The price you pay

I've gotten into watching "Blue Bloods" lately, thanks to Hils. Tom Selleck's commissioner has become one of my favorite TV characters of all time. Recently, in talking to his granddaughter about the strength needed to face the emotionally draining duties of a cop, he hit on something that I think has equal relevance to being a pediatrician. I substituted in some words, but I think you get the idea.

I've cried, but I learned pretty quick that you can't be a [doctor], especially a good [doctor], if you let your emotions take over, so you sit on 'em, push 'em way down. I don't know if that's a good thing, but it's a necessary thing. I had a partner who always said [doctors] can't cry so that their [patients] can. You pay a price? I think so. But it's the price you pay for the privilege.

Just within the last week, I saw a teenager come in nearly dead from septic shock, and watched my attending have the very tough (and necessarily brief) conversation with her father that she may not make it. I had to tell a family that their son had cancer. I called a mom to tell her that her son was not outside playing anymore like she thought, but had just been brought to the ED by ambulance after being knocked out of his shoes and thrown 20 feet by a car. While each of those moments touched me, they were also routine. Pushing fluids, calling consultants, ordering CT scans. Breaking things down into English so the parents could understand them. And then moving on.

I hate having to be stoic in the bearing of bad news, being objective in the middle of a crisis, ignoring the parents while I order epinephrine and chest compressions, having to finish rounds when a patient has just died, and then not being able to process it afterwards. I would rather sit and cry, hold hands, be silent, stay and answer questions, tell them it's all going to be okay. But that's not my job (at least not most of the time).

When I was taking care of my mentor's son in the ICU, for that brief week, I questioned every decision I made, avoided going in the room because it felt like an invasion of privacy, and had to leave the room when things went downhill because it was too hard to see people I knew watch their son dying. In short, I wasn't a good doctor. So instead we sit on it. We don't let emotions take over. It doesn't mean that we don't go home and cry, because I think all of us have. But it probably means that we seem a little distant talking about illness and death. That we're overly focused on the medical details. That we often forget that it's not routine for the families like it is for us. It may not be a good thing, but it's necessary.