May 6, 2010

a neurosurgeon and an alcoholic

What's the difference between shame and guilt?
With guilt, you feel like you made a mistake, with shame, you feel like you ARE the mistake.

So began our session this evening about physicians and substance abuse.

An orthopedic surgeon came to talk to our group of seven about his experience with an addiction to pain medication - and talked about how the first time he ever felt "normal" was when he had a shot of demerol (a narcotic used to treat pain) after having knee surgery as a 15 year old. When we asked what "normal" meant, he thought for a moment and then said, "comfortable in my own skin", "not anxious", and "calm". These are qualities that all 15 year olds crave perhaps, but they are also not qualities that medical school or the entire process of becoming a doctor really supports. In fact, a lot about the process is incredibly uncomfortable, you're put on the spot all the time, and it could hardly be described as calm - physicians are often involved in the most crazy moments in peoples lives - and yet have to remain calm.

And we're not supposed to talk about it either. There's a necessary confidentiality that comes with having access to people's most private details, but it's hard when there is no one, not even colleagues, with whom to really process what goes on in ones day. And while it's improving, there is very little space given to processing the complicated emotions that come with caring for peoples lives. It's sort of hoped that medical school and all its training will prepare us to somehow magically be able to internalize these emotions and maintain steadiness when everything around us is going crazy. Yet there's also not a lot of time to create or maintain a support network.

In one of the excerpts we read to prepare for this discussion, the author attends an AA/NA meeting for physicians - and the group goes around and instead of the normal (?) Hi I'm Joe and I'm an alcoholic", they start with their profession first:

I'm Joe and I'm a neurosurgeon and an alcoholic. I'm Jane and I'm an orthopedic surgeon and a narcotics addict. I'm Bob and I'm an anesthesiologist and a cocaine addict.

They also say (and the physicians who spoke to us reiterated) that the work is the very last thing to suffer, so it's not always clear to colleagues that something is going on. that's pretty scary, especially because personal details are not really encouraged so much in medicine - it makes you a bit too human to be asking to put our fingers in someones rectum - or something...

I feel very lucky to have deep friendships with people both in and out of the medical field with whom I feel comfortable processing - but man, is it tough already, and I'm not even really expected to do much of anything yet. I can't imagine next year.

"like so many of us, perhaps he was drawn to doctoring because he subconsciously thought that if he attended to the pain of others, it would take care of his own"
-Abraham Verghese (in his book, the Tennis Partner)

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