Emotion versus logic in medicine: where do physicians draw the line?
Reflections on death, emotions and logic in medicine
It’s 9:30 am on a Wednesday, I get on the elevator and I hear a man, in his 40’s, having a conversation on his cell. He says: “He had a brain bleed yesterday and they had to put a breathing tube in, they don’t know how much damage his brain has suffered at this point.” He gets off on the adult ICU floor. I quickly think “that sucks” and carry on with my day.
A little bit later that day, as if the theme for the day was brain injury, I walk by a woman standing on the street. She speaks on her cell phone and says: “there was a blood clot that went to his head and now they are trying to bust it, I’m not sure what’s going to happen.” I quickly glance at her, think “that’s not good” and move along.
Reflecting on your day
That night, as I thought about my day, I contemplated how often I hear people complain about physicians being cold and removed. I analyzed my own reaction to the two strangers I overheard during the day. The language I heard is such an integral part of my everyday vocabulary. I honestly didn’t think too much about it. Clearly the people talking on the phone were distraught and upset. A loved one was seriously ill and they were at a loss.
Then I thought, was it that I really did not care? Is it that the system, with the ever-growing work load and the rising demands, has jaded me to the point that I’m truly “cold and removed”? I took a trip down memory lane and looked back on my own journey and development as a physician.
The young physician
When I first started training, every child that died, every family that suffered, it was personal.
I remember calling my dad during the early days of my pediatric ICU training. One of my patients, whom I had been caring for during many months, died. I was upset and crying. I was in pain. Each death was an emotional drain.
If I would have continued getting so upset over each death, I would not have been able to continue doing what I was doing.
As time went by, I went through an emotional evolution of sorts.
During my last year of ICU training, I volunteered at a hospital in Tanzania for a month. This experience turned out to be key in changing my view on death.
As in most developing countries, death in children happens much more frequently over there. They don’t have the technology, money or resources that we have in the United States or other developed countries. While in the US, we had 1-2 deaths per month in my hospital, in the hospital in Mwanza, Tanzania, where I volunteered, they had 6-8 deaths per day.
This was inconceivable and outrageous to me. At the same time, it opened my eyes to a different view on death. Their grief reaction and their perspective on death and dying was unlike ours. Naturally, parents grieved the loss of their child. However, the grief seemed shorter lived and less extreme. It felt as if death was not such an unexpected event, as it was back home. Death was very much a part of life. You live and you die, some sooner than others.
For the first time, I was able to internalize that. Yes, losing a patient is terrible, but sooner or later death comes for all of us. Sometimes, even if you have everything at your reach, you still can’t save someone. To be honest, after doing this job for many years now, occasionally, death is a kinder alternative for the patient and the family. It is so easy for us to forget it, because we have so many life sustaining and prolonging interventions at our reach.
So, my outlook on death changed. I finally understood that to be able to do my job, and to do it well, I could not be led purely by my emotions. I learned to separate emotions and feelings from logic.
Walking in someone else’s shoes
Being led by logic in medicine may not seem as a great solution for some, but picture this:
Imagine if you are a physician and you are trying to resuscitate a patient, but you are so upset for the family and the patient that you are unable to think logically.
I don’t think this is the kind of doctor you would want. It is certainly not the doctor I would want for myself or my family.
What I look for in a physician, and what I think we should all want, is a physician who is able to take a step back and unemotionally BUT compassionately (one doesn’t preclude the other), tell you the facts and information, so that you and your family can make decisions.
Once I saw the kind of physician that I would want for myself, I had a clear picture of what I needed to become. Levelheaded, cool in a crisis, even when everything around you is falling apart, and at the same time, compassionate to fellow human beings who are suffering, but emotionally neutral (as much as humanly possible). This is, of course, no easy feat, but it is possible.
So, are we cold and detached?
Big nope. Now, when I hear people talking about physicians being cold and unemotional, I have to disagree. Of course, I am sure there are some docs that, due to their formation and experiences, actually are cold and unemotional. However, this is the exception, not the rule.
Think about the life of a physician, from medical school to being a fully “grown” physician practicing on their own.
Think of all the patients they have lost along the way. All the tears that were shed. The sleepless nights spent at the bedside of what was undoubtedly a lost battle.
Imagine how that doctor could survive if they continued to feel and suffer throughout their career as they did when they lost that first patient.
It is simply not humanly possible. Personally, I would have left long ago. Logic in medicine has to be the ruling force.
After my daughter was born and I went back to work, I had to take a step back. Suddenly, every baby reminded me of her. Whatever age she was, if a patient her same age came along, I could see her lying on that hospital bed. I again had a hard time separating from emotions. I would lock myself in the office and cry, not infrequently, during that first year of her life.
Then I remembered Africa, remembered what I learned, that death is natural and normal. That life comes with joy and suffering, and part of my job is to help families and patients navigate during one of those moments when they are suffering. This is an honor, and not something to be muddled by my own emotional distress.
I remembered that I was there to help that patient and provide a service to the best of my abilities. In order to that, logic in medicine needed to be the ruling force, not emotions.
Interesting and right that the place of origin of life as humans is the place that taught me about its conclusion.
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