March_eMagazine Volume 39

OUR PEOPLE,
OUR MISSION
Global Health
eMagazine
March 2022
Stay Human
Written by Mahsheed Khajavi, MD
This pandemic, with its deep human consequences along with
its divisive social and economic upheaval has drawn attention
to the vulnerability of our critical healthcare system.
Heightened stress levels have frayed emotions and the general
collective fear has resulted in angry social media disputes,
flaming emails, and raised voices in all venues of expression.
During these times, it is often easier to accept some version of “thickening one’s skin” and becoming
more mechanical and emotionally distant.
I have heard this from colleagues and watched as many become so distant that they no longer
derive any pleasure or meaning from the mission of medicine.
Midway through 2021, I found myself in this same group. Waking up and thinking about getting
through rather than getting into my day was the best I could achieve. I would fall out of my bed,
go through the ritual of daily preparation, drive with my NPR station discussing SARS-CoV-2, and
tune out.
A Note from Dr. Sadigh
Reflections on 2021
Highlights
Nursing Division
SARS COV-2 Pandemic
and Us
Unification
Condolences: Paul Farmer
Art to Remind Us of
Who We Can Be
Articles of the Month
Videos of the Month
Announcements
Calendar
Resources
I would walk into the hospital with a census of 45 patients, the majority of whom had respiratory
failure from COVID-19 multifocal pneumonia. Returning home after 16 or 18 hours, I would skim JAMA
and NEJM for any new reports or changes in guideline-directed therapy.
Becoming less and less present with those around me, the idea of putting my backpack on and
going for a walkabout was the most satisfying desire.
I thought back to my years of medical school and training. The advice, sometimes implicit and
sometimes overt, was that as a physician I had to develop emotional distance. Otherwise, I would
be utterly overwhelmed and unable to complete my duties.
I remember an attending telling me “you will lose your intellectual acumen if you take these patients
home with you.” This was in Atlanta during the early AIDS epidemic. This was the time when Grady
Hospital placed eight patients in each room on the AIDS floor, the vast majority of whom were
emaciated and unable to stand without assistance.
I remember quietly condemning this philosophy. Although I could not articulate my understanding
then, I believe that on some level there was an innate and intuitive knowledge that without empathy,
both patients and caretakers would be compromised.
Twenty-seven years later I found myself becoming the person I had so easily condemned. I told
myself to “toughen up” if I did not want to end up on the shower floor sobbing each night. I convinced
myself that creating an emotional barrier would help me continue to work in a clinical atmosphere
that, up until this point, I had never experienced.
I could not have been more misguided. I can’t say when or how I lost myself and truthfully, I can’t
really say when I came back.
I think part of my return came after reading an article on physician burnout. The article noted that
about half of all physicians reported burnout last year, highest among those who worked in the
hospital and intensive care units.
The article discussed the fact that burnout caused emotional distancing and that the cudgel of
“emotional weakness” was a long and ingrained tenant of medicine.
And somehow, I realized that demanding “toughness” only resulted in my inability to experience the
full range of emotions necessary to connect with my patients.
I had this backwards. It was not burnout which caused my lack of empathy. It was my deliberate
decision to distance myself (in order, in some bizarre way of thinking, to keep myself intact) which
had caused my burnout.
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Reflections continued on next page >>