Every July, a fresh group of newly minted doctors puts on their white coats. No more playacting “doctor” as they did moving through medical school — from here on, they’ll be trusted with keeping people alive. A close doctor friend told me the best piece of advice she could give me for my internship was to “externalize.” I’m training to be a psychiatrist, but my program has me rotate through several other fields, such as emergency room medicine, and for these tough, bloody months, my friend told me I had to leave my emotions at home. It was a survival tactic, she said: To do your best, you need to slip on a suit of armor. I took her advice and during months of grueling night shifts in the ER, I’d imagine pulling a layer of slinky silver armor over my thin blue scrubs. I hoped this make-believe psychological armor would protect me from the constant noise, the stressed-out staff members, the frustrated patients and their family members, and even the bone-grinding effects of exhaustion. I could tune out everyone and everything except the patients right in front of me, and my responsibility over their basic health and survival. And when I arrived home in the early morning and stripped off my scrubs and clogs in my apartment entry, I assumed the armor came off with them. Three weeks into my time in the ER, the son of a woman I’d been tending to asked whether I could give him a call when his mother got into her transportation, as he had to leave the hospital. It was my busiest night, and I was managing many other critically ill-patients, and I was scared of making a fatal mistake. I responded quickly: “It might be late. Does your mother have a cellphone? Remind her to give you a call.” I could have quickly written his number down, but at that moment it felt like too much; not a “critical” action. I wish I could say I ran after him as he left, or got his number from his mother so that I could call him as she was leaving, but I didn’t. My psychological armor was doing its job. But it was getting in the way of a much simpler piece of advice from a different mentor: “Be kind.” A bad moment This moment kept nagging at me. I thought about my own family members, who had been patients themselves, and remembered stories of them asking for help in hospitals. Stories of doctors who had brusquely ignored simple requests, like where to find the cafeteria or bathroom. These doctors had been too consumed by their duties and their own stresses to extend a small but critical kindness And later that night, when I finally got home, I cracked off the armor and cried. I cried because I now related to those doctors who’d failed to help my own family members. When I had refused to call the son of the woman I’d treated in the ER, it had felt like too much — another task I couldn’t fit into my brain. I wanted to think that those doctors, like me, were having bad moments. Moments of emotional and intellectual exhaustion — burnout. But that lack of simple kindness wasn’t the real me. It’s become a buzzword, “burnout.” It’s a term that any med student sees splashed across slides, training modules and news reports. A term that can mean many different things: depression, physician suicide, an inability to do one’s job well, a dissipation of meaning from one’s work. And now I saw it in another form: a loss of kindness. After I took down my defenses, I felt all the things they were protecting me from: the smells of the ER, the screams of pain and frustration, and even the heaviness of my own swollen legs. But I also had time to recognize small acts of humanity. A nurse who runs to get a patient a peanut butter-and-jelly sandwich from across the building because those are the patient’s favorite; attending doctors ordering food for their teams in the middle of the night; family members holding each other. I’m now beginning to understand the delicate balance that my doctor friend’s advice requires, a balance that every medical student and doctor in the country has to maintain: to protect yourself, but not to cover yourself in armor so thick and so heavy that you lose yourself inside it. Source
