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My 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.

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

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.

  • As an MD…once must realize to treat each patient with empathy as well as be empathetic about the way to treat the ailments present in the patient being treated. …

  • A kidney stone is God’s punishment for something. It MUST be because it hurts like hell. Took 2 rounds of Lithotripsy to get rid of mine. I’ve heard from Women friends that it’s worse than childbirth. Show some empathy, Doc.

  • What an excellent article! You have touched on something that all of us have to deal with. Your experiences are with much higher stakes than most of us, but the phenomenon of being less upset with a situation as you gain experience in life can be both a blessing and a curse. Experience and age can make us relatively sanguine about things that would have been upsetting to us when we were younger and less experienced – and to those around us that are now younger and less experienced.

    Your story reminded me of a time when my younger sister (younger by 14 years) broke up with her first boyfriend in middle school. She was very morose at the dinner table, and all ten of us (big family…) were trying to cheer her up.

    She cried: ” You don’t understand! Two weeks of my life down the drain!” Upon which we all started laughing. Pretty insensitive at the time. Now that I look back on it, I think I should call her and apologize!

  • I’m the daughter and grand-daughter and niece of MDs, and looking back at the history of my grandfather and father, I often think that this ‘deadening’ of emotion, this dispassionate behavior, can be taken too far and can impact one’s relations to other humans in very bad ways. My grandfather started his practice at the beginning of the Spanish flu epidemic in the 1900s. If ever a situation was destined to ‘deaden’ someone to excess emotion, that was it,as almost nothing could be done for his patients then. But his increasing dispassion also impacted his children and grandchildren, as well, in very negative ways. One of his sons, my father, was an MD who never really learned that severe degree of deadening, and always took it hard when he lost a patient or was less than successful in treating them. It ate away at him his entire life, until he ended it by suicide. His brother did the same, partly as a result of the ‘absence’ of a real father, emotionally, I think. When my grandfather was dying of terminal GI cancer, I went to see him in the hospital and said that I could hardly bear it (his illness). His response was “what choice do you have?” While this was a model of reality and dispassion, it was also the WRONG thing to say to someone who cared about him deeply and was going through the loss of a beloved relative. That made me think that such objectivity can be taken much too far, and is by some MDs, which will have very bad consequence for both their families and their patients. Just my personal opinion, however.

    • Thank you for sharing such a deeply personal and honest view from a physian’s family vantage point.

  • In the case of doctors emotions, they are most often “damned if the do and damned if they don’t” feel emotion in the aftermath of a patient’s illness and death.

  • Beautifully written article about a topic that we all as physicians grapple with — how to remain human! Agree with comment that fact that you wrote this article means that you’ll never lose this empathy for your patients.

  • Dr. Okwerekwu, you may be interested in the work of Notre Dame’s Hillebrand Center for Compassionate Care in Medicine in this area.

  • Great article. I think that the fact that you’re even discussing this change shows that your still empathetic. How to keep in check over the decades…I don’t know. Was just at a conference and heard Arabella Simpkin speak about being comfortable with uncertainty. She recounted (using the now famous picture of him hunched on the ground in his scrubs) the physician who after losing a patient went out to the parking lot to cry and was back in the hospital seeing patients again within 15 minutes.

  • Thank you for this thoughtful, inspiring essay, and for your commitment to your work and patients.

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