Why Doctors Lack Empathy: A War Story

I wrote this story for you, but when I began it I had not realized that girls grow quicker than books. As a result you are already too old for fairy tales, and by the time it is printed and bound you will be older still. But some day you will be old enough to start reading fairy tales again….

As I was reading, a shrill siren rang out as an ambulance came screaming by our beach house… with the full power of the doppler effect.

They’ve got it handled, I thought.

A little further into The Lion, The Witch, and The Wardrobe… we heard a helicopter outside.

Naturally, my second little philosopher blurted out, “Daddy, stop reading! I wanna see the he-wa-copter”

As we went out on the balcony of our beach house, we saw the same ambulance that had passed by minutes earlier was now parked next to a vacant field.  Landing in that field was a helicopter.  It became clear that they were going to airlift the unfortunate person in the back of the ambulance.

Lookin’ like a Beach Bum

Good or bad, it’s always been my personality to run towards calamity and not away from it.  In the thick of it, my emotions turn off.  Medicine has taught (and trained) them out of me – and for good reason. Just like a solider in combat, emotions simply aren’t helpful in these kinds of moments.

We had a prime time view of what was going on below.

After a few minutes, no patient had been transported to the chopper from the ambulance. So, I put my boat shoes on to complete my beach wardrobe of sports shorts emblazoned with my favorite college team and a white t-shirt. I also hadn’t shaved in a couple of weeks.

I looked like a bonafide beach bum.

Need my Help?

As I approached the road where one of the first-responders was directing traffic, the following conversation occurred:

“Sir, I am sure that you do not need my help, but I thought I’d let you know that I am a physician and I am happy to help, if you need it.”

Expecting a short, “We got it,” I was surprised by his response.  “Actually, we are having a hard time getting a breathing tube in the back of the truck.”

Think about this.
What are the odds that a person would be getting air-lifted with a difficult airway immediately behind the random house on a random week that a family decided to stay – where one of the people happened to be an anesthesiologist?  

I said, “I am an anesthesiologist.  Would you like my help?”

“Seriously? Yes. Head on over.”

The Scene

At the back of the truck, I repeated the same conversation with the young EMT I met there.  That’s where I got the response I originally expected.

A blunt, “We got it.”

I don’t blame him. I looked like a beach bum, remember?

Peering into the back of the truck, I saw a man with lots of grey hair having a hard time trying to intubate the patient.  He clearly had a lot of experience and was the lead member of this crew.

At this point, I looked him in the eyes and said, “I am an anesthesiologist.  This guy over here (the young EMT) is saying you don’t need my help.  I am happy to walk away, but wanted to check with you first.”

His response was full of purpose,  “Please, come save me.”

Brushing past the arrogant EMT that told me to get lost, I hopped in the back of the truck.  With my emotions properly turned off by the years of training, I took over the situation.

Inside the ambulance, I noticed the patient had been placed in a c-collar and taped down.  In-line stabilization was an understatement.  Honestly, this person’s neck was truly immobile.

Sizing the patient up, I said, “Hand me a Miller 2, a bougie, and a 7.0 ET (Endotracheal) Tube.  And tell me the story.”

With limited resources, I tubed the person on the back of that truck.  It was not easy, though.  I could see why they struggled.

After securing the tube, I took a closer look at the scene and examined the patient.  It wasn’t good.

Humor Produced from Horror

We got the patient safely on the helicopter shortly thereafter.

As the grey-haired EMT and I walked back towards my beach-house, the first-responder that originally allowed me to approach the ambulance asked, “Did you guys get the breathing tube?”

To which my grey-haired companion responded, “Yeah, the doc did.  But he cheated.  He used a bougie.”

I patted him on the back and said with a wry smile. “That’s called being prepared, brother.”

We both gave a hearty laugh.  Humor is the way many of us deal with tragedy.

I am no different.

Turning My Emotions Back On

As I came back to the house, my father-in-law put his hand out for a high-five.  But, I didn’t feel like I deserved a high-five. Actually, I didn’t feel much at all.

The problem and the point of this post is that turning our emotions back on later is a major issue that many doctors face.  Like a light switch that has been turned on and off too many times, sometimes the fuse fails.  This even has a couple of names; compassion fatigue or secondary PTSD.

