Kristin Prentiss Ott, M.D.

Medicine: The Truth about Calloused Care

My visor was fogging in front of my face and I wanted to tear off my suffocating mask.  My breath was hot, the blood-proof gown was hot and those ultra-powerful O.R. lights were HOT.

On the table, was a frail octogenarian with ovarian cancer. Giant steel retractors looked like metal jaws holding her open. I peered down with interest at her glistening liver and intestines from my perch behind the surgeon’s shoulder.

Then two grown men grabbed opposite sides of the retractors and pulled as hard as they could to expand the operating field. The jaws *clicked*, *clicked*, *clicked* wider and it looked like they were literally ripping her apart.

Nausea rose and I stepped off my viewing stool.

The next thing I knew – I was in the hall sipping orange juice.

I passed out.

I’ve heard people say, “I could never be a nurse/doctor, because I faint at the sight of blood.” But if you see enough of something, your emotional response fades. The psychology term for this is “desensitization.”

The day I passed out in the O.R. was the first time I had seen the inside of a live person. Fifteen years later I can pull skin back over exposed bone like pilots fly planes and bankers read spreadsheets. I have been desensitized to human gore.

This kind of adaptation makes us better at our jobs. In medicine we are able to stay calm because we’ve seen enough blood pouring from gaping wounds to not freak out or pass out (responses that would be hugely counter-productive to patient care).

Unfortunately, our emotional response dulls to everything we see a lot which includes suffering, tears, poverty, addiction, self-harm, homelessness, abuse, deviancy, depression, and despair.

Seasoned medical professionals are often calloused or jaded or both. It is the natural result of repeated exposure to disturbing stimuli. Baggers at the grocery store are more likely to offer sympathy for hardships than some healthcare providers.

So how does someone desensitized to blood and guts remain sensitive to suffering?

For me, there are 3 keys to staying people-centered in a densensitized, compassion-fatigued workplace.

  1. Remember your own suffering.

In The Chosen, Chaim Potok writes about the importance of experiencing pain. He writes,

“One learns of the pain of others by suffering one’s own pain…by turning inside oneself, by finding one’s own soul.  And it is important to know of pain…It destroys our self-pride, our arrogance, our indifference toward others.”

  1. See the person, not the problem.

I have heard staff members complain about low-income parents bringing their kids to the ED for fever without giving them Tylenol or Motrin at home (usually because they don’t have any). And I have watched these same staff members look at the face of “Michelle,” a young mom with a brown-eyed, chubby-faced febrile infant and then dig in their pockets/purses to pool cash for a bottle of Tylenol.

This is actually a real, human phenomenon that has been studied. Nicholas Kristof wrote about it in Half the Sky and also in an article called “Advice for Saving the World.”  He wrote,

“A classic experiment involved asking people to donate to help hungry children in West Africa. One group was asked to help a seven-year-old girl named Rokia, in the country of Mali. A second was asked to donate to help millions of hungry children. A third was asked to help Rokia but was provided with statistical information that gave them a larger context for her hunger. Not surprisingly, people donated more than twice as much to help Rokia as to help millions of children. But it turned out that even providing background information on African hunger diminished empathy, so people were much less willing to help Rokia when she represented a broader problem. Donors didn’t want to help ease a crisis personified by a child; they just wanted to help one person—and to hell with the crisis. As we all vaguely know, one death is a tragedy, a million deaths is a statistic.”

So forget about the twenty people abusing the ED for food this week and feed “Sam,” the hungry, bearded guy with an Army hat sitting right in front of you.

  1. Bring God into it.

It doesn’t matter what religion you practice, there is something holy about serving others. When we are most worn thin, my husband and I say to each other, “Go be the hands and feet of Jesus.” What a tremendous privilege it is to play a part in easing suffering. In Jesus Wants to Save Christians, Rob Bell writes,

“Our standing in solidarity with the single parent, the unemployed, the refugee, our joining the God of the oppressed to work for justice in the world, doesn’t just make a difference for those who are suffering.  It rescues us…Our destiny, our future…using whatever blessing we’ve received, whatever resources, talents, skills, and passions God has given us, to make the world a better place. Disconnection from the suffering of the world, isolation from the cry of the oppressed, indifference to the poverty around us will always lead to despair.”

I admit that I often fail to follow my own advice. I admit that at times a compassionate approach has been mocked as naiveté and inexperience by co-workers. I admit that it’s easier for me to maintain my sensitivity to suffering because I work part-time. If I work three shifts in a row, I spend a lot more time thinking about me (and my exhaustion and chart load and children) during the third shift than I did during the first one.

But I know the secret to joy in our work is not through indifferent efficiency, but honest compassion.  Preserving sensitivity to suffering in medicine has to be intentional. Remembering our own pain, focusing on one patient at a time, and making the most of our opportunities to serve people in need is not only good for our patients, it’s good for us too.

 

                   

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Kristin Prentiss Ott, M.D.

Author of the viral post: 10 Things to Know Before Your Next Visit to the Emergency Department. Board certified emergency medicine physician, wife, mother, aspiring novelist.
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1 Comment

  1. Kassi

    “Go be the hands and feet of Jesus” was so beautiful I can’t stop thinking about it.
    I did spend 6 days at the bedside of a beloved family member last week.
    She grew up in a complicated family, was not taken to the doctor or dentist ever as a child and the hospital was very new and terrifying for her. Which is why I stayed. I needed each and every person who attended to her to know that she is bright and successful, even though I know her chart screams, ‘poor’, ‘no medical history’, ‘no insurance’…
    I was pleasantly surprised that the ER doctors did not show any negative judgement, they admitted her, and she ended up in a beautiful private room. But she was subjected to many tests that terrified her, but we found all but one doctor to be compassionate and patient.
    Because I have known her all her life, I know her beautiful heart and defiant spirit that moved her up and away from her past. But I know how easily it is for Doctor’s to make a quick judgement. One neurologist did just that, and it was tough keeping this proud girl to stay in the hospital for more essential tests.
    I love what you wrote because it is so important for all of us who may feel a quick judgement, that you are blessed and just plain lucky not to have walked in some of your patients shoes. This girl is a survivor and a professional. But she and her husband are members of the working poor, and it’s a long way up when you start with nothing.
    I would just like to let you know how very important it is for all the hard working doctors out there, not to give up on your patients that are unfamiliar with your system. It can be terrifying to be surrounded by white coats & machines.
    Poverty is not a character flaw, nor it is a weakness. This girl works harder than anyone I know.
    Bless you, Kristin, and your husband, always.

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