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How Emotions Are Like Asbestos

Shah, Arya

doi: 10.1097/ACM.0000000000001931
Teaching and Learning Moments

A. Shah is a fourth-year medical student, Mayo Clinic School of Medicine, Rochester, Minnesota; e-mail:

An Academic Medicine Podcast episode featuring this article is available through iTunes.

I was once told that, to go into psychiatry, I’d have to learn how to keep my heart in a bag to protect it. I pictured myself tying my ticker in a sack with an airtight knot so as not to let the fumes of others’ emotions contaminate my own well-being. On a superficial level, I guess this makes sense. Maybe emotions are like asbestos. You can work in a naval shipyard for years without thinking you’re being adversely affected, until one day your doctor tells you that you have mesothelioma and that your lungs have become hardened by a thick layer of calcified plaque. Maybe that’s the fear with committing to a career in psychiatry—by exposing yourself to the noxious vapors of hurt, sickness, and sadness, you run the risk of waking up one day to find your heart hardened beyond repair.

However, I think that to endorse this mind-set is to undervalue the role emotions play in keeping us connected with others.

Two 16-year-olds, both African American, both tall and lanky, both with short cropped haircuts and tattered gray sweatpants, required sedation and isolation after becoming violent on the hospital floor. I remember being able to hear their pounding and screaming throughout the ward. I also remember having very different visceral responses to their wailing.

In response to one boy, I felt angry and agitated, like I wanted to storm out of the hospital and never come back. His utter lack of concern about his situation, his smirks, and his profanities left me fuming. After he earned a trip to the isolation room for lunging at a physician, I felt fear. It was a fleeting fear but a strong one.

Twenty-four hours later, I witnessed the other boy suddenly shut down while speaking with us. The same fear as before started to bubble in me as I watched his arms tense, his fingers fidget, and his eyes become unreadable. He then exploded. Multiple nurses swarmed him, holding his arms while he screamed and convulsed. In that moment, I was very aware of the fact that I was not feeling fear but sadness. My nausea, chest pain, and the pressure building behind my eyes came as a surprise. It was in such sharp contrast to what I had felt 24 hours earlier.

As I sat in the workroom later that week, processing my responses to these two events, I tried to look back and identify the reasons for my differing emotions. One boy’s actions were full of rage, his arms swinging at the physician as his legs propelled him forward. The second incident was tinged with subtleties—tears smeared across the boy’s face as he was held down, his wailing punctuated by desperate cries for his mother and his devastation at the news that he’d have to stay in the hospital another night. I learned later that the second boy had been thrown from foster home to foster home, had been physically and sexually abused, and had been estranged from everyone he knew and loved. While one boy’s reaction was the result of a lifetime’s worth of anger exploding in response to being locked up against his will, the other’s was representative of a lifetime of tragedy.

From my interactions with these two boys, I learned the value of exploring my feelings instead of hiding them away. In doing so, I saw my fear of an aggressive teenager transform into understanding; I saw my reaction as a reflection of the boy’s fears about being trapped and feeling helpless. Similarly, instead of allowing sadness about the second boy’s trauma to harden me, I was able to use it to empathize and provide him with the support he needed.

I’ve decided that as a future psychiatrist, my personal heart sack will not be airtight. It will be a bag with lots of holes, like the ones you steam your vegetables in. I will welcome my emotions, not only because they are a useful tool but also because channeling my feelings to connect with others is a form of self-preservation, a way to not become cynical in the face of so much hardship.

In medicine, emotions are thrown at you constantly, whether you open yourself up to them or not. We can ignore them or explore them. I choose the latter.

Arya Shah

A. Shah is a fourth-year medical student, Mayo Clinic School of Medicine, Rochester, Minnesota; e-mail:

© 2017 by the Association of American Medical Colleges