After doing what all doctors are trained to do – objectifying and compartmentalizing the experience – I walked back in side, washed my hands, and then finished reading the first chapter of The Lion, The Witch, and The Wardrobe to my two oldest kids.

“Goodness, gracious me!” Exclaimed the Faun.

The Faun knew exactly how I should have felt, if only I could.

We all have our war stories. Has medicine jaded you in any way or made it difficult to process your emotions?
Do your emotions run dry at home?  Leave a comment below.

TPP

 

28 thoughts on “Why Doctors Lack Empathy: A War Story

    • Sometimes it’s hard. But recognizing we are at risk for compassion fatigue from seeing bad outcomes is the best way to fight against it.

      Sometimes I have to talk it out with colleagues. Other times I cry. Bad patient outcomes are always tough to deal with it. The day that I stop recognizing it after the fact or stop caring is the day I’ll stop practicing medicine.

  1. Awesome post TPP!

    As you know, I use writing to help me process. It slows me down since I’m constantly thinking about everything all at once, pulls me out of my algorithm mindset and helps me access my right brain.

    Editing then re-editing helps to consolidate what the actual emotions are as I trim off the fat.

    It gets easier over time – I’d say you’re doing a great job of tapping into that voice 👍🏽

  2. TPP that really is a “Wow” story. Did you ever get any follow up on the patient? If he did make it he was extremely lucky that an anesthesiologist happened to be there at the right moment. Odds are staggering to think of.

  3. finding a way to transition back to real life is hard. And to be jolted out of your solitude like that, when unprepared, is even harder.

    I used to work a long 1.5hr car ride through traffic, curses and people finding all sorts of ways to make the drive even more stressful. I’d come home spent, not want to talk to anyone and just vedge. A job change that came with a 20min, medium dangerous bike ride was a huge lifestyle change that helped give me the time/space I needed to transition from work to real life.

    We all need something to aide with this transition and when we don’t have it or when work creeps in to our non-working lives (after hours and late night calls from residents/patients/parents or life saving ninja anesthesia moves in a parking lot) we can be left feeling spent.

  4. Me: “I had three meetings today, and two of them had no agenda!”

    (EM) Wife: “I had a 12 year old who was hit by a car die.”

    We have really different days at work. Turning off emotion and doing the important stuff she does seems like the only way someone could handle her job. Thanks for your story.

  5. I think it’s so valuable to share our war stories. It definitely does help in processing all the emotions.

    I’ve had a few.

    The one that sticks with the most is the following…

    I was a new R1 (a first year intern for those not familiar with the terminology) where I trained at a major hospital in Los Angeles. As an R1 on call, we carried a code pager so that we can respond to all code blues and gain some experience early on.

    The code blue pager beeped: “Code Blue in postpartum”

    My heart sank and I thought: “Postpartum? This can’t be good. I hope it’s a false alarm”.

    Along with a senior anesthesia resident, we promptly went to postpartum to survey the scene. There was a man outside the patient room holding a baby and crying. Inside the room was the lifeless body of a new mother that an entire team of healthcare professionals were trying to resuscitate. I assisted in the intubation and with the administration of chest compressions, taking turns with other members of the staff. For what seemed like an eternity, we were desperately trying to bring her back to life. After a while, the primary team called it. No more CPR. No more blood. No more cardiac defibrillation.

    I’m not sure why they called it so early. I wanted to keep going. What about ECMO? What about her baby? She needs her mother!

    I don’t remember the exact reasons for the sequence of events. But the leading diagnosis was a suspected fatal amniotic fluid embolism or massive PE.

    Sometimes I have flashbacks of the patient’s lifeless body.
    Sometimes I have flashbacks of her husband, a new father at one point was crying tears of joy for welcoming a new baby to the world, the hours later crying tears of sadness for mourning the loss of his wife and mother of his baby.

    New mothers are not supposed to die! I kept telling myself. Events like this are a reminder to me that anything can happen and that life events (especially labor and child birth) are not benign.

