Photo courtesy of Rachel

The trauma page came over my beeper at 5 pm: Category 1. ?60 yo male. Fall 15 ft. +LOC. Intubated. BP 85/50. HR 127. ETA 5 mins.

Off I rush to the trauma bay, thinking to myself, this won’t be any good.

Five hours later, outside the ICU in one of the waiting rooms, I watch Dr. Carter, the trauma attending, deliver the news to the patient’s 10 family members, slowly and carefully.

“What I’m saying is we’re using a lot of medicines to keep him alive. Even with that, he might not make it through the night. If he does, his brain hasn’t been getting enough oxygen because all of the blood loss… Too much of his brain has died for him to be the person you knew. At this point, I think it would be best to make him comfortable…and let him go.”

With each word, I can feel the emotion building up in the small room, like a volcano, ready to erupt.

And then it does. There is an explosion of shrieks, cries, and “No, God no! Porque? Por QUE?!”

In my line of sight is the patient’s son, a 6 foot 6 inch tall, leather-wearing, tough-looking, biker type guy; he grips the chair, flushing red in the face and eyes to hold back tears, as the weight of the news strikes him. Next to him sits one of the patient’s daughters, eyes and nose flowing nonstop, rocking back and forth to comfort the 12-year-old girl sitting in her lap, who sobs, “I don’t want Grandpa to die!”

In the worst shape is the patient’s wife, her head completely buried underneath a hospital towel, hands pressing it to her face, as if somehow the towel would help shield her from what she’s just heard, making it less painful, or less true.

It is chaos and tragedy, all at once. I stand to the side in silent respect, as the family grieves before me. Taking it in, I’m a little disturbed to find, amidst all this emotion, I am completely numb to any sort of feeling.

I recognize the situation is heart breaking. I think it’s unfortunate the family must experience such hurt. Yet sadness—hard to believe—is not necessarily being evoked.

I feel for the family, but not with the family. I sympathize, but very distinctly do not empathize.

What’s wrong with me?

Is it troubling to say, well, nothing really? Or that a little loss in med student empathy during clinical training has become common enough to be a frequently discussed medical education topic?

Even with the knowledge that what I’m experiencing is expected, I’m still startled at how quickly it happened. I’ve only been on the wards for a year. I feel like this sort of snuck up on me.

There’ve been a range of reasons identified as to why medical students lose empathy: stress, the ward focus on problem solving, lack of role models, increase in cynicism.

For me, I think it’s a mixture of de-sensitization and self-preservation.

Over the past week and a half, this was the third emotionally charged, tragic death I’d seen (the next worst was a 16-year-old gunshot-wound-to-the-chest victim, who’d been caught in gang fight crossfire); it was the second “the outlook is bad, it would be better to just let go” conversation I’d witnessed.

Subconsciously (or maybe now consciously), I think I started blocking out emotions because I’ve had my fair share of poor patient outcomes this year.

There was Mr. Jenkins, my pancreatitis patient who I literally watched die.

And Chris, my unforgettably entertaining 39-year-old longitudinal patient with end stage kidney disease. The goal was to follow Chris to various doctor’s appointments, to get a patient’s perspective of the healthcare system. My schedule, though, kept interfering. Two days before we’re supposed to meet up at his dialysis center, I find out he’s died—bled out after a partial nephrectomy to remove a tumor. I couldn’t believe it; I’d just talked to him on the phone only days before.

Then there is Heng, the three-year-old I began following after Chris, because of his medical mysteriousness (doctors from Asia to the US had yet to figure out why his left arm and ear had been swollen since birth), and because his family, like my father’s, is from Burma. I followed Heng to his new immigrant health check, and helped relay his extensive past medical history to the new pediatrician, since the family speaks little English. I played with him and his brother, while interpreters explained to his parents how to operate his inhaler. I saw the family so often his parents told him I was a “Jie Jie” (Chinese for older sister).

With the pediatric surgeon, I actually excised the lymph node that ultimately led to his diagnosis: systemic lymphangiomatosis. The condition is so incredibly rare there’s only one page devoted to it in Nelson’s, the massive pediatric textbook. If Heng is lucky, he’ll live to sixteen. Heng I think was the final straw.

When these patients, my patients, didn’t do well, though, realistically, I play a tiny role in their lives, a part of me mourns for them. It’s been draining to get emotionally involved, then feel a stab each time there is a poor prognosis. I’d lose focus, couldn’t study, couldn’t be a medical student. You can’t think when you’re feeling all the time—something I really can’t afford to do, I have exams to prepare for…

So perhaps selfishly for now, I’ve just turned my empathy off a little. I hope to get to a point soon where I can turn it back on.

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