Doctor Capes and Disassociations

I have worked in the operating room for about 15 years in some capacity. I remember during one of the first operations I saw, I ran to the bathroom and dry heaved. My scientist brain was totally fascinated: my feeling body had another idea.

Surgery in and of itself is not natural. It is fascinating how we can make an incision, open and explore the human body (and hopefully help a patient) and then close them back up and they actually HEAL and go back to their lives.  

That first time I saw inside another human, my body knew that this process was counter-intuitive and let me know by making me sick. I’ve since spent the last 15 years seeing parts of bodies most people hope to never see. It is an honor, a miracle if I might say so. I love being with people in that tender place of vulnerability.

Until recently I thought that in order to do my job successfully, I had to disassociate a part of myself. Since putting a knife to skin to help someone, rather than hurt them, is part of my job --- for years a part of my brain had to go into a different state of being to rationalize and cope with it.

I believe this disassociation is incredibly common in helping professions, including health care, and it is a common point of pain for both patients and health care providers alike.

What often happens is that health care providers learn early on in training to disassociate and this behavior gets reinforced throughout their career. This is likely a survival/coping mechanism for most. Unfortunately it often results in behavior that appears to the patient as uncaring, sterile, curt and cold.

Part of my personal journey as a health care provider and a human trying to live my most authentic life has been trying to balance these seemingly opposite forces: the common reaction of disassociation and distance (which could leave me too cold and unavailable) versus the pain of letting things in so deeply that it left me almost unable to continue to provide quality care for other patients because I was too brokenhearted about a specific situation.  Neither of these responses were sustainable and I've learned neither is necessary or healthy.

As health care providers, what we see on a regular basis is enough to make us disassociate if we don’t have the proper self care and awareness of the process. Unfortunately this concept is not discussed very much in our training.

It may be the un-natural but needed surgery, sitting with someone facing a new diagnosis, talking with a patient about how her fear of cancer coming back is disabling, celebrating with a patient at the end of treatment (thus going into remission or cure), or sitting on someone’s hospital bed with them as they slowly fade away. While these experiences are an absolute honor to witness and be a part of, they are also incredibly intense and can be difficult to hold.

I am learning that the answer to how to best hold this intensity is neither disassociation nor owning/carrying the pain of another.

For me as a health care provider and a human, the answer to the intense complexity of my work and life is not disassociation. The answer is empathy, self care, healthy boundaries and awareness/integration of all of my authentic experience and parts.

As Brene Brown says, empathy is not feeling for someone, it is feeling with them. It is providing a caring presence that lets someone know they are not alone in their pain without taking on their pain. Empathy does not mean carrying someone's pain for them. To attempt to do so takes away from the healing opportunities for the person who is suffering -- and it is also unhealthy for the person trying to carry what is not theirs to own.

Part of a healthy energetic boundary is embracing that each patient is strong and is on their own journey. Our job is not to save them but to walk beside them and provide a healing space for them. To let them know they are not alone. Brene also says explains in this short video how boundaries are essential to being able to provide empathy. Healthy boundaries are not divisive, they are not about separation. They are knowing where you end and I begin. Boundaries are necessary for us to thrive as social beings.

I was at a conference where a doctor was talking passionately about how she creates relationships with patients to help them have better health outcomes. I was in total agreement until she said that she has these relationships with patients where she “can actually save them”. In that moment every cell of my body screamed “NOOOOO!”.

We often put capes on as health care providers at the same time we disassociate. Taking care of patients turns into a reflection of ego for the provider --- if I can “save them” I’m good. If I can’t, I’ve failed.

I do not think medicine is about saving patients. Rather I’d like to posit that health care is about creating a presence of support, utilizing our special training to help patients make informed decisions about their bodies (while embracing the extensive knowledge the patient has about their own body), and creating a space for healing where a patient works with us on their terms to heal themselves

It is true that sometimes you need an operation to save your life. It is true that sometimes you need a surgeon to remove the cancer or give you life saving medication. In that way, YES, the training the surgeons and health care providers have courageously dedicated their lives to is indeed saving your life. 

It is also true that the best kind of healing is the kind where the provider and patient work together. I believe this can occur in all settings. This is not about the provider putting on a cape and declaring themselves the savior. It’s about the provider standing alongside the patient, sharing their expertise, and working with the patient towards mutual goals of care. In the example of surgery, this includes the health care provider utilizing the unique skills they have mastered to help a patient by providing something for them that they cannot provide for themselves. But do not confuse this with playing the hero. A successful surgery is not possible without a patient's body healing itself.

We as health care providers need to put our capes away.

Capes create distance because there is such a profound power dynamic that true connection cannot occur. Capes create pressure for the hero in such a way that ego gets so wrapped up in the experience it stops seeing the person who we tell ourselves “needs to be rescued”. Capes worn by providers inherently make patients small because it feeds into an archetype that no longer serves us.

Capes cut patients off at the knees instead of acknowledging that the most powerful healing happens as a result of a patients own actions. We must also acknowledge that as a result of the way that our system is set up, there is an inherent power dynamic between health care provider and patient. Both parties being aware of this and working together to equalize it is also a way that we create safer health care interactions.

I am learning the skill of knowing where I begin and end. I am learning to integrate all the parts of me, including the scientist and deeply caring sensitive human. I am learning that empathy requires vulnerability on my part but does not ask me to carry what is not mine. I am learning that as we operate, I am capable of allowing my loving sensitive side to be present as the scientist takes the wheel. All of me can be there together so I don’t have to disassociate. It’s better for everyone that way. This process is not easy and it is something I am learning and re-learning every day. But it is some of my most important work.

Let’s put away our capes and instead stand beside our patients, acknowledging that the best work we do is together.

We are a team, not a hero’s story.

Now let's do this.