Change You

Back during the first weeks of med school last year, there was much talk of how medical education "changes you." It is something I still feel many ways about.

I can embrace being changed, when I view it as a sort of "change lite." This is the process of expanding knowledge of human function, emotion and disease, growing manual and relational skills. The most significant one here is control of affect, learning to convey empathy while withholding disgust, devastation, fear, etc.

The real change, though, the one that many seem to undergo in medical education, is one that I want to avoid. This is the evolution from to someone who doesn't just suppress emotions in front of patients until they can be experienced safely but who no longer feels many things. It is the process of replacing human patients with bodies and disease processes. I have been told that I cannot continue to feel the normal sadness I would have felt two years ago upon learning of the cancer diagnosis of an acquaintance or friend's child and survive in this profession. But I want to continue to believe that that isn't true. I think that these emotions are at the foundation of true empathy. There are these moments, when day after day of memorizing disease names and processes out of textbooks without attachment to the real people's live they impact, that I see that staying connected to my former self will require vigilance.

Last week, I sat with some students and a preceptor as we watched a video of a patient relating the devastating story of losing one of her twins in utero. As she spoke, I fought back tears, telling myself it wasn't the place. At the same time, a nagging fear crept up in me. If this wasn't an OK time to demonstrate sadness as a medical professional, when was? But as the clip ended, I turned around to see my instructor, suit-and-tie clad man in his 50s, had made no such effort at self-restraint. He audibly sniffed and tears tracked down both cheeks as he turned to us to open the discussion.


  1. i love your blog. thanks for sharing...

  2. I think it's our own responsibility (maybe our foremost responsibility) to make peace with the world and find a way not to be numbed into indifference. Truth be told, all of our experiences change us, and not always in ways that we immediately recognize. I'm glad your instructor didn't hold back. I probably would have been bawling.

    GREAT post, my dear.

  3. Thanks, guys!

    S: I agree, it is often not obvious the way our experiences change us. I hadn't really thought about it that way, but I think that is part of why I'm feeling more driven to self-analysis than in much of my past life.

  4. To me, the people are the underpinnings. Sure, biology and disease and anatomy is fascinating. Our excitement over an "interesting case" is part of the change as we become doctors. But underneath, it is the people. For me, the lack of medical excitement of a patient with a cold is more than compensated for by the unique human and family the mundane cold comes in. GW your instincts are solid. OK to cry. OK to cry with families, you just still have to be their doctor too.

  5. Thanks for sharing. I find that much of what you say these days about the medical profession is applicable to my experience learning how to be a social worker. Figuring out how to protect yourself from feeling it all so deeply that you burn out and yet not actually closing yourself off from your emotions is a tricky balancing act. I think it's one that all of us in the "helping professions" should constantly be aware of, so thanks for the reminder