Hey guys. Welcome back to the podcast. I'm Amanda. I'm Laura. And I'm Kendra. And as we're recording this, National Physician Suicide Awareness Day has happened, and so it's appropriate, even though it's not releasing at that time, that we're gonna talk today about diving into harder, heavier feelings that often show up while we work in medicine.
Things like anguish, hopelessness, despair, sadness, and grief. These are emotions that we are taught to push down. Sometimes we're even taught that they're wrong, that we don't have enough faith, that we're not doing life right if we are feeling any of those things. And I would offer that's inconsistent with being human on earth.
Medicine I think teaches us to stay professional and I felt like many times at work the strategy was basically just to compartmentalize. I don't know why I always say that, like I'm South African—compartmentalize. And push it down. Stay professional. Don't shed a tear. God forbid you have sadness.
But as Brené Brown reminds us in Atlas of the Heart, naming and understanding these emotions is essential if we want to lead and live with courage. We've done several series so that we have the tools to name what it is that we're feeling. That's called emotional granularity. And so many of us can only name sad, happy, mad, and that's not accurate.
What we're trying to do is accurately name these things. Brown distinguishes anguish as an almost unbearable emotional and physical pain. It's a traumatic swirl of shock. We feel it in our bones. It takes us to our knees, and we feel powerless. And hopelessness is a combination of negative life events and negative thought patterns, particularly when you get stuck in a self-blame loop or you have a perceived inability to change your circumstances. Whether or not it's true, it's how you perceive it. Hopelessness is one of the strongest feelings related to feelings of suicidality. Despair, in contrast, is when we believe the suffering will never end.
It's related to one's entire life and future, like we'll never get out of it. Extreme hopelessness is a desperate and claustrophobic feeling. Rob Bell, who is a theologian, said it is the belief that tomorrow will be just like today. It's gonna be Groundhog Day, over and over and over.
Sadness and grief we'll talk about in the next episode, and it's also often tangled together in medicine. Sadness at a bad outcome, for example, or grief for the life of a patient who has a terminal illness. Sometimes the grief of a family in the waiting room as we hold it in our own bodies—there is nothing more devastating or more impactful to me than the wail of a mother. It's the worst. And I just broke—it is. It is. I don't even wanna talk about it because it doesn't leave you for a long time, but okay. I'm gonna get it back together. Okay. And dare to leave that. It's okay. That's why we're talking about this. I know.
Absolutely. These conversations have to be normal. We have to feel all the things. We have to exactly experience all the things and what we were taught in medicine—to push it down and to not experience—is almost asking us to be inhuman. Well, and so you bring up a good point is that when you get good at pushing it down, you do lose your humanity.
And that is the last thing I ever signed up for when I went into medicine. And think about that. But you don't get the high highs without the low lows. Somebody explained it to me like your emotions are like a sine wave, and if you narrow that sine wave down, it's all very similar. So if you want to have the most exhilarating experiences of your life, you do have to open yourself up to all the emotions that come with being human.
Mm-hmm. So, oh, well. Here we go. Brené agrees with that. We can't selectively numb our emotions. If we shut down grief and despair, then we also lose access to joy, hope, and connection. So how does this show up in medicine? Let's be honest. Our emotions walk into hospitals and clinics every day. These emotions come with our patients.
They come with us. They come with whatever's going on at home. I mean, being human means having emotions, both good and bad. And just a reminder, if you're doing it right, about 50% are gonna be awesome and about 50% are gonna be not so awesome. And that doesn't mean you're doing anything wrong. Mm-hmm. So maybe anguish—you're standing at the bedside of a young trauma patient knowing despite your team's effort, it's not gonna be a good outcome. Hopelessness. Oh yeah. Just to talk about examples, just like you said, that wail of a mom is like, never ever, ever will leave my brain and my ears, anything. And, you know, it was a perspective check in the moment.
A lot of us, when we see that trauma patient come in and they're like, 15, 16, I remember this 16-year-old just got his license in a terrible, terrible motor vehicle crash. But when the patient's coming in, you're like "16-year-old male, motor vehicle crash, GCS three, unable to get a tube." You know, it's just information that you're given.
