When I bring up feelings and emotions with residents, I can almost sense the suppressed cringe. It’s actually very easy for me to imagine it, since I had that very same cringe whenever one of our didactics was on, let’s say, ‘softer topics.’ As a resident, I was there to learn straight up clinical medicine - not touchy-feely things.
It’s actually really interesting that it’s common among physicians to equate emotions with touchy-feely. There’s a wide range of emotions present in everyday life. And when you look at the neuropsychology of it – feelings are what drive all of your actions.
Let me demonstrate via a series of feelings and actions with the same circumstance: Feeling emotionally exhausted? You will likely choose Netflix over reading about the case the next day. Physically tired, but feeling excited or nervous about the case? You will pull up that video, or article, learn and review. Feeling frustrated about only holding the retractor for the procedure? You will spend a lot of time ruminating over the injustice of it all. Feeling indifferent to the case? You will do things completely unrelated. It’s fascinating really. With the same case the following day, what you do the evening before is motivated by your emotion. Feelings drive action. (I mean - even JT admitted that it was the feeling that made him dance, dance, dance).
One way to look at emotions is to understand that in this life, we pretty much will experience 50% positive and 50% negative emotions. When you accept that, and you’re having a “low-light” kind of day, like my friend Rita says, you realize nothing has gone wrong. You’re just living the full human experience. By accepting that, it eases the burden and you’re no longer thinking “What’s wrong with me?” It becomes, “Oh, this is just a time of experiencing the other 50%.” And how much more do we enjoy the positive emotions, because we have felt the opposite? Just as important, is the fact that many of those “negative” emotions are necessary for growth. Uncertainty, anxiety, and even courage can feel bad, but because we were willing to experience them, we made it through interview processes and testing needed to become physicians. We didn’t run away from those things to avoid the feeling.
We do, as physicians, however, learn to stuff certain emotions away. Feelings of grief, trauma, sadness, or fear in the medical setting – whether learned from modeling or from a natural mechanism for self-preservation, are stuffed down and ignored. Cy Wakeman says something along the lines that physicians and therapists both get Lesson number 1: Regulate your emotion in the professional setting. But most physicians miss out on Lesson number 2: At some point you need to process those emotions.
What does that look like? Maybe you’ve heard the phrases “process the emotion” or “sit with the emotion.” But I’m a practical person and not a therapist. So, I’m going to tell you the way I understand it from a coaching perspective.
I like to start with what it doesn’t mean first. It doesn’t mean you react to it without thinking. By doing this, you are likely to show up in a way in which you’re not proud. Several years ago, I had a resident who would call me on my cell frequently after hours or pop into my office frequently as a reaction to a lot of anxious emotions. The resident wanted immediate relief. They just hadn’t learned the skill of sitting with it.
It doesn’t mean you ignore it or pretend it doesn’t exist. It doesn’t mean you white-knuckle it to keep it from consciousness. Those bottled-up emotions will either dull all emotion (good and bad) and/or come out down the road in an undesired way.
It doesn’t mean distracting yourself from it. It doesn’t mean trying to comfort yourself by seeking temporary false pleasure via a big dopamine hit by over-eating, over-drinking, over-shopping, constantly venting, over-gaming, etc.
So, what’s left? Allow it. Allow the emotion to be there. Notice it. Become curious. Be a compassionate observer of how the emotion feels in your body. Is it fast or slow? Is it in your chest, throat, or stomach? Is it heavy or burning or pulsating? Psychologically move toward it instead of trying to push it away. With focused attention, it will lighten within a few minutes, and occasionally, it will come back in waves, and you process it again. Sometimes, it just needs to live in the background while you perform tasks. Over time and with enough allowing and sitting with it, you stop fearing the negative emotion and it will dampen and abate.
Think about it, we experience negative emotions on purpose all the time. We watch a tear-jerker movie knowing we will be sad. We get on a roller-coaster knowing we may experience suspense or terror. We are willing to experience those emotions. So, when they arise in natural life, we need not try to avoid experiencing them.
There are other things you that you can do with those intense negative emotions, especially work-related – talk with a trusted colleague or mentor, bring it up in a Balint session, journal and reflect, move toward acceptance. Remember to practice self-compassion over self-blame. Coaching is particularly helpful for the common emotions we experience as physicians.
If you or a colleague is ever in a situation where the emotion is super intense and intrusive, that’s a good warning signal to seek additional formalized support from trained therapists or specialists that deal with second victim syndromes and the like. (See other resources below).
I’m glad I have learned this now – better late than never. There are countless times that this would have been helpful to me in my career. Such as, when my continuity OB patient that I delivered only weeks before was in a house fire and her son that I delivered ended up in a persistent unresponsive wakefulness state from the smoke inhalation. I’m sure each of you has your own stories and events that you can apply this to.
As physicians, emotions (both positive and negative) are normal. We need to embrace that life is 50/50 and learn to process, rather than try to escape or ignore, the half that are negative. Afterall, it’s part of the full human experience. Remember, we can so appreciate the sun because of the dark. In a future blog, I’ll cover how to tap into the feelings you need to get the results you want.
Have a joy-filled day - Tonya
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