Once upon a time, I went to counseling, for a year. The reason was that I had lost my empathy somewhere along the way in medical training. It was my husband who suggested I get help, because the numbness could no longer be turned ‘on’ and ‘off’ for my work and I remained frozen and unable to relate when I came home. It turns out, you can turn off your ability to feel painful emotions, which is protective and allows for functioning in the face of medical tragedies. But, it bleeds over into the ability to feel joyful and relational emotions as well. You can’t have one without the other. Interestingly, the routine response, when the hubby describes any medical concern, of “are you dying? Then I don’t want to hear about it” is not great for relationship building.
Originally a compassionate person from childhood, it was part of my identity. It is even the meaning of my name, “Ruth: compassionate one.” Over the course of 5 years of OBGYN residency after 2 years of clerkship in hospitals, that compassion unconsciously began to feel like a soft underbelly, a weakness, in the way of doing my job efficiently. I began to protect myself with an armadillo shell. If the bleeding’s not audible, I would no longer bat an eye. This makes someone incredibly calm under pressure. But where is the humanism, the “I’m sorry for this suffering, I care about your suffering”? Men and women dealing with health concerns will agree that it’s the humanistic side of caregivers that helps with the healing, after the emergency resolves.
We know from studies of burnout in physicians that when humanism depletes, the quality of medical care decreases too. It is also no way to be as a wife, daughter, and relational human in the world. There are many systemic factors involved in this habit of ‘numbing out’, too, which therefore calls for systemic change. We need to work toward better duty hours, hospital culture that values self-care more than overwork, and the option for a doctor to take more time to spend with each patient. Until we reach that point in healthcare culture, we need to have an approach that can be used now.
Something my psychologist shared is a lesson I want to share with you now. There is a difference between being responsible for someone, and being responsible to someone.
- When I am responsible FOR someone, I mistakenly:
- Carry their feelings
- Feel fearful and liable
- Am concerned with “being right”
- Am responsible for their suffering, and their sorrowful feelings
This is sometimes called being “over-responsible”. Of course this is too painful for a healthcare provider to carry. So my solution was to numb out to the pain of others (unless audible bleeding involved). This is not a long-term solution. Furthermore, it is possible that by identifying as responsible for someone, I undermine their ability to draw on their own resources to deal with the current challenge. It is, surprisingly, a lack of trust in their own strength. I am (we all are) ‘responsible for’, one person only: myself. My feelings, actions, thoughts. In certain philosophical traditions (Stoicism, Buddhism) there is a sense that we all have been “assigned” a portion of universal suffering. This idea can be helpful as we realize that we cannot complete the assignments of others, only what we have been assigned. Also when we suffer, it is part of the universal story of all of us and we are not alone in our suffering.
So instead, let’s try this out.
When I am responsible TO someone:
- That person is responsible for their own suffering, actions, words and feelings
- I feel confident and calm
- I take action within my sphere of influence
- I simply trust and let go
This approach must be constantly balanced and negotiated. It is tempting to enforce professional boundaries — for instance, a strict “no late” policy to preserve and avoid being ‘over responsible’ for the latecomer. But as was seen recently in the case of Ellie-May Clark in the UK, someone with other social determinants of health can be late for many reasons, and suffer severe consequences for the policy. It may also be tempting to err in the opposite direction (I observe this more often in female healthcare workers); that is, to constantly badger a patient with reminders – get this test done, take this prescribed treatment, did you follow up with the surgeon I referred you to? There comes a point where the patient herself needs to take responsibility for her own health, letting the provider release the outcome. Where this ‘point’ lies may differ depending on the case.
In my work each day I see women and couples with infertility including failed IVF treatment; miscarriage; pregnancies with congenital abnormalities; sexually transmitted infections; cancer; chronic pain; sexual abuse; unwanted pregnancy; consequences of poverty. Yet if I can continue bringing my best as a caregiver, I need to remind myself of this: the suffering is theirs, not mine. As much as someone may even want to blame me for a particular outcome – that is a natural human reaction. Yet the truth remains the same: The suffering is theirs, not mine. I have my own assignment, my own suffering, and they have theirs.
Punishing myself will not alleviate their pain, but it definitely could restrict my ability to care for them and others. Suffering on their behalf will not make me better at my job either. Dwelling on: What could I have done better? Why did I say that? Did I connect with them? What were they thinking of me? No. Not useful. Not a tool of self improvement. Only makes me want to become an armadillo and not feel empathy again. The caring expression “I am sorry for this suffering; I care about this suffering” is an appropriately human and tender response, and many times it is enough.
As I hone my habits in this area, I am learning to self-reflect on a personal encounter or work day once, squeeze out all the lessons (maybe go over it with a trusted mentor) and then move on. To express empathy, and then get out of the replay loop and not dragged down into someone else’s suffering. I am responsible to others, not for them.
Dr Ruth Vilayil is a Canadian trained obstetrician-gynecologist with a collaborative style and a holistic approach to health and wellness. She has particular interests in Minimally Invasive Surgery, surgical education, and global health. She grew up in rural Alberta, western Canada and enjoys running, mindfulness meditation, and cooking Indian food. She currently lives in Kampala, Uganda with her husband and son.
Thank you for your post. I struggle with this problem daily. It is complicated, as you point out, by the many challenges our patients may face that are beyond their control requiring flexibility in some rules or boundaries (such as societal determinants you mention). Yet at least with the highly vulnerable population I work with, recognition of these factors can be a slippery slope. We can only manage this, I think, by careful attention to our own needs, awareness of our own vulnerabilities, and the ways we can be flexible while maintaining our own health vs the ways we cannot. Glad you went to counseling and I would encourage others to do the same. As a psychiatrist my own treatment has been essential for my education and personal health, including tackling challenges like these.
Thank you for this post. Reduced work hours offer more opportunties for maintaining our health, but when that was not an option, I placed a reminder to myself to practice some form of self-care. THis has worked wonders for me. Effective healers incorporate some form of self-care, so that they are unimpacted by the energies associated with states of illness which they are surrounded by. Caring for our own outer and inner states (aka “self care”) is an aspect that is wilfully neglected during our conditioning through years of training, etc. but it is time for a paradigm change.