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ER Goddess

ER Goddess

Desensitized till Hardship Hits Close to Home

Simons, Sandra Scott MD

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doi: 10.1097/01.EEM.0000503382.69118.91
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    He didn't correct me when I addressed him as “Mr.,” only grimaced in his hospital gown like any other 80-year-old with abdominal pain. I knew he was intelligent when he began giving a history of present illness so precise I could transcribe it verbatim into my note, but it wasn't until he described his pain as “epigastric” that I gleaned he had a medical background.

    “Are you medical?”

    “Yes, I'm a retired surgeon.”

    This octogenarian's entire career had been back in the day when surgeons were demigods, and his hospital experience had been calling the shots. Now he was lying on a stretcher completely at my mercy, waiting for me to order pain meds and give any inkling of news regarding lab and ultrasound results. He had never had surgery himself, but a workup revealing acute cholecystitis meant he would be going back to the OR on the other side of the knife. This time it was his turn to wait nervously in the ED for the surgeon to come see him.

    The younger surgeon who came to take this retired surgeon to the OR remembered working with him. “He used to be so acerbic that I was afraid of him,” he said. That night for me, however, he was mild-mannered and gracious. Ultimately, every physician, no matter how powerful and intimidating, will one day have to put his health in someone else's hands and be just a fretful patient looking for comfort.

    As I took care of this doctor, I understood how difficult it must be for someone used to being in control to go from powerful provider to powerless recipient of health care. I knew how reluctant he must have been to be vulnerable, to be human because I know all too well the expectation that doctors have superhuman infallibility. Getting a glimpse of another doc in a moment of vulnerability reminded me of my own frailness.

    Often we are in denial of our own human fragility. To survive as EPs, we unintentionally acquire self-protective habits to clad ourselves in armor. We compartmentalize patients' suffering and sorrow into locked boxes in our minds that we try not to open after leaving the ED. We try to maintain professional distance between ourselves and patients to keep their misfortunes from becoming too personal. We become desensitized and detached over time to protect our own emotions. But sometimes the hardship hits too close to home and puts a chink in our armor. This happens to me every time a physician is my patient or even a family member of my patient.

    Rekindling Empathy

    The wife of an anesthesiologist colleague was recently brought into my ED in cardiac arrest, and the code became uncomfortably personal. He stood next to me at his wife's bedside as we exhausted all possibilities in standard ACLS protocol. He peered at her pupils and saw that they were fixed and dilated. He studied the monitor and saw asystole. As an anesthesiologist, he should have easily seen that she was gone, but as a husband, he couldn't let go. He glanced at the monitor, then focused on me, expecting me to work a miracle that I simply couldn't. I had to tell him, “Now is the time I would normally call it.” He still looked longingly at his wife's body and at the monitor, praying and wishing and hoping. We were doing compressions just for him at this point. My heart ached for him. After decades of being the one running the code, it was his turn to be the grieving family.

    As capable as we think we are, we can't always protect our loved ones. I watched him stand by helplessly as his wife died in front of all of us despite my training and his training, and I identified with him more than I ever had with a decedent's family. He was not an objective doctor but a gut-wrenched husband. I finally had to spell out for him what years of training and experience should have allowed him to see clearly. “She's gone.” It was one of the hardest codes I've ever run.

    Because we are desensitized, we often don't think about how every step we take in a code will be remembered forever by our patients' families. Some of the nurses that night expressed frustration when I considered lytics on his wife before she went into asystole, but I needed to be able to tell that husband, who was educated about all possible treatments, that we exhausted each of them to try to save her. It's unfortunately too easy for everyone on the ED team to detach and forget that the patient is a spouse or a parent until something comes along that is especially relatable to our own life and rekindles our empathy.

    It is a wakeup call for me to see someone with whom I identify go through an illness or loss that I like to think can never happen to me. Another physician being wheeled into my ED in pain reminds me that one day I will be sick and become a patient, too. Telling another physician his loved one died makes me acutely aware that someday someone will say that to me. I like to think I can handle people dying. After all, I routinely have to tell families their loved one is dead and have witnessed firsthand acute grief and heartache. But it's always someone else's loved one's death, never mine. I too often forget that one day the death of someone important to me will reduce me to the same grief and despair the anesthesiologist felt that night, no matter how accustomed to death I think I am.

    As much as I try to clad myself in steel, misfortune that hits close to home makes its way through weak spots in my armor and stirs up feelings I suppress to survive working in the ED. Reminders of our common fragility put my detachment and desensitization in check. Seeing someone who has also committed their life to healing in pain or facing death makes me uncomfortably aware of my own mortality. In that discomfort, however, lies one of the beautiful things about this profession: It confers an exclusive vantage point, putting my problems back into proportion and reawakening me to my blessings. Sometimes it takes remembering how vulnerable we are to appreciate how much we have. Taking care of the caretakers grants us this valuable dose of perspective.

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