This job is tough in many ways. It challenges you emotionally, physically, mentally and even spiritually. We also see bad things happen on a regular basis. Over the years I have diagnosed terminal illnesses in patients who I have really liked and knew as friends. And then I saw them die. There is risk of being too human, however, and breaking down with every bad outcome is not a good option either. You can become emotionally paralyzed and you can’t recover to see the next patient. In summary, expose your emotions too much and you don’t survive in this profession. So we become hardened and we thicken our skin. We all do it but unfortunately this “skill” bleeds over into our home life as well.
I am no stranger to being thick-skinned. There is a story in my house that typifies how even disgusting things just don’t bother me anymore. Years ago my dog, who was getting quite old, had a bad case of diarrhea. Instead of barking or scratching to alert us, he chose to just let it go and laid in it. I thought I was going to get a little extra sleep that morning until I heard the gagging and the “oh my god!” from my wife. That is when I knew I had to get up and play the good husband. And it wasn’t pretty. When I went downstairs, I just did what I had to do. I was able to go into the room, clean it all up and wash the stool covered back end of the dog. I did it unemotionally and without complaint.
My wife was totally amazed. “How could you just go in there and clean that stuff up? You didn’t even gag? Actually, it looked like it didn’t even bother you” she said.
The truth is it didn’t. I told her that as a physician, we deal with these “unpleasantries” all the time. You just put your head down and ignore the olfactory or visual stimuli and get the job done. No, I didn’t enjoy the smell. But to tell you the truth, I am so thick-skinned to this stuff that I bet for $5 I could eat a ham sandwich while cleaning another bout of canine stool incontinence or cutting open an abscess or sewing back a severely severed arm or whatever.
Don’t get me wrong, I am not sure if this quality is a good thing or not for doctors. It really doesn’t matter because it is what it is. We can’t change it. It starts right from medical school. In fact, I remember in my anatomy class there was this sweet girl who was very bothered by the cadavers. The school had done all the right stuff to slowly introduce the new students to their “bodies”. There were prayer sessions for those so inclined. There were even warm-up periods so that people could acclimate to the cadaver. Still, people were squeamish and this one young woman especially. I didn’t pay attention too much to her because I had enough work to do trying to do well in the class. I had forgotten about this student totally until halfway through the semester when I saw her whistling as she walked by with a sawed-off leg over her shoulder like a slab of meat. I thought to myself “haven’t we got a little sassy?”
Thickening of our skin may be a survival instinct for us doctors but it does have its repercussions. I believe that if it is not offset or counter-balanced by something else then we become withered and smoked like those crusty doctors who walk around like drones and never smile anymore These are the ones who die early or worse, live long and miserable lives.
So there you have another example of the duality of medicine. On one hand we have to be sensitive so we can be human to patients yet on the other hand we need to be detached and thick- skinned so we can survive in this career. It’s a constant balancing act that never gets easy. The key is to know when and how to be sensitive and when and how to be detached or thick- skinned. I am not sure I am that great at it but I do think about it. I can cut open an abscess with smelly, cheesy discharge from someone’s pannus and stay detached. I see a woman who needs something for the grief from losing her husband and I ignore checking quality indicator boxes to please others and instead open myself up more to the patient and just sit and talk to her. More examples of the “art of medicine”. So don’t anyone tell you that being thick-skinned is bad or good. It is what it is.