In medical school, I was taught to keep my distance. To remember that the patient is the one with the disease. I was told to protect my heart, to be a little cynical, a little deprecatory, to keep a separation between me and the patient. Because they can hurt you.
The Worst Days
For 18 years, I met people on what was arguably the worst day of their lives. You have cancer. You have a bowel obstruction and need emergency surgery. You need to have your entire colon removed and poop in a bag for the rest of your life.
I sat by bedsides while people withered away into skeletal decrepitude. I did wound care on people whose wounds went all the way down to the bone. I saw people in astounding pain. I watched people die -- quickly, slowly, peacefully, in pain, unaware. I talked to families about the prognosis for their loved one. I endured the anger, frustration, confusion, and despair when the news was not what they were expecting.
I fished out bullet fragments from a man's face after he shot himself. I supervised a thoracotomy on a 15-year-old boy who had been shot by another 15-year-old over a girl. I tried desperately to save the life of a woman who stood in front of her teenage son while he was shot by gang members.
I took care of one of my fellow surgeons when he was fatally injured in an airplane accident, and then I went in the next room and took care of his wife.
I Failed
I failed to save lives, I failed to bring the miracle others expected of me. I watched people waste away from cancer when I couldn't get all of it. I took care of people for months on end when their surgical course became complicated.
I endured many, many sleepless nights. In the beginning of residency, before the rules changed, we were often on for 36 or more hours at a time. I got delirious. I forgot when I needed to eat or go to the bathroom. I fell asleep at the desk trying to write a note. Every new patient that came in became a pain I was uncertain I could endure.
Good Times
There were good times as well, people who got better when I had no reason to expect it. I watched a man walk out of the hospital months after the night I was certain he would die of pancreatitis. I thanked God he had no memory of that night.
And plenty of people came in, had "routine" surgery, and walked out of the hospital without any issues. I didn't take credit for that. It's expected.
"You Need A Thicker Skin"
They told me over and over in residency, you need to develop a thicker skin. Because I cried at bedsides. I had trouble sleeping when someone wasn't doing well. I hugged family members. I went to funerals. I let people, both patients and family members, into my heart. I was passionate and at times hot-headed when things didn't go well. I was emotional. I was sensitive.
Over time, as residency went on, I learned to separate myself. I learned that no matter what, good or bad, the best course of action looked like remaining aloof. Cynicism set in. I survived. The long hours, the pain, the drama, the discordant opinions about the best course of care -- I survived all of it. Some days, it felt like it was me or them.
The Cost
Here's the thing. That cost me. It seemed like the right thing, until I began to see that I didn't just stay separate from the patients, from the pain, from the drama. That thick skin kept me from feeling anything. It kept me from enjoying life.
Eventually, I couldn't stand myself anymore. I couldn't stand how bitter, removed, sarcastic I had become.
Stop Protecting My Heart
I started to see that the advice I had been given just didn't work for me. I didn't need a thicker skin or a harder heart. I needed the opposite. I needed to crack my heart wide open. I needed to let every bit of it in. Stop protecting my heart.
I didn't do it all at once. It took some time. That conditioning was hard to beat.
But I began to open myself up to patients, to their stories, to their pain, their fear, their confusion. I started to see that I could take it.
Halfway Hurt More
In fact, what I began to realize was that it was the halfway measure that hurt the most. Not quite open, not quite closed, let a lot of pain in.
What if I let you in, and then you die? What if I come to like you and something terrible happens to you? What if I get so attached to you I make the wrong decision?
If I start to cry, will I ever stop? If you die, will I ever get over it? If I sit with you while you're upset , will I be able to do my job? If you start to cry, will you ever stop? What if there's really nothing I can do? What if you're in pain because I did something wrong?
The answer was, open more. Crack my heart open. Feel everything, see everything, touch everything, be touched by everything. This is how we were meant to live.
Stop grounding myself, putting up barriers, surrounding myself with protections and sarcasm and thicker skin.
Pray. Oh yes, pray. Because I have so little power over how this will all turn out. And trying to control it, trying to stem the flow, that, that is what hurt me. Patients can't hurt me. Love can't hurt me. Control. That is what hurts me.
Be Human
Surrender. Things will go the way they go. The knowledge, the understanding, the patience, the compassion -- that will come as needed. Stop trying to be God. I'm not God. I'm human.