On Regaining My Empathy

I’ve found that I get angry a lot, especially while driving in LA traffic. I’ve been cutting off cars and dodging between lanes to get ahead. I honk more than any human being really should and spew profanities like no one’s business. This is a new thing for me.

I was talking to an OBGYN resident a couple of months ago that said she had recently started yelling and honking at slow pedestrians in the crosswalk to hurry up. She supposed it was so she could speed home and get a few moments of a ‘normal’ life before she had to work again. She knew it wasn’t a good excuse but couldn’t help herself; she had become wired this way. It was a huge light bulb moment for me because I finally had an explanation for this sudden onset of road rage. Obviously I need to take personal responsibility for it, but there’s something to be said that it started over the last year.

We’re in a fast paced field, where we wear our 80-100 workweeks like a badge of honor. We try to out compete each other by bragging about how early we got into the hospital or the number of procedures we did that day. But I’ve found that I’ve become exhausted and numb (especially during rotations that challenge our circadian rhythm). How can you not be? It chips away at you. 12+ hours spent in the hospital and then you go home to study for the final exam. If you go out to do something fun that week, you really maximize it, which usually forces you to recover for most of the next day, and then back to work by 6 am. You may recuperate during an ‘easier’ rotation that is 30-40 hours a week and regain your sanity. And then you’re thrust into another crazy schedule again. And the cycle continues. You feel like a zombie going through the motions until you can find a night to catch up on sleep and feel something again.

Your patients don’t suffer, the quality of your medical practice doesn’t suffer, but you do. You throw yourself into your work, giving 100% of your empathy, intelligence, and effort into helping your patients that you leave the hospital with only a reserve tank to help yourself. Doctors and medical students have enough empathy and compassion for everyone but themselves. We hold ourselves to impossibly high standards that if any of us falter it’s better to make her an anomaly than to accept that she represents the otherwise silent norm.

I used to think that feeling overwhelmed in this field was a sign of weakness. We all knew what we were getting ourselves into and if you’re not cut out for it then maybe you’re in the wrong field. Suck it up or quit. But this mindset perpetuates the type of environment that has led to high rates of physician burnout, substance abuse, and suicide. This is the life we signed up for. I’m well aware and don’t think there’s a way to change it. But we can change the culture to one that is kinder to one another. We can be more compassionate and understanding of our colleagues not just our patients.

They say the lowest point of empathy in a doctor’s life is during their third year of medical school. I believe it. I used to pride myself on my empathy; it’s something I would list as one of my best three qualities. But I’ve found that it has eroded over time and is harder to draw on especially in my personal life. I get annoyed if I have to wait in a long line at the grocery store and get frustrated if things aren’t done quickly. I feel like my mind is going a million miles an hour and there’s always something to do. I’ve been fortunate to not have experienced depression or anxiety this past year, and have been really lucky to have great experiences overall as far as third year rotations go. And yet I still have felt beleaguered, frustrated and burned out. Maybe I’m alone in this, but I have a feeling it’s something we’re all going through but few are talking about.

I wasn’t willing to acknowledge it until recently. I thought that it was a rite of passage and these feelings would pass once residency was over and I began my life as a real doctor. Earlier generations had it much harder than us; my mom was forced to work 30 hour shifts as a resident when she was 8 months pregnant with me. Things have certainly gotten better, but there is much more work to be done.

 

A classmate of mine recently passed away and we had a memorial today to commemorate his life. While I originally wasn’t going to write anything because I felt that it was a personal moment within our community to reflect, I realized that a lot of my friends are in medical school and are likely experiencing something similar to what I mentioned above. Many of the speakers at the memorial, students and faculty, shared beautiful speeches with gems of advice that I’ve listed below. These ideas are not mine, but I felt the need to share them because they’ve made me reflect deeply and I want ready access to them the next time I feel overwhelmed or irritated:

 

  • It can be very difficult to recognize depression. People can be good at hiding it and going through the motions of being happy and sociable. Just became someone is smiling doesn’t mean they aren’t hurting inside.  We need to really listen to one another and work harder to reach these individuals. We also need to remove the stigma on mental illness. Depression, schizophrenia, and anxiety all have biological basis of disease like diabetes or rheumatoid arthritis. We need to treat them as such in all fields of medicine and be compassionate towards those that suffer from them, especially doctors.
  • We have to care for each other the way we care for our patients. Empathy should extend beyond the clinic walls and should not be exclusively reserved for patients. It’s time to stop the hierarchies and mistreatment of one another. Just be kind to other doctors and medical students. The work will get done either way, you might as well make it pleasant for everyone.
  • Take time for yourself. You cannot give to others if your cup is empty. It’s ok to be selfish and recharge. There’s a reason why they say to put the oxygen mask on yourself first before helping the person next to you on an airplane.
  • Don’t be hard on yourself. We’re all human beings which means we’re inherently fallible. Forgive yourself and learn from your mistakes.

 

I’m starting residency a year from now and will begin final training to cement the type of doctor I will be for the rest of my career. I’ve realized over the last few weeks that I need to make a change in my attitudes and perspectives towards medicine. I need to regain my empathy. I’m forcing myself to take time to slow down, be patient with others, and to not be so demanding with my colleagues or myself. And if the road rage doesn’t subside, I’ll blast meditation music on Spotify while I drive.