On Callousness

A reflection on Clinical Anatomy
journal entry created October 26, 2008

We are now nearing the completion of our clinical anatomy block, and we have been working with our donors for many weeks. In an earlier entry I commented on how strange our donor’s body looked – so alive while dead. It’s interesting how accustomed one can grow to things that were once shocking. On my first day in the lab, a peak at her face was wholly disturbing, yet that was nothing compared to the grisly sights of more recent labs. Last week our donor’s cervical vertebrae were severed so that we could easily flip her head and lay it face down on her stomach in order to observe a posterior view of the esophagus. This week we skinned her face to observe the musculature and vessels beneath. I certainly would not have been able to handle such invasiveness during my first few experiences in the anatomy lab. It’s interesting how accustomed one can grow to disturbing situations. I think this idea of desensitization is applicable across the board - in medical procedures, in death, even when facing injustices. Over time we grow accustomed to things that once shocked us. I think it is self-protective.

I noticed that I myself became quite desensitized throughout my three months working in post-war Liberia last fall. While I was there it was undeniable that fourteen years of civil war had utterly devastated the country; nearly ten percent of the population had been killed in the conflict, the country’s infrastructure – education, healthcare, etc – had been destroyed, and eighty-five percent of the people were living in poverty. At first everything was overwhelming. During my first week there I remember meeting an emaciated man with desperate, hollow eyes on the shipyard dock who was looking for work so that he could earn money to feed his family. My coworker told him that our ship was not hiring but took his contact information just in case, knowing that there would be no offer for work. The hopelessness of that encounter and others like it at first haunted me for days. It was incapacitating. For my first two weeks in the country I often felt emotionally exhausted. Then over time I noticed a strange shift in myself. I became able to encounter desperate situations and remain for the time being unscathed. I could interact with broken families, starving babies and innocent detainees who had been imprisoned without formal accusations or hope of a trial, and I didn’t shed a tear. Not that I didn’t care about their situations, but I had become calloused.

I have taken several personality tests over the past few years, and consistently my strongest personality trait is compassion. By default, I tend to consider the situations of others, and I find myself very impacted by others’ feelings. This made the desensitization I experienced in Liberia rather unsettling. By the end of my time there I did not like my unsympathetic response to suffering. I remember wondering if I had been permanently roughened. I wondered if would return to the US with much more cynicism than I had left with. I departed from Liberia via a ship that set sail for the Canary Islands, and it was while at sea – two or three days removed from the Liberian coast - that I was finally able to process all I had seen. I sat alone on the deck of the Mercy Ship, I looked out over the ocean, and I wept. I wept for patients who never were healed, for the children who never were nourished, for the prisoners who were never released. It was cathartic. Emotion had returned to me, and I felt human again.

I’m not sure I know whether or not callousness is such a good thing. To what degree is it appropriate in medicine? What is the most beneficial to my patients? Do I connect with each one so deeply that their hurts become my hurts, their family struggles my family struggles? It seems that could burn a doctor out in a hurry. Do I wall myself off completely so that I see my patients as mere clients who pay for services rendered and have no bearing on me or my personal life, nor I theirs? It seems that would make it difficult to build a covenant relationship.

At this point in my medical career, having had limited clinical practice in the physician-patient context, I consider myself to be rather naïve, and I’m not sure I know the right answer. I want to be detached enough to remain objective in emotionally difficult situations, but I want to be engaged enough to feel sorrow when my patients feel sorrow and joy when they feel joy. The art of engaging is one of many things that I hope to develop as I continue on my medical school journey.