A physicians journey to emotional agility.

soon after my sister

was diagnosed with leukemia her doctors

told her only chance for survival would

would be with a bone marrow transplant

our older sister caroline and i

went to be tested hoping we could become

donors

we waited weeks for answers only to find

out that we matched each other but

neither of us could help victoria

that long wait for answers was agonizing

i thought i understood what patients and

their families go through and how to

balance between

caring and self-preservation as a

neurosurgeon i cared

but within limits striving to maintain

objectivity and detachment

i knew compassion was important but this

only went so far

over years of training and practice i

had developed emotional armor

to protect myself from grief and from

sadness

i was afraid of making mistakes

of being wrong of being overwhelmed by

powerful emotions

i didn’t think i could handle i didn’t

even know i developed this

self-protective shell until i found

myself on the receiving end of medical

care instead of the provider’s end where

i normally live

and i saw all too clearly what it’s like

to be a patient

and how inadequate was my prior stance

both for myself

and for my patients

i’d like to take you on my journey of

transformation but first

i need to introduce you to my younger

sister victoria

victoria was 18 months younger than me

she was always in my life

she was fearless and would never back

down

but was also incredibly loyal and kind

she was extroverted and brave an actress

she was at home in front of a crowd

nothing would have made her happier than

to have stood in front of this

audience i on the other hand am far more

introverted

and much more comfortable one-on-one

with a patient

in an exam room four years ago

victoria developed an aggressive form of

leukemia she wrote about it in her

journal

she was hospitalized for nearly eight

months continually

much of that time sealed in room from

the outside world she couldn’t even open

a window to get a breath of fresh air

she had her bone marrow transplant and

ultimately her son nick

became her donor i watched by her side

as she went from vital actress and

mother

to cancer patient

i saw far more clearly than ever before

how terrifying it is to be a patient

how families hang on the doctor’s every

word

things i had taken for granted

like waiting for results become very

different if you’re a patient waiting

for tests

for a doctor’s call or visit victoria

checked her identity at the door

she had her head shaved when she grew

tired of her hair falling out the time

all the time

she was hooked to iv pumps which seemed

to beep continually

an iv pole was her constant companion to

her doctors

she was a patient only months before

she had been a vital actress mother and

wife

few knew the little girl i had grown up

with

but this is the story of each and every

patient

i began to appreciate the power of

empathy and compassion

compassion means to suffer with

patients want to know that their doctors

care about them care not

rooted in compassion doesn’t feel very

good at all doctors miss

opportunities we avoid

emotional exposure and tend to

substitute

technology and precision or procedures

for meaningful connections

i wince when i look back on those missed

opportunities in my own practice

connecting with my emotions and with my

patients became vital to me

i realized the emotional armor i had

created

didn’t work it didn’t protect me from

these emotions

only just pushed them away and buried

them

and it was starting to interfere with

the quality of my life

foregoing a defended posture led to a

personal transformation

it was as if i went from seeing in black

and white to suddenly seeing in color

we become able to connect when we allow

ourselves

to be vulnerable doctors avoid this

often out of fear they say they don’t

have time

but it takes only 17 seconds to forge an

empathetic bond with a patient

all it really takes is a willingness to

go there

being vulnerable means admitting that

i’m unable to solve

problems or cure patients i desperately

want to help

and to admit failure

one moment brought home this change for

me i was standing at the bedside of a

young man with his mother

he had been paralyzed in a devastating

car accident and was about to die

there was nothing we could do to save

him words

completely failed me

instead of retreating to my normal

stance of fact-based detachment i

reached out to her and i hugged her

we held on to each other and both of us

cried

i would never have done this before

victoria’s illness but afterwards i was

far more aware

of the depth of this woman’s suffering

there was nothing i could do to help her

son

i tried to help her and she in turn

helped me by helping restore my humanity

in her ted talk brene brown invites us

to welcome

our vulnerability and shows us that it’s

a sign of strength and power

not one of weakness but surprisingly

she says that surgeons in their jobs

can’t afford to be vulnerable and i

disagree

surgeons must allow ourselves to be

vulnerable we must connect with our

patients

compassion must come with us to the

operating room

without it we expose our patients to too

much risk

such as over operating or cutting

corners

especially under anesthesia our patients

interests

need to be foremost in our minds through

victoria’s experience

i began to appreciate that we will all

become patients and procedures

while sometimes important are not always

paramount

megan white was an example of this like

victoria she was a young woman with a

terminal illness

she had been sent to me to have a

reservoir placed in her brain to be able

to deliver

medications chemotherapy to help control

but not to cure her metastatic breast

cancer

i asked megan what was important to her

and she said finishing out the school

year with her fourth grade was something

she did not want to miss

that meant delaying her surgery for two

weeks something that didn’t matter in

the end

but being able to say goodbye to her

students

was important to her the old me would

have scheduled her surgery and moved on

the new me sat and held her hand

i listened to what she wanted me

before me she was putting on a brave

front

but i could tell she was terrified and i

thought of victoria

who had faced similar daunting

challenges

with courage and i cried

i would never have done this in the past

but i had allowed victoria’s spirit to

change me

18 months after my sister victoria died

her husband packed

had a brain hemorrhage from a ruptured

cerebral aneurysm

his son nick the one who had donated his

bone marrow for his mother did cpr and

his father

and called ems and pat went to the

neurosurgical icu at ucla where he spent

the next two weeks

i was his healthcare power of attorney

which means i had to make medical

decisions on his behalf including

agreeing to brain surgery

and ultimately deciding to withdraw

treatment i was also a neurosurgeon

suddenly on the receiving end of patient

care

again how i saw how disruptive and

terrifying it is to be a patient

and how families cling to the every word

