Tuesday, October 9, 2012

Cold Hearted

Talking to people outside of the medical profession about what I do at work, I often get the reaction that I am callous, cold hearted, or insensitive. 

After all, how could a person talk about going to codes, calling time of death, talking to patient's families about withdrawing care, how could a person do all these and not break down crying without being an insensitive, horrible person?

Because that's what I do.  In my job, I have frequently been the face associated with the worst news families may ever get.  I have told families and patients horrible things, such as diagnoses of cancer, brain damage, and worse.  At the bedside, I do my best to be sensitive, to be professional, to be available in every way possible.

Step away from bedside, and it is common to be casual and impersonal about the situations.  To talk about what happened in non-emotional terms.

Thus, the accusations of being cold hearted.

But I promise that is not the case.  After all, I'm the girl who cries at Johnson and Johnson commercials, who cried in front of a Monet painting, who gets choked up with each goodbye to my boys.  I gush over baby animals, I tear up at weddings and births.  I'm not an insensitive person.

But at work, it's just that...it's work.

When I walk through the doors of the hospital, I do become detached, objective.  I think it is essential to become this way.  This is what allows us to be good at our job, our ability to be objective.  I have to focus on the physiology, on the numbers, and not the person.  When I'm transfusing blood as fast as I can during a trauma case, I have to think about normalizing the blood pressure and the labs, and not about the hopes and dreams the patient may have had.  When I'm placing an emergency airway, I have to think about the algorithms, and not about the patient's history and stories.  When I arrive at a code, and chest compressions are started, when I push on a patient's chest and feel the crunch of breaking ribs underneath my hands, I have to focus on what I'm doing, and not on the family standing outside the door. 

If I think about all the other things, all the stories and family and hopes and dreams, there is no way to stay objective, to think about what needs to be done.

The other part of this is separating the horror stories behind every door at work from the domestic happiness of my home life.

There has to be a way to call time of death and console a family, and then leave, drive home, walk through the door, sit around the dinner table and ask about what happened at school.  A way to separate the seriousness of my job from tickle tag and story time with my boys. 

I recognize the sadness and the hugeness and the terribleness of what so often goes on within the hospital, of what I am called to do. 

But at some point, I have to go home.  I have to go back to being a normal person.  I cannot allow the sadness I see to become my sadness. This is the only way to not only remain good at my job, but to remain sane.

So, if you ever hear me tell a story about a terrible thing that happened at work, and I don't break down crying, if I don't seem that I'm falling apart, it's not because I'm cold hearted.  It's because this is what is required. 

This is how I survive.


  1. My sister is a nurse and she's as professional as can be. The only time I've ever seen her break down was over a baby who'd died just hours after birth. It was the first time she'd witnessed someone's death. It's hard but it has to be done. I admire what you do because it's certainly not an easy job.

  2. yes! i am completely with you on this one...and i'm not sorry about it. hang in there! your sicu month will come to an end, i promise!

  3. I can't imagine how you could possibly have the career you do if you let yourself feel every piece of bad news. It would be too crushing to handle!

  4. Well said. You are soft and tender and reach out to understand from the heart every day. All others must sooner or later come to a place where, even if the breath catches, the next moment is unbelievable, or too dark to be real, even if there is a future that cannot be imagined, we still breathe, cannot stay awake forever, and must eat.. we live because it is ordained to live, not always because it is perfect or normal. You must walk through that place often, others less often. But you have made a good choice to gather all the joy and normalcy there is to gather.You have perspective few arrive at so soon. You are an amazing person.

  5. Wow, I sure hope you never take care of any member of my family...wouldn't want you anywhere near me, you sound uncaring and shouldn't be in medicine, just sayin.'

  6. What a horrible comment from anonymous! You don't sound uncaring at all. When I first read your post a few days ago, it hit home for me. My husband is a 911 paramedic, often in the "bad" part of a large metropolitan city. I can't imagine how he reconciles what he sees every day with the rest of his life, but you summed up the "why" very well. In fact, I came back today to reread your post since I was thinking about it again. I don't usually comment on anyone's blogs but had to after reading anonymous'. Ugh!

  7. Thank you Jen2010. I too get to see people try to stop crying and pull it together before another patient. It is difficult at best, heart rending often. Going home and making the transition to little ones and family who cannot go there with the caregiver is a trauma all its own. Thank you for you kind comments and support. Anonymous Oct 15 obviously doesn't get it.