day.

I dreamed for so long and so hard of being a doctor. And I want to be a good, high-functioning doctor. This slight deadening inside, is it what I was asking for? Is this an ultimate sign of competency?

Medicine has changed me. I don’t know if it’s making me better or worse. All I know is that I’m different now, six years after that white coat ceremony, six years after that promise to myself, well into my second year of residency.

Enmeshed in the demands of training and practice, I haven’t really noticed the change. But it’s in the look of horror on my husband’s face, or in the moments not spent mourning a patient’s death that I recognize how easy it is to betray the promise I made to myself just a few years ago.

It’s enough to make we wonder if absorbing, reflecting, understanding, and even feeling my patient’s emotions every single time was a promise I was ever going to be able to keep.

But, as my experience builds, it also makes me wonder if it was a promise I ever really needed to keep.

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  • It’s not the idea of being upset with illness that you only lost, you have lost empathy. You cannot be devastated by your patients experience but you must recultivate empathy. If not you will be one of those doctors who doesn’t care You will be disconnected and unable to provide patients what they really need. It sounds like you want to be the doctor who cares about their patients. Recognizing where you are will allow you to get back to who you want to be. It is not inevitable that a competent doctor is a doctor who does not care. Thanks for sharing.

  • You’re going to be ok, Dr. O. It’s a tough line. While empathy certainly makes one more effective as a physician for a variety of reasons, and I strive to be so, I’ve also been a worried patient.

    Having a provider smile and reassure me that this is absolutely not a big deal, or that it is surmountable has been just as helpful.

    There’s a difference between condescension and confident, accurate recognition from a trusted source that this [insert your pain/angst/ condition] is nothing new under the sun and is manageable.

  • Having similar problems. Along with tests being done. Glad you stay objective, bad enough we freaking. Don’t need our doctor crying with us. Stay tough. Makes you a good doctor. Our family can cuddle us. U fix .

  • Thanks for this article. I have been healthy my whole life but now have a stone and might have to have a procedure because its stuck in the ureter. It is a big deal for me, but my doctor insist its nothing and I can tell is annoyed by all my questions.

    • dont worry its just a stone..
      doctors are taught to treat your illness at medschool..they are not taught to talk to patients(at least in india dont know about other countries).senior doctors say you learn by experince and theres no one to question us whether we learn or dont learn .the only time we are questioned is when something goes wrong..then the blame game begins..my excuse is we dont know how to talk to patients bcoz we are not taught or its not part of our sylabus..anyway take care of yourself its nothing serious its just a stone

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