During my final year in residency, while I was on a 30-hour call shift, I met a young woman who came into the hospital sedated and intubated after a car accident involving her whole family.
Her husband was pronounced dead on the scene, and her two children were life-flighted to the children’s hospital down the road. The young woman was admitted to the ICU, and because she was unconscious, we were unsure if she knew the status of her family members.
The nurse paged me and told me her parents were in the ICU waiting to speak with me; I had a feeling I would be the one to break the devastating news to them.
Sharing the awful truth
I introduced myself and asked them what they knew about the accident. They said they didn’t know much, except that their grandchildren were at a different hospital in the pediatric ICU. I sat down next to them and told them the extent of their daughter’s injuries, and that her husband was pronounced dead on the scene. I was not given an update on the children, but I told them I could call the hospital and get one. Then, they asked me whether or not her baby was still alive.
“Baby? I was not aware of a baby.”
They told me she was 16 weeks pregnant.
I wasn’t aware she was pregnant, so I immediately consulted the OB/GYN attending on-call and performed an ultrasound at the bedside. I was able to visualize the heart, but there was no heartbeat. My OB/GYN attending double-checked the ultrasound and confirmed the baby did not survive the accident. Because the young woman was intubated and unconscious, we would most likely have to perform a dilation and curettage. These parents had already lost so many loved ones, all I could do was apologize profusely. I felt utterly helpless.
What a bad day means for a physician
For most people, a bad day at work usually means some kind of task didn’t get done correctly, but when physicians have a bad day at work, it most likely means one of their patients died.
Physicians know all too well how important it is to be grateful for your life every day. Life is a gift, and we are taught this lesson daily.
Learning to manage negative emotions
We try to remind ourselves of these positive parts of the day, but it can be hard to avoid dwelling on the negative. We may often use defense mechanisms to cover up our real emotions and detach from reality when we have a terrible day at work.
"Repression and sublimation help us manage the emotions that come with witnessing so much suffering to continue to do our jobs."
— Kristen Fuller, MD
Although these defense mechanisms can be beneficial, used as a way to cope, they also have the potential to cause more harm than good. Repression is when we suppress our feelings and pretend like everything is fine. But the heavy stuff doesn't just go away on its own.
It can fester and bubble to the surface when you least expect it. Therefore it is crucial to take some time to work through the emotions—we can find comfort in talking with a coworker, a trusted loved one, or a therapist during these moments.
Sublimation is the attempt to transform a negative experience into something positive or at least easier to deal with. Dark humor, for example, can provide a lot of relief from emotional tensions that builds up in a grim clinical setting.
However, other outlets, such as exercise, listening to music, cooking, or reading, are positive ways to help work through and transform negative feelings into positive ones.
The difficulties of being a physician
Physicians are in one of the most emotional and challenging careers; we are dealing with people’s lives and holding the hearts of their loved ones in our hands. While this career can be difficult, it is essential to remember that it is also rewarding.
"The vast majority of our patients and society hold us in high respect, and the amount of trust placed in our hands is humbling."
— Kristen Fuller, MD
Even if we have a terrible day at work, we shouldn’t go home feeling like we have failed. We have done something positive in someone’s life—maybe that means we comforted someone who lost their mom, or made sure one of our patients passed away with dignity and respect. We must return home—our place of solace—with our heads held high, knowing that we did the best we could.
Each week in our "Real Talk" series, mental health advocate Kristen Fuller, MD, shares straight talk about situations that affect the mental and emotional health of today's healthcare providers. Each column offers key insights to help you navigate these challenging experiences. We invite you to submit a topic you'd like to see covered.