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Doctors spend a lot of time listening to stories.
Stories show us who people are and give us a window into their world. But doctors also have their own stories that they often do not share, or if they do, they are usually only shared with other doctors. Stories of defining moments and experiences that have shaped their careers and personal paths.
The reason such stories are only shared with other doctors is often a fear that they may be too shocking for a lay person’s ears. They may portray us as less than human, depicting times when emotions had to be dialled-down so low that they were practically at zero to allow us to get on with the task at hand.
Like the story that one doctor told me recently about the time, many years ago, when he was a paediatric SHO in a Special Care Baby Unit. Upon reporting for duty on a Saturday morning, a premature baby was admitted to the unit in a critical condition. The doctor spent the next 48 hours trying to save the baby’s life, with little sleep or support from senior colleagues. The baby died in the early hours of Monday morning. The doctor described his reaction as one of relief and resentment. Relief that at least now he could put down his stethoscope and possibly snatch a couple of hours’ sleep before the Monday morning ward round. Resentment that the baby had not died sooner, which would have spared him a weekend of anxiety, sleeplessness and fatigue.
Years later, this doctor still wondered how he felt nothing, at that time, for the baby or the family. How had he become so dehumanised that he could not appreciate the parents’ grief or the fact that the previous two days were the only memories they would have of their child?
This dialling-down, or switching off, of emotions is something with which most doctors can identify. Roger Neighbour, in his latest book The Inner Physician: Why and how to practice ‘big picture medicine’, argues that it is a necessary requirement for coping with human tragedy. It often begins in medical school, in the dissecting room of the anatomy department, where we either focus intensely on the muscles, nerves and tissues, blocking out the fact that this is the body of a real person who, until recently, was very much alive, or engage in black humour to hide our discomfort and existential angst.
By the time we have completed a medical, surgical, paediatric, emergency department and obstetric rotation, we are adept at dialling-down emotions and can attend a cardiac arrest, a stillbirth, deal with burns, scalds or road traffic accidents in the focused, calm, concentrated manner required to get the job done. It is often later, sometimes years later, when on reflection, we tell our story to those who understand and support us, that the humanity that was always present becomes visible again. Feelings may have been dialled-down or switched off, but the fact that we still remember the experience shows they were not absent. The dial is re-set.
Doctor storytelling was a feature in this year’s dotMD conference in the Smock Alley Theatre in Dublin. A day of learning, entertainment, art, literature and humour. Three doctors told stories from their careers to date. GP Dr Ciara Kelly spoke about the powerlessness of hospitalised patients, which she observed during grand rounds, and how this impacted her decision to become a GP. Prof Brendan Kelly, Consultant Psychiatrist at Tallaght Hospital, Dublin, gave an account of witnessing a young, distressed and inebriated girl attempt to buy four packets of paracetamol at an all-night supermarket on Dublin’s O’Connell Street, but abandon the process when the shop assistant told her she would have to buy one pack at a time and so queue up four times if she wanted four packs.
As a psychiatrist, he was aware that he was witnessing the human side of the law that prohibited the sale of any more than 12 paracetamol tablets to any one individual and probably the prevention of serious illness or death. Dr Paul Reynolds, Consultant Psychiatrist, St Camillus Hospital, Limerick, told how he spent his childhood within the confines of mental institutions. Not because he was ill, but because his father was a psychiatrist and those were the days when the chief psychiatrist was provided with on-site accommodation. His descriptions of playing and gardening with those housed in these facilities, and his accounts of the fear and uncertainty many of them felt when the institutions closed, reminded us that there is no difference between those who lived within and without those walls.
Stories connect us to each other and help us understand ourselves. As doctors, it is important to tell our tales to those who understand where we have been and where we are trying to get to.