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