Losing empathy

I remember my first patient on Trauma. It was an old man who had shot himself in the head. I remember thinking that there was surprisingly little blood, and that he was very very pale. The back of his head had been blown off, but the pressure of his skull on the gurney had tamponaded the bleeding mostly.

I also remember feeling paralyzed and numb and unable to function. Fortunately, I wasn't the primary survey person. My only job was to call the CT scanner if it was determined he needed to be scanned.

He didn't. A few minutes later he was pronounced dead.

All these thoughts ran through my head. Why did he kill himself? Was his life so bad? His foot had been guillotined.... did he have health problems? A family? Money problems? Had he been suffering for a long time, wondering when the right moment would be to put the gun in his mouth and pull the trigger? Had he practiced? Written a note?

Would anyone even notice that he was gone?

It was hard not to cry, but I didn't.

And then I looked around me. Nobody else seemed upset. The EMTs and some nurses just put him in the black body bag and mopped his blood off the floor while prattling on about what they'd done over the past weekend and how they were buying a new house.

The doctors were similarly unphased.

I wondered if they had been born tougher than I was, or if they were just used to it. One of told me that she didn't find it upsetting at all. That it seemed a rational decision. His choice.

Anyhow, as the month of trauma progressed, I became more involved on the team, doing primary surveys, chest compressions, taking histories, sewing people up. When a patient was announced overhead in the ED, or your trauma pager went off, you'd just run from wherever you were in the hospital to the trauma bay so you'd get to be a part of the action.

Which ever medical student got there first got to to the primary survey if one of us wasn't in the OR on some other case.

*******

My last day of trauma ended the same way that my time on the service began. With an old man who had shot himself in the head. This time, the EMTs were doing compressions on him as they wheeled him through the door. He wasn't actually dead yet, and we ended up doing a whole bunch of procedures on him in the hopes that we might keep him alive long enough to use some of his organs for another patient.

I ran the primary on him, and did compressions. We never really got past "C" (of the ABCs) and after about 30 minutes we pronounced him.

My emotional response this time?

Meh.

After we'd bagged him, I sat and thought about this for a bit. It really didn't bother me. There were no almost-tears, and I was ready for another one. I had been able to function and do my job without any problems. I noted that his body was still warm as we zipped the bag over his head, and scurried around the bay filling out paperwork and getting work done.

But this lack of feeling.... I wondered if it would be a problem in other ways. Would I lose my ability to empathize with people? I feel like this happens a lot to doctors. They see so many tragic, intense things that they stop being able to feel. They can't understand why a patient would be upset by some illness that has befallen them because they have seen worse. They have lost the ability to feel what the patient feels. To see the world through the patient's eyes.

Why is this patient taking up so much of my time?

Whiners.

On the other hand, it's probably necessary that this happen to them for them to be good at their jobs.

Do they become unfeeling and hard in their lives outside the hospital too?

I don't know.

If they do, is it worth it?