So when that patient arrives, it's like, there's my job. And so we got the airway, we continued CPR, like blah, blah, blah, blah, blah. And then the parents arrived and like in the moment, that was just like in the movies where the perspective that this is somebody's kid was just realized in a moment when those parents arrived and whereas five minutes ago it was like, "Hey team, you have any ideas? You have any ideas? You have any ideas?" I mean, it was a devastating situation and it was like, "Nope." And then it was like, "Okay, have the parents come in just so they can see last ditch efforts." But like you could not even continue that when the parents came in. Like it was just so thick of that perspective that, oh my gosh, this is somebody's kid that won't ever come home again. And so to see that mom and dad and to feel their anguish, it superseded anything else—heroic efforts or medical knowledge or anything that we were gonna do at that moment. It was incredible.
Yeah. So that was anguish. You might feel hopelessness, and that might be, you know, you've got a disease process and you've started this drip, you've started that drip, you've started the next drip, and all of a sudden you're running out of options. And now you've given all of the options and it's still not working. And that can feel very hopeless and very powerless. Sometimes you might feel sadness delivering bad news to a family who thought today was just a routine checkup. Gosh, I hate that when they're like, "I've been—I've had this for three years and I can't get anybody to work it up." And I'm like, "Great," because ugh, that usually ends up—I can't tell you how many times.
That's unfortunately why ER doctors keep ordering CAT scans, 'cause we keep finding stuff on. Yeah, for sure. I wish it weren't true. I would like to stop ordering them. Right. And then grief, seeing the empty chair at morning rounds after losing a colleague to suicide. Devastating. Sometimes it shows up in unexpected places.
Tearing up in the car on the drive home, feeling an edge of irritability at your kids or shutting down emotionally at your partner. This can manifest in several different ways. I think it's interesting—we were talking about emotional granularity and learning how to notice and name emotions, and we have these clinical ideas of what depression looks like, you know, of what sadness looks like.
And oftentimes we don't even see it in ourselves when we're experiencing it. We're just like, "Ah, just can't get it, can't get it going," or "Just, everybody's so annoying lately." And is it that everyone's so annoying or are you actually depressed? Are you actually just having a bunch of sadness you need to process?
You know, classically men do that. They don't manifest sadness and depression in a recognizable way, and I would say a lot of women physicians do the same. We just get grouchy. So if you're grouchy and you're not sure why, or if you're having some negative emotion, the first step is to notice it and not judge it. So many of us are like, "I shouldn't feel bad, I've got it so good," or "I got nothing to feel bad about," or "I should feel bad because I did that horrible thing, or I missed that thing and I should feel terrible." Let's just not judge it. Let's just say what it is. "I feel sad. I feel kind of despairing. I feel a little hopeless. I feel morose. I feel melancholy." There's lots of different nuance and variations to these sad feelings. And noticing them and naming them actually reduces their intensity by like half. So it's worth learning that skill. Notice what's happening in your body. Are you feeling some sensation like tight chest, lump in your throat?
Heaviness—like with anguish or grief, I feel nausea. A lot of times I'll feel just dizzy and kind of disoriented with that. Then notice what is the story your mind is telling. It can be a true story. Someone you love died. It can be a fake story. "I'm a horrible person." Just notice, and if you're having a story like "This should not have happened," ask yourself, is that helping me feel better or is it making me feel worse?
There's some more like, "I can't fix this" or "I failed." And just notice the story. Is it true and do you wanna keep believing it and do you wanna keep thinking about it? 'Cause ruminating on these thoughts is gonna generate more of the negative emotion. Name the feeling. If you can't, go to feelingswheel.com. They've got a great feelings wheel that will help you look at all the different words for different feelings. Is it sadness? Is it anguish? Is it hopelessness? Naming it helps put some space between you and the emotion because so many times when we're feeling these intense emotions, it feels like we're never gonna feel anything else ever again. And putting some space between your mind and the emotions will help with that.
So what are some ways that we can cope while we're still practicing medicine? You know, when we're at work, most of us don't have the luxury of time to do like a 30 minute yoga session after we deal with the failed resuscitation. No, that's not realistic probably. I don't even know if it'd be helpful because I'd be thinking about it the whole time and just needing to get back to work. But there are some little micro resets that we can do, like mindfulness at work. One client that I've worked with talked about when they put their hand on the doorknob or the door handle, every time they're going in a room, they really notice it and feel it in their hand, and it kind of helps ground them and they have an intention as they go in the room. "I'm bringing goodwill and caring to this patient." Taking a breath. Those deep breaths are so helpful at regulating that sympathetic state that we get into when we're having to deal with something really difficult and complex, especially after a code or some other emergency.
