Also human : the inner lives of doctors

276 Pages·2018·1.95 MB·English

by  Elton

Copyright
Copyright © 2018 by Caroline Elton
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First Edition: June 2018
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The Library of Congress has cataloged the hardcover edition as follows: Names:
Elton, Caroline (Vocational psychologist), author.
Title: Also human : the inner lives of doctors / Caroline Elton.
Title: Also human : the inner lives of doctors / Caroline Elton.
Description: First edition. | New York : Basic Books, 2018. | Includes
bibliographical references and index.
Identifiers: LCCN 2017060197 (print) | LCCN 2017061784 (ebook) | ISBN
9780465093755 (ebook) | ISBN 9780465093731 (hardcover) Subjects:
LCSH: Physicians—Psychology—Popular works. | Physicians—Job stress.
Classification: LCC R690 (ebook) | LCC R690 .E48 2018 (print) | DDC 610.92
—dc23
LC record available at https://lccn.loc.gov/2017060197
ISBNs: 978-0-46509373-1 (hardcover); 978-0-46509375-5 (ebook) E3-
20180430-JV-NF
Contents
Cover
Title Page
Copyright
Dedication
Epigraph
Author’s Note
Introduction: Medicine in the Mirror
Chapter 1: Wednesday’s Child
Chapter 2: Finding the Middle
Chapter 3: Which Doctor
Chapter 4: Brief Encounter
Chapter 5: Role Reversal
Chapter 6: Leaky Pipes
Chapter 7: Risky Business
Chapter 8: No Exit
Chapter 9: Natural Selection
Epilogue: There’s No Such Thing As a Doctor
Acknowledgments
About the Author
Notes on Sources
Index
For my family
Mary [W.] is a psychologist who lives in Michigan… More than a decade
ago, when I was trying to decide whether to go to medical school to
become a psychiatrist, I called her to talk about her practice.… Mary
shares my love for northern Michigan and its lakes. Without thinking, she
reached to that shared territory for a metaphor.
“The patients we work with have fallen through the ice in the middle
of a frozen lake.… My job—your job should you take this path—is to go
out to them, to be with them on the thin ice, and to work with them to get
them out of the frigid water.… But you must know that if you go out to
them on that thin ice, there’s a real danger that you’ll fall in, too. So if you
go into this work, you’ve got to be anchored to the shore. You can reach
out one hand to the person in the water,” she cautioned, “but your other
hand needs to have a firm grip on the people and things that connect you
to the shore. If you don’t, you lose your patients and you lose yourself.”
—Falling into the Fire: A Psychiatrist’s Encounters with the Mind in
Crisis, Christine Montross
Author’s Note
A note on client confidentiality, which I have taken very seriously. I have
changed names and all identifying particulars so as to preserve my clients’
anonymity. Before using any personal information in the book (even under the
guise of anonymity), I showed each client the draft, invited comment, and sought
their permission: all were willing to share their experience. Most were willing to
do so on the basis that it is this book’s aim to help doctors facing career struggles
and highlight the extraordinarily difficult pressures that many doctors face.
Introduction
Medicine in the Mirror
A
s the airplane wheels touched down on the tarmac I instinctively reached for
my cell phone, like many others around me. The flight from London to
Washington, DC, was only eight hours, so there wasn’t much to work through.
And there was nothing that a breezy “out of office” message wouldn’t hold at
bay for the next eight days. Nothing of concern—until I reached the last email:
Dear Caroline
I have questioned from day one whether medical school was right for
me, and since then things have only gotten worse: I have got more
depressed and felt more hopeless as I have gone through—persisting
always with the hope that things might get better (and everyone around
me encouraging me to do so). But I just can’t cope with the pressure and
stress of hospitals, and the thought of starting work as a doctor fills me
with dread.
I am now a month away from finals and very distressed about what to
do. I keep trying to tell myself that I just need to pass my finals then can
always stop and do something else with my medical degree. But I have no
real clue about what I would do instead—and am just as scared that I
may regret it if I stop…
I am just not sure I will survive working as a doctor, and I’m worried
I would get so stressed, anxious and depressed that I would end up either
hurting someone else by accident or more likely drive myself to the edge.
I am sorry if this comes across quite melodramatic. I really have reached
crisis point though and am in desperate need for some sane input.
Leo
I froze. This was not an email to ignore. But how could I provide “sane input”
when I was on the wrong side of the Atlantic? In the taxi to my son’s house, I
phoned a colleague in order to pass the baton to her—but I only got her voice
mail. There was no option but to answer Leo’s email myself.
Everybody goes to the doctor from time to time. For some, visits are a frequent
occurrence, while for others they are mercifully rare. But however often we seek
medical advice or need treatment, most of us, quite naturally, tend to be
preoccupied with our own concerns and make all sorts of assumptions about the
doctor who is listening to us, taking our medical history, or cutting into us during
an operation. If we think of them at all.
We take it on trust that the doctor is up to the task and doesn’t feel tired or
overwhelmed. We rarely consider whether the doctor, like Leo, is terrified of
accidentally hurting us. We simply assume that if they are relatively junior, there
will be a senior clinician somewhere nearby to answer their questions and ensure
that they’re doing their job correctly. We tend not to worry whether they are
bright enough for the job—after all, they will have trained for years and will
have passed countless exams to get through medical school and beyond. And
when parts of our body are being examined, we don’t want to entertain the
possibility that doctors may find some patients attractive. We don’t wonder if the
doctor likes patients at all, finds them disgusting, or resents the responsibility
inherent in patient care. Instead we imagine that doctors enjoy their work and
find it satisfying to treat patients like us.
For many of us, much of what we know about the medical profession comes
from watching television. But neither the medical soap operas nor the fly-on-the-
wall documentaries paint an accurate picture. We don’t see junior doctors feeling
so overwhelmed by work that they run away in fear. Neither, for ethical reasons,
would we be shown doctors telling parents that their baby has died. Yet that’s
just one of the many traumatic tasks that might be on a doctor’s to-do list
alongside calming down a delusional patient or deciding whether to call a halt on
a failing resuscitation attempt. And television, compelling though it may be, is
restricted to sights and sounds; it can’t convey the smell of decaying flesh, or as
one doctor described it to me, “the feel of burnt, crispy, human skin.”
Much of what we require doctors to do is shielded in secrecy. “We cannot
speak of these things to people outside medicine, because it is too traumatic, too
graphic, too much,” wrote one doctor recently in the New York Times. But the