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Bouncing Back

Bouncing Back

‘Being Vulnerable Set Me Free from Guilt and Shame’

Swisher, Loice MD

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doi: 10.1097/01.EEM.0000544434.14452.2b
    guilt, shame, vulnerability
    guilt, shame, vulnerability:
    guilt, shame, vulnerability

    ‘I may have been blindsided by her brain tumor. I failed her by taking her too late, and now she would be a medical device kid with a VP shunt for life. But I was still a doctor. The least that I could do now was to make sure if the inevitable became excruciating for my daughter, I knew enough not to let her suffer. I was still a doctor, and I could prevent torture. Insulin was my choice, and I didn't plan to go to jail.”

    I wasn't surprised when those words came out of my mouth as I lectured on physician suicide. I had confessed my thoughts of killing myself after releasing my child from anguish multiple times in the past. I always leave wondering what people thought. Did they think I couldn't handle my daughter's diagnosis? That I was weak? That I was depressed? Would they be afraid of my abilities as a mother or as a doctor? Did they get that I felt responsible?

    This time was different. I was scheduled to tell my story at an emergency medicine conference, but I realized during the morning sessions that most of the people in attendance had already heard it. I challenged myself to give them more. I reworked my thoughts for my lecture that afternoon.

    I started my story with a simple statement—“I think some people thought I was depressed”—and then I crushed that thought: I never thought I was depressed. I never thought I couldn't handle her diagnosis. I thought it was my fault. As the sole judge of whether I had been found competent as a mother and as a doctor, the verdict was clear: Guilty. There would be no grace, no compassion, no forgiveness, no mercy.

    As I flashed the MRI image of her brain tumor on the screen, I shared the impossible puzzle in my mind. How could a good mother not know that monstrosity was in her child's head? Was I not paying attention? Was I working too hard on my career? And if you could forgive the mother's ignorance, how could you excuse the doctor's? Look at the image. It is huge. Isn't everyone thinking the same thing? And if both of those thoughts are acceptable, how can I ever let anyone leave the ED again? How do I have any clue what is really going on with my patients if I didn't even know what was happening with my own child?

    No, I wasn't depressed. I felt responsible. And I had second victim syndrome. I buried those thoughts inside of me for fear that those around me would share my opinion. It took me 17 years to share her MRI with another doctor. I did it by email. I couldn't bear to look into a colleague's eyes reflecting the horror of this miss.

    Vulnerability Heals

    Interestingly, in a short period of time, three EPs, all male, praised me for being able to tell my story. All mentioned that vulnerability seemed to come easy for me. No, vulnerability isn't easy or natural for me. Expressing my vulnerability feels like playing emotional Jenga every single time. This could be the time that goes too far, the time everything comes crashing down. I am scared every time I go just a little bit further to expose my soul.

    When my daughter was first diagnosed, the term “second victim syndrome” hadn't even been coined. I didn't realize the sense of responsibility as a doctor would spill over to the care of my family. I didn't realize that the key to getting through it was “surviving the inquisition.” I didn't realize that the ruling in my mind was far harsher than those in virtually all others'.

    I was still clueless more than a decade and a half later when I first revealed my story to another doctor, Christopher Doty, MD, at the 2016 CORD Academic Assembly in Nashville. I knew he had a resident who had died by suicide prompted by issues with a sick family member. On one hand, I felt compelled to connect because maybe we could change things. On the other hand, if that went badly, I never had to belong to any EM group that he belonged to, and I never ever had to go to Kentucky where he lived.

    In the intervening two years, I have discovered the work of Brené Brown, PhD, on shame resilience theory and the power of vulnerability. Dr. Brown describes shame as an intensely painful feeling that one is unworthy of belonging. Addictions, depression, eating disorders, bullying, and, I believe, suicidal ideation are correlated with shame.

    “Shame needs three things to grow exponentially: secrecy, silence, and judgment,” she said. “Shame cannot survive being spoken. It cannot survive empathy. ... Empathy is cultivated by courage, compassion, and connection, and is the most powerful antidote to shame.” (Signs of the Times. July 4, 2013;

    I am fearful every time I talk—or write—about this experience, but the increased depth of connection has made it worthwhile. Vulnerability has healed me. Looking back, silence was the prison that I thought was keeping me free.

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