Taking some deep breaths will help us get out of that fight or flight state back into our parasympathetic state, help us calm down. As we name these deep, deep, sad emotions like grief—I had someone I really loved pass away recently, and I practiced this. I tried this. "This is grief, and I'm glad that I can feel grief because it means that I loved." It helps. Instead of resisting against it, whenever we resist negative emotion, it somehow makes it 10 times worse. And if we just stuff it down, then it's gonna give us a bunch of autoimmune diseases. So don't do that either.
Outside of work, maybe we have a little bit more time. I have a little bit more time to process. Right before we started recording this podcast, I was processing with a client who's a neonatologist, and we were talking about a difficult case, and sometimes processing means talking to someone who understands and could give you actual feedback on the case, which is, "You did an excellent job. You did everything that you could have possibly conceived of, and then some. The resources were poor and that person was never gonna make it." Being able to process these things, even if there was some error that we made, helps us too—not go down in this shame spiral and blame ourselves and tell ourselves that we're causing harm.
None of that is true. We are there at work showing up, doing the best we can every day, doing an incredibly hard job, and we need to give ourselves some self-compassion is what we need to be doing. So taking some time, talking to somebody—whether it be a friend, colleague, coach—just talk it out.
Journaling. Journaling, especially after you get yourself in a space where you understand it wasn't your fault, then journal about it, write about it. You know, "I'm sad. I'm sad that I don't have God-like powers to bring everyone back from the dead. I'm sad I can't prevent these tragedies from happening to families. I'm sad that I can't keep hurt away from people all the time, and I'm grateful for what I can do." Going for a walk, doing something with your body, especially when emotion feels beyond what we can handle. A lot of emotion we can manage just by shifting thoughts, but if it's to an extreme, we have to use our body to be able to regulate it.
So going for a walk is a great way to help regulate negative emotion. Crying is an incredible release. Yeah. Yeah. Again, practicing self-compassion. Kristin Neff's work—you know, she's the expert on self-compassion. She says, instead of "I should be stronger," try "This is hard and anyone in my shoes would feel this way."
And I would say too, that you might have heard this as a kid. Yeah, that's helpful to notice too, if you're having a shaming voice that says, you know, "Suck it up," or "You should not feel bad," or "Get over it, you've felt sad long enough." Does it sound like a relative? Does it sound like an authority figure from your childhood who also was probably doing the best they knew how, and now is showing up in an unhelpful way in your brain? Just notice—if you wouldn't talk to your child the way you're talking to yourself, then maybe reassess.
Another idea is rituals of closure. So for a patient, you could write their name or their initials in a private journal. Write your feelings about that. Honor them, honor their family, light a candle, and think about them. Debrief with a colleague, as we mentioned before. Also EMDR—I'm thinking this in my mind as I'm getting flashbacks of patients in my head. I'm like, I really should have been doing some of these rituals of closure for sure.
Over time, so young in your career, if you have a visual memory, those pictures are not ever gonna go away. So go ahead and figure out a ritual of closure. Get yourself in with a good EMDR therapist and process them as you go so that you don't get a big old pile up of negative emotion over decades of working.
So why does this matter? Why do we need to talk about this? Well, if anguish and despair and sadness and grief go unprocessed, these are the insidious ways it shows up—as cynicism in our everyday practice. It accumulates and contributes to burnout.
We talk about one of the main contributors to burnout is self-criticism and the lack of self-compassion. But this is an insidious way that it can build up. And when we are able to just recognize, like Laura and Amanda said, notice these things, name them. Name these feelings. Even if we can't get to the point where we totally can be neutral, like they're just all signals—even if you still have to label them positive and negative emotions, being able to connect deeply to others who've experienced the same thing, that's that part of connection and meaning that completes that loop or closes the circle or brings that closure. And I'm sure everyone listening, if you're a physician, you've had a case that just brought about a profound meaning to your work that wasn't somebody's life you necessarily saved. It could have been other, and how come you didn't expect—or a devastating, you know, diagnosis carried with an immortality or whatever. But the bottom line is the antidote to all of this is hope, and I think it's easy to forget this. If you grew up in a family of origin or a community where you weren't taught this growing up, this can be learned and it can be something that you could start today with acknowledging.
