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Of course, after three months as a house officer it wasn’t my first cardiac arrest. But the others had been expected, controlled affairs, where the steps of resuscitation were swung through calmly, efficiently and with no real hope of success. This one was different.
This one was a man in his sixties, recovering from percutaneous angioplasty for angina. He’d been doing well and was scheduled for discharge the next day. Then out of the blue at 6pm, just as I was finishing up my ward paperwork and planning to head home, he had a massive myocardial infarction and died.
There was nothing seriously wrong with the resuscitation effort. The team was there within a few minutes, and all the right things were done, more or less in the right order.
The feeling, though, was different: there was a sense of urgency, of panic – perhaps of hope. And having been first on the scene I felt involved, responsible, in a way I hadn’t done before.
After about 30 minutes, when VF had progressed to asystole and it was clear we were getting nowhere, the anaesthetic registrar looked at the clock, exchanged nods with the rest of the team, and called time. Everyone spoke briefly, unemotionally, about what needed to be done and documented. And I tidied up my remaining paperwork and went home to my supper.
A few hours later, watching TV, an advert came on about how to recognise a stroke. It was nothing special: a calm voiceover explained the importance of getting help FAST, while on screen an elderly lady’s face began to droop down on one side. And suddenly, out of nowhere, I was terribly upset.
The fact simple of people having strokes, fine one minute and permanently damaged the next, seemed unbearably tragic. My eyes prickled and a lump gathered in my throat.
I was startled at my own response, that first time. Why on earth would I, who coped calmly with unexpected death at work, crumble emotionally over a mawkish advert? Since then, though, I’ve realised that many other doctors share this kind of experience.
Distressing events at work – that is, events that should be distressing, but which we are obliged to deal with dispassionately – leave a kind of emotional debt.
We come away from a particularly gruelling scene of suffering or death, having maintained a strictly professional detachment throughout, but once safely away from the hospital any little thing – a sad film, a sentimental song – suddenly becomes a focus for the sadness we could not acceptably express earlier.
Perhaps it’s a protective response, and certainly a less harmful one than taking things out on our families. Perhaps, too, it’s a sign that we’re still human.
By the Secret Doctor. Read the blog and follow @TheSecretDr on Twitter and on Facebook
Though now retired and therefore sheltered from such events (although not long ago an elderly gentleman did develop a stroke in the wine section of a local supermarket with which I was able to offer advice - FAST) I am sure that many of us have experienced such delayed emotions because if not, perhaps it would suggest a psychopathic personality? Do not assume that this all ceases once you retire. I experienced frequent flashbacks and still do for some time which to me suggests that PTSD can be a consequence of a medical career.
As a paediatrician with an interest in palliative care this makes total sense to me. My preferred crying time is when listening to the Archers (ok sad in itself I know) in the car on the way home. This way I don't have to explain myself to husband children etc. We have to allow ourselves some time to deal with the emotional response to what we see and do, otherwise we would never cope with the next one.
After caring for young people who disclosed sexual exploitation in my sexual health career as a sexual health advisor I was diagnosed with complex trauma. I just couldn't listen to it almost every day anymore. Sure we were acting on signs of CSE and safeguarding kids but god, i couldn't do it anymore. Total lack of supervision and emotional support. It's important to have restorative supervision and not just clinical supervision. Put boundaries in-work/home. letting go doesn't mean you don't care. It means living to fight another day and saving perhaps your marriage, home and sanity.
That’s so true for me. Now I know why I cry at sad events in the movies. It has become evident since I have been a Med Reg. Gosh...atleast I got an answer !
I went through a phase of feeling as if about to cry every time an athlete's Olympics went wrong for them (e.g. fell over in a race). I'm not even that bothered about sport. I think the emotions just had to go somewhere xxx
This is so true. Where are we supposed to unburdened? This is rarely possible at work. We are our own worse enemy. We tell ourselves we should be able to cope and see it as weakness or failure if we don't. Are we self imposing this expectation or is it historically expected from us? I hope this is changing. I am near retirement but sounds like the tears may continue.
I may not be an actual medical professional but I can still relate. I used to work as a receptionist for a doctors surgery in my younger days and I felt miserable going home most nights knowing that some of the patients we had were going to die sooner rather than later. It drains you emotionally, mentally and physically and eventually, it got so bad I had to resign from that particular job. Sometimes, I think life would be easier if we would temporarily turn our emotions off but then I remember, that is what makes us human.
As a doctor who has worked in Palliative Care for several years I can easily relate to this. Although the deaths I am involved with are expected, I have often got to know the person and their families quite well (at least from a HCP point of view), sometimes having been closely involved in their care over a period of many months, first in their home environment and later in the hospice. For many HCP in other specialities this relationship can extend into many years. I have recently taken the opportunity to start regular supervision and am just at the very beginning of understanding the importance of, and gaining the skills to, help my self cope with this. The intensity that HCPs see death is unnatural and we need to recognise that that has consequences. Yes, I find solace in the fact that my tears mean I’m still human, but I also know that if I am going to be able to provide a high level of care in a speciality I love for many years to come, I need to learn how to manage this aspect of my work. Being human is what makes us all able to provide the amazing level of care we strive to provide on a daily basis, but we need to start to recognise that we also have to look after ourselves....the stiff upper lip approach belongs in a different era.
Thank you for a candid and fascinating piece, and also to other commenters for similarly moving testimony.
I have noticed a similar phenomenon whereby it can be something sad or indeed happy in the media or just something that I remember, which has me welling up, and it is strange and surprising just how distant this can be from any particular real-life event. I used to work for Samaritans and speak to people who were genuinely suicidal, and sometimes in the process of trying to end their lives, but it was often something unexpected like a conversation with a very lonely older person which had me in tears. To be able to speak openly as doctors about the emotional impact of our work is of fundamental importance. I would heartily recommend Balint groups in this vein.
I read your blog and started to cry. Just like you I work with life and death every hour of the day. When I come home little things trigger off grieve.
Watching a movie in which a dog was ill upset me. Called virgin media for a small technical fault with broad band. They kept me waiting on line for nearly two hours and when I got through to them the operator said they were closing by that time and put the phone down on me. I started to sob and cry.
I feel we work too hard as robots at work and come home with internal grieve. Have others had similar experiences
I love your explanation and yes that does make sense .I constantly feel like we live in this culture of being "fine " and it's kind of unacceptable to show any kind of emotions , but you known what some days I don;t feel "fine " yet I'm still expected to act like it and put on a smile