    I kept all this inside of me. And for a while I was afraid to start my own family. I didn’t want to put my wife at risk for such a catastrophic event. Eventually, I got over it. Though it wasn’t easy. Seeing stuff like this makes it difficult. Really difficult. But events like this also give you a greater appreciation and gratitude for life.

    I’m incredibly grateful to be alive, to have a healthy wife and baby, and to have the ability to help others who aren’t quite as fortunate.

    Thank you again for sharing your story and allowing me to share one of mine.

  6. Same with veterinary medicine. We always say when minutes count you have seconds. So sad to loose one. All the sad thoughts come later when you have time to think. I learned to listen to audio books on my drive home specifically Janet Evonvich and her humor got my mind onto better thoughts. I have highest regards for doctors, policemen and firemen and anyone else who has to make quick decisions and sometimes things don’t work out.

    • It’s funny how time warps like that, right? Some call it being in the “flow.”

      I’ve noticed the same phenomenon in the long term time game too… “The days are long but the years or short.”

      Thanks for the encouragement. I’ve always thought a lot of veterinarians, too. My daughter is wanting to become one right now. She is still less than ten, though. So we will see what happens over the next several years!

  7. Reading your story and the subsequent comments (especially about the new mother, which is haunting) gives so much insight into the mind of a doctor. While we laymen must look on from the outside, sometimes judging about the lack of bedside manner or empathy, you must keep your emotions buried as a survival skill. At the moment of decision, it matters not whether you display sympathy or detachment – just that you can do what you are trained to do. Possibly, this carries over into non-life threatening interactions. Your column has shifted my mindset. Thank you.

    • Thanks, Johanna.

      Compassion fatigue is the real deal. I’ve heard it said that entering medical school we are the happiest and most satisfied of the graduate students. Leaving we are the lowest.

      There is something about the transformational experience of becoming and practicing as a physician that changes us. I think we can fight against it, but we must first realize that we need to fight.

      Thanks for your support.

  8. Thanks for sharing your story. It sounds like you were in the right place at the right time. Hopefully the person that told you “we got it” was able to learn the lesson that sometimes you need to put your ego aside in the best interest of the person that needs help. That’s definitely a tough lesson to learn at times and many never do.

    • I think that he might have. And we all have to learn that lesson at some point. The patient should always come first above and beyond anything else.

      He likely meant well since I looked like a beach bum, but he learned a tough lesson that day, too.

  9. Wow, what a story. I can’t imagine the stress of having someone else’s life in my hands. Must take a lot of practice to keep emotions in check. To a much lesser extent, we were taught similar tactics in college during sports to reduce stress in high pressure situations.

    • Yep! I was only division 2, but I played as a college soccer as a goal keeper. I wasn’t the best at it then until I got my hands on the ball and it calmed me down.

      The perspective I have now would have been useful then, for sure.

  10. Thanks, TPP for your honesty and transparency here. It helps remind me of something I know that is so easily forgotten. Everyone is fighting a battle of some sort. Doctors, often get a bad rap. I never thought about the what happens emotionally to you when you lose a patient. Or when a procedure goes bad.
    The tragic story told by Dr. McFrugal was hard to read. I can only imagine how difficult it is moving forward.

    Thank you for showing me the other side of what docs have to endure. I have a new appreciation. For that I’m grateful.

  11. Thanks for sharing your story and more importantly, what goes on behind the story. It’s given me a lot to think about when it comes to what doctors deal with. As a not-especially-compliant patient, I don’t always make things easy for the doctors that help me, although I am grateful for their help.

  12. Thanks for sharing your point of view. It completely makes sense to me since I was in the military for 20 years. I thought about being a counselor but I realized that compassion fatigue or secondary ptsd could happen to me.

    Again, thanks for sharing!

  13. Thanks for sharing this story, and thanks to Dr. McFrugal for sharing his experience in the comments, too. As individuals, we are incredibly strong, but we’re also incredibly fragile. Being in the helping profession takes a toll. I’m a social worker, and my coworkers & I are constantly reminded to take care of ourselves due to the secondary stress of the job.

    • That’s a good reminder. I could not imagine being a social worker. In my mind, you have to deal with all of the negative sides of people without experiencing too many of the positives. Admittedly, I know very little about your job outside of hospitals, but you are all angels in my mind.

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