And so Brené Brown talks about Martin Seligman. We've talked about his research in the past, but he really gives us a guide or a framework or guidelines in order to kind of allow for hope in a situation where we feel that there could not be any. And so he talks about the three Ps. So the first one is personalization.
So when we're caught in this depth of despair, we believe that we are at the root of the problem. And I think as physicians, we connect with this a lot. We are going to look inward first. "What could I have done better? What could I have done differently? Could I have done this? This should have worked." Whatever. Whatever thoughts we have in the moment after experiencing the unexpected or something that brought about sadness or grief, we are really quick to self-blame. We're really quick to criticize maybe the way that we practice, the situation that went about. We're criticizing others maybe for, you know, just not showing up in time—where was respiratory? Where's this resource, whatever. But realizing that there are factors outside of us that actually play a role gives us a new lens to look through this experience. I've talked about this before. One of the things I'll never forget is my attending in the ICU, you know, reminding me that whether there's a good outcome or an outcome we don't expect, we cannot take credit for either.
So in and of itself, you show up for work and do everything you're supposed to. The outcomes of patients are not under our control, despite the fact that we do try hard to control every aspect of patient care. There are things that happen and there is a, whatever you wanna call it—universe, there is a God out there who does have a divine plan and thank God because we are not in control of it.
Permanence. So permanence is the idea that this struggle will never end. So we talked about this—this hopelessness. Is tomorrow gonna be just like today? Just an inability to kind of see out of this realization or just the reminder, the perspective of "this too will pass." This is a temporary setback or struggle. So shifting from "This will always be that way," shifting from those definitive terms to, "Okay, today I am feeling sad, it doesn't mean tomorrow I will, or next week or next month." And Brené, I love how she puts it in Atlas of the Heart. She's got herself out of her limbic system by thinking, "I'm really sad, I'm feeling despair, hopeless, whatever"—interject your quote unquote negative emotion there—"about this situation."
Then she asks herself, so she notices and she names, and then she asks, "Will this issue be a big deal in five minutes?" And if you're like, "Yeah, probably 'cause I'm in a good cry right now, five minutes," then go five hours. "How about five days? What about five months?" And then if you can't, then "What about five years?"
So really just giving some temporariness, giving this temporal feeling its place. It's what you're feeling now, but I guarantee you, you'll not be feeling this in whatever amount of time you can relate to in the moment. It really pulls that thinking brain back online and allows for us to come out of permanence and into the temporal nature of this.
And then pervasiveness. So this is the belief that whatever we're up against has stained or changed every single thing in our life, right? So when that patient, you know, passed away, I'm like, "I will never be able to take care of a swollen knee again." Right? Like, like really? Okay. But just understanding like, "Am I even competent to be taking care of an acute care patient?" Right? So those are the thoughts that it's very pervasive. "I'll never, I'll always." I like the example she used. She was in a sad state. And she went through an experience at work and she just thought, "Oh my gosh, this is gonna affect my entire life." And five minutes later, her daughter text her, "Hey, do you know where my goggles are? I'm getting ready to go to practice." Right? So she just pulled herself back into that prefrontal cortex and we're like, "Yeah, see this hasn't even touched my home life, my daughter's, you know, getting ready for practice."
It's just bringing us back to the present and understanding that this is affecting this situation and this aspect of our life, but it may not have touched home life or whatever, whatever. So while this is kind of a heavy podcast, it does have a place. It is a very real situation that we are up against and, you know, we take care of complex patients. We're taking care of sicker patients and this idea of anguish and despair and hopelessness, and then we'll talk more about sadness and grief. We see, and sometimes we feel it so heavy because not only is stuff that's causing these feelings going on at work, then we go home or we scroll social media, we look on the TV and we hear more and more and more about things happening outside of, you know, our workplace.
And so then you really could get a sense of pervasiveness, like, "Oh my gosh, awful things are happening everywhere." Right? And that's just not true. So hopefully we were able to give you some language in order to experience this. It is normal, and if we can offer anything or if we can just listen while you debrief from a situation, please let us know.
We always offer a free session with one of us. You know, physician coaches—you just go to our website, www.thewholephysician.com. It's there. We'd love to hear about it. Email us at [email protected] and tell us about it. We always love to connect with you there and we try to put up lots of goodness on our socials, so find us at The Whole Physician—Instagram, Facebook, LinkedIn, everywhere where you scroll. And until next time, you are whole. You are a gift to medicine and the work you do matters.