of the doctor in the medical team

i saw how pat ceased to be the vital man

he was prior to admission and instead he

became a head on a bed

all the decisions we made only made

sense in the context of who he was

but the medical team didn’t know him or

what he wanted and i knew as a

neurosurgeon

that procedures while they mattered only

mattered so much

the compassion of the medical team was

vitally

important to us its absence felt like a

searing wound

i had to push to level the power dynamic

between

the medical team and his family at times

it felt as if we were on a conveyor belt

of care where decisions were being made

based on protocols

rather than as expressions of his hopes

and dreams in the end we decided to

honor his wishes

to withdraw treatment and let him die

even with all my knowledge and training

this was very hard victoria’s sons

had been shielded from their mother’s

death

they had never realized how sick she was

and when she died they were shocked

and devastated with pat

we did things differently we invited

them into discussions

and included them in decisions on his

patient on his care

late one night we sat at their kitchen

table

and we told them it was time we thought

it was time to stop

i was scared of having that discussion

with them but they thanked us for our

honesty and for including them

in their father’s care and i was

surprised by their gratitude

they were able to help plan his funeral

and this allowed them to begin to heal

palliative care came too little and too

late in both victoria and pat’s cases

palliative care is goal-centered care

focused on comfort

it’s multi-disciplinary and includes

nurses and doctors

and needs to become much more readily

available currently 55 percent of

doctors describe themselves as

burned out many quit or retire

early i don’t think it’s the exposure to

sadness and grief that causes them to

burn out if it were

palliative care doctors would all be

burned out instead they’re some of the

happiest doctors around

no i think it’s the barriers we place to

these emotions

and the armor we put in it’s in place of

real

close experience that cause that

contributes to burnout

connecting with our emotions and opening

our hearts

is actually a source of power and great

satisfaction

still i agree with dr brown

surgeons can’t afford to be vulnerable

all the time how do i take a patient and

have an intense conversation within one

minute

and the next minute take them to and

perform brain surgery

without falling to pieces how do i

protect myself

the answer is through emotional agility

this allows us to experience a range of

conflicting emotions without becoming

bogged down or stuck

through emotional agility people with

emotional agility are dynamic and

powerful

they gain power from facing rather than

avoiding difficult emotions

and they recognize that life’s beauty is

inseparable

from its fragility with emotional

agility

we’re able to connect deeply with our

patients and with ourselves

increasing engagement and satisfaction

and staving off burnout

with emotional agility i’ve been able to

have a meaningful conversation with a

patient one minute

and then take that patient to surgery

the next it’s no longer a choice between

emotional connection and dispassionate

technical precision

you can have both it’s no longer either

or but

and an important component

of emotional agility is self-compassion

this is the ability to forgive ourselves

for our inevitable failings and

shortcomings

empathy and agility can both be taught

they must become central in medical

education

they’re difficult to learn even with

direct training and almost impossible to

master without it

i only began to learn them through the

personal crisis that rocked my world

i have spoken about my evolution as a

neurosurgeon

but what’s the take home message for us

as patients

why does my journey even matter it turns

out what i’m talking about matters to

each of us

we all deserve physicians with whom we

can forge

a meaningful connection

bedside manner is important it’s not

just window dressing

if you feel dismissed by your doctor

find a new one if your doctor isn’t

interested in who you are

or what’s important to you choose

someone else

compassion needs to be at the center of

the patient doctor

relationship without it we may agree to

procedures we perhaps shouldn’t have or

let people make decisions on our behalf

that maybe may not be in our best

interests

without asserting our interests

hospitals can be cold mechanical

inhumane places

where our loved ones may languish half

dead against our better instincts

victoria was unwilling to accept the

possibility that she might die

and she wouldn’t consider the survival

statistics of her illness

this included a six percent five-year

survival rate for her type of leukemia

essentially a death sentence at the time

of diagnosis she believed

that breathing life into this would make

it happen

denial was her emotional armor

so when her transplant failed and her

leukemia came back

her doctor substituted milder

chemotherapy

which didn’t work like a magic show

that’s distracted everyone from the

inevitability of her death

her doctors never spoke with her about

dying and as a result she never said

goodbye

to her husband pat or to their two sons

nick and will

and this was tragic and a missed

opportunity

for all of them patients have

responsibilities to become

educated about their conditions so that

they can make better choices

education is important but so too is

preparation we’re all going to die

we’ll all become patients this isn’t a

mystery the time to talk about this is

before we get sick not after

everyone needs advanced directives and

to have thought these things through

you can’t believe how often i take care

of patients who’ve never

spoken about this avoidance doesn’t work

here either

it turns out a good death requires

planning and forethought

it turns out we all use emotional armor

to protect ourselves

from intense emotional experiences and

it rarely does this any

good i have become happier and healthier

striving towards emotional agility

giving up my pursuit of perfection and

precision in favor of connection and

compassion

has made me feel happier and healthier

and i feel better without my ill-fitting

emotional armor weighing me down we will

all be happier with doctors who aren’t

detached and offended

defended and if we can forego our own

emotional armor we’ll be happier and

healthier too

so don’t let health systems

define us by our illnesses stand up for

what’s important to you

and your family member this is all the

more important if like pat your loved

one is in a coma and can’t speak up for

himself

compassion needs to be

the core value of our health care

experience

this is all the more important with the

isolation and anxiety we’re all feeling

during the covid pandemic we are all

vulnerable

we can no longer afford to take for

granted our shared humanity

and the power of connection

now more than ever compassion

is the key foundation for healing

take a moment to imagine how sweet life

would be for all of us

if we followed this path