Embracing the Other

Working in a hospital as a doctor is an interesting experience because while you are working on a team, you are often the only doctor on the floor, especially if it is overnight and you are on call.

The responsibility of being the only doctor feels HUGE the first few nights any resident does call by themselves, and it never really goes away as staff physicians often tell me. Once in awhile, a physician from a different specialty will work on the floor with you as a part of a “buddy system” to be an extra pair of hands on the floor, which is always greatly appreciated. The downside of being that “off specialty” doc is that they are often othered by the team, seen as less competent, and treated as such as well.

I was having yet another overnight shift at the ED where my staff happened to be this off specialty doc. However, he had been working as a ED physician for many years and considered himself (perhaps accurately) a specialist in the area. Unfortunately, the night went very poorly for him. Several resuscitation cases came in that he could not manage on his own – he had to call the help of another ED doc but alas, it was not enough to save the patients. I was not involved in those cases so I did not know of the details of what happened in that resuscitation room.

The rest of the night marched on with a heavy mood. I could hear whispers from all corners of the hospital talking about how these cases did not go as they should have, that another physician would have been able to save them. It was hard to control myself from not thinking what they were thinking. Would the outcomes have been different had it been a different doctor? Someone who was trained in ED from residency?

When it came time to review some of the patients with this physician, I could see the worn and defeated look on his face. As soon as I started presenting, he abruptly cut me off and without giving me a chance to finish, he started to ask basic questions, insinuating that I basically did not know what I was doing. When I showed him my documentation proving that the information was all there, he LOUDLY told me that residents are not to be trusted and that because of this, I must follow a way of presenting as per his preferred style to demonstrate that I “am not making stuff up”. I was dumbfounded by this experience. Immediately my mind went to what I was going to put on this supervisor’s evaluation for treating his residents this way. Then, the goddess whispered in my ear, “no, Embrace the Other”.

He was alone in this entire ED, managing a highly acute floor by himself in a truly difficult night. He was further othered by the staff here due to the failed resuscitation cases. I imagined what I would have felt in his shoes, and my heart immediately broke for him. The thing is many resuscitation cases are not “salvageable” when they come into the hospital. Patients often have the wrong idea of what a resuscitation is like from TV shows – miraculous recovery is extremely rare. Even if a person’s heart is to start beating again, the chance of them regaining much of their baseline level of functioning is even smaller. With his years of experience working at the ED, I am sure he knew this too, and so did the rest of the ED team who were judging him. However, amidst all this background information, his identity as the “other” is what shifted their view into judgement and criticism instead of understanding and empathy. His harsh criticism of my work, increasing his voice so that everyone else could hear, was probably an unconscious effort on his part to re-exert his power and sense of control on this floor. Yes, it came at my expense, but what I had to endure was far less than his suffering.

Gritting my teeth and controlling my breath, I told him “Thank you so much for teaching me this, it is very helpful.” He nodded and sent me on my way to see more patients. At the end of the night, when he was doing my evaluation, he said “I was so glad you were here, it would have been a rotten night without you”. It was in this moment when the teaching of the goddess became apparent. Had I not shown understanding and patience in that moment, I would have pushed him further into the darkness. In choosing to set my ego aside to embrace the Other when nobody would, I accompanied another physician, another human being, in his journey from darkness back to the world of light.

Anger, Compassion, and Forgiveness

It was the first one of my series of night shifts at the Emergency Department – I was excited to work in the ED again (one of my favorite places to work at) and was looking forward to having a productive and rewarding night.

Unfortunately, not quite having adjusted to the night schedule, my brain was foggy and my body was exhausted. I still tried my best to be chipper with the team and present for my patients, reminding myself of my goal to be a good team player and a healing light. Despite my efforts, I made two consecutive mistakes within the first 3 hours of my shift – both small mistakes not affecting patient care, but still quite a deviation from my usual performance. I tried to not think about it and move on, telling myself that I need to be more careful tonight as I am having an “off day”.

After suturing a patient at 3AM in the morning who had decided to do laundry in the dark in the wee hours of the morning, my staff and I had a disagreement over the type of sutures I chose to use. I decided to go with patient preference in the choice of sutures, and he wished that I had used a different suture which has evidence for causing less scarring. It was a matter of opinion and practice, and he did not hold this against me in any way. He just provided me education and made it clear what his preference would be if we were to suture another patient that night. Normally, I appreciate this kind of straight forwarded communication because it allows for a smooth shift and running of the team. That night though, I found myself getting extremely angry over this, thinking to myself “HOW DARE he decide to make an issue of this on a very busy overnight shift”.

Recognizing that my anger was completely out of proportion and irrational, I took a small break and sat in the lounge area where I could take off my mask and breathe. I went over my shift and my experience working with him so far. He was a great supervisor – he had clear communication, let me know right away what he likes and what he doesn’t like, and allowed me a good amount of independence. Why then, was I so upset with him over this small disagreement?

In situations like this, psychiatrists recommend that patients go back to the time before the argument had even started, to check in with their emotional states that may have influenced their reactions to the argument or discussion. In that moment, it became crystal clear to me that I was already very upset at MYSELF for making those small mistakes in the earlier hours of the shift. Despite my best efforts to suppress these thoughts, my mind was already on edge by disparaging thoughts targeted at myself. Specifically, I was telling myself that I was a failure and a bad doctor because I had made those mistakes.

Everybody has off days. Doctors and nurses are human, and therefore, are vulnerable to making human error. The mistakes that I made had not harmed anyone, although they did cause minor inconveniences. I took a deep breath and meditated. I looked at the sigils I wrote on my badge – protection, peace and patience. I thought of my goddesses and asked for their guidance. I then thought of what I often tell my patients – What would you have told your friend if they made these mistakes? This made it clear what the issue was. I had no compassion or patience for myself and immediately jumped into a judgmental mindset – an attitude I would have NEVER taken towards any of my colleagues. The consequent feelings of being a failure was so painful to sit with, that I had displaced my anger towards myself to my supervisor as soon as there was opportunity for such transference.

Displacement, according to Freudian principles, is one of the maladaptive defense mechanisms where one unconsciously transfers/ displaces their inner conflict, usually stemming from earlier life experiences, to a situation or a person that is not a part of that inner conflict.

I was grateful for the guidance of my goddesses for giving me the space and calm to realize that self-compassion, or lack there of, was at the root of this issue. I inwardly expressed my gratitude to my goddesses and allowed myself to feel the feelings of shame and disappointment at myself for the mistakes I had made. I then told myself “I forgive you – I forgive you for these mistakes and for being harsh on yourself. I honor that your desire for perfection came from a place of wanting to be a healing light. I embrace you and I love you”. Immediately, I felt a sense of relief come over me.

I was able to return to my shift and had a great night – we helped many people and my supervisor and I made a fantastic team through a very busy ED shift. While this shift had not gone exactly as I had planned, I was grateful it happened. It was a wonderful reminder of the importance of self-compassion and forgiveness. I was also reminded that when all else fails, I will always have my spirit guides and higher self to show me the way.