The CPR was pure mechanics, zero emotion, only adrenaline. Everyone was working in a frenzy—an ad lib ballet on a stage of blood. They were sticking needles, pumping blood, shouting orders, holding pressure. I stood over the dying woman and pushed hard on her chest, trying to not get distracted, and compressed her sternum into her heart. Again and again and again. I stared at her feet. Her skin was pale, like spilled milk on wax paper. Her toes were perfectly pedicured and painted a happy orange for her son’s birthday, today, his first.
The woman died from an amniotic fluid embolism despite our best intentions. The amniotic fluid that had encapsulated, protected and sustained her child’s life for nine months entered her veins like black heroin, flowed into her heart and lungs, and with the same power for which it allowed life, for her, dealt death. Her boy, however, was born perfectly healthy, alone and abandoned by a dead mother who lay in the hospital basement while he basked under warm NICU lamps.
Her death broke through the numb: the protectant white coat shield I’d built and developed and nurtured for my own survival. As the numb broke, I saw my shield as a malevolent transformation more than as a skill gained. Like the amniotic fluid, something inherently protective had turned toxic.
I remember my first code more than five years ago as a medical student. I watched in a mix of awe and panic as I watched the team perform CPR, and tried to decipher what had led to the patient’s downfall. It ended quickly, and before I had time to process the loss of life, there was already another patient to see. The years rolled by and so did the deaths. Surgeries gone wrong, ventilators turned off, fatal arrhythmias, blood infection, gunshot wounds, and bodies ravaged by chemo. With each death witnessed, the stronger my survival instincts became. I began to cocoon myself from the sadness.
I suppressed sadness. I suppressed fatigue. Sometimes I suppressed joy or hope because of the eventual downturn I expected to come. I suppressed fear. Fear of making a mistake. Fear of having someone die on my watch. Fear of looking incompetent, missing something crucial and things going wrong. In my attempts to cope I shed emotions I deemed arduous. In those years where there seemed like little else but work, sickness, and death, I did what I had to make it out intact.
At times I was oblivious to the emotions I discarded, , because as they disappeared my competency grew. I started to buy into the fallacy that the loss of an emotional response was simply the achievement of proficiency, and while I was growing more capable in my abilities, the blunting of my mind and body’s response to medical maladies was not without consequence.
There were times at home when my wife would have a nebulous ache, or my son would spike a fever and scream, and instead of being fearful and accessible, I became hardened and short in my response, running differentials in my head as I formulated plans in response to the worst-case scenario. I’d brought the hospital home. At times it seemed like no one had the capability to stay healthy. Sickness was ubiquitous, which it was, but not the type of sickness I was seeing day in and day out. To me, my family’s ails were signs of impending doom, and instead of feeling fear, or stopping for a moment to address it, I skipped right past into action, letting fear percolate somewhere in my unconscious, never fully realized or reckoned with.
While letting go of many feelings and emotions, I unintentionally grasped onto another. There was always part of me that would latch onto mistakes and refuse to let them go—a haunting, pervasive element of my personality that lead to betterment but left behind torment and regret.
During my intern year, I asked a woman in the emergency department when her last period had been and she reported about three weeks ago. I deferred the pregnancy test and ordered an x-ray which showed a full grown fetus in her abdomen. I was devastated to have radiated that baby. I still regret it now. I regret the multiple times I ordered the wrong dosage on patients for their medications. I regret being short with a family at four o’clock in the morning when they were concerned about their father’s deteriorating condition. I regret talking to a mother of a twenty-year-old woman like I could somehow empathize with her. Her daughter was being ravaged by graft-versus-host disease and her lungs were barely functioning. We’d stop by on ICU rounds, the attending would adjust the ventilator and then later on would speak candidly about the futility of our care. With patients dying left and right in the ICU, it seemed such a simple answer to let the daughter go. I took some time after rounds and spoke to the mother. I wasn’t being cruel or cold. I felt sorry for her and sorry for the patient. I couldn’t imagine what she was feeling, but the part that I regret most was that subconsciously, I thought I did. But of course I couldn’t. I never allowed myself to even get close to feeling what she felt. At that time in my life, I didn’t think I’d be able to keep doing my job if I was able to feel her pain.
I spoke to the mother about the prognosis and withdrawing care. I spoke with such certainty—as if medicine had no impossibilities—that her daughter would soon die and the right thing to do was to withdraw care. I remember the look on her face. It was the look I would give if I were ever in her shoes with my own son on the ventilator. A look that said, ‘You will never know until you know.’
Once I became a father, I realized immediately what that mother must have felt when I spoke so candidly to her. It keeps me up at night. I realized that what I was discussing with her wasn’t about the right thing to do, but rather, the mother’s impending emotional engulfment. The same emotions I’d learned to suppress, this mother had, too. But her daughter’s passing—the finality of it—would be, like death, unrecoverable. Sometimes I imagine the mother leading her daughter through the dark woods, hoping to find a clearing to rest, or a path out. Then I come to her, in the depths of the forest and sit with her for a minute, and when I depart, her daughter is gone and the mother is alone, abandoned like the baby in the NICU, insulated by her heartbreak and gloom.
In the end I’ve learned to feel again. I’ve learned to cry, to get angry, to be part of the world again. Sometimes it makes my job harder. Sometimes it makes watching my children in pain or discomfort unbearable. But it makes it all worth it. I became a physician to empathize, to heal, and while my survival instincts paid their dividends in training, my more humanistic side has conquered. I no longer fear emotional engulfment. I accept it as an eventuality—an essential part of being a human, a doctor, and a dad.
S. R. Schulz is a physician living in Portland Oregon with his three sons and wife. He has been published in Litro, Maudlin House, Train, Pidgeonholes and others. In his free time he tries to sleep.
