‘‘Being ‘Strong’’’ 219
Burnout resulted, too, from physicians feeling unappreciated and not
thanked enough. Anger can ensue. Stuart continued:
Physicians who get furious at patients are saying, ‘‘No one is say-
ing thank you enough.’’ Good compassionate docs want something
more. Some of them translated it into money: ‘‘They’re not pay-
ing me enough’’ or ‘‘They’re cutting into my fees.’’ I realized that
when I got angry and resentful, in part I just wasn’t hearing: pa-
tients were saying ‘‘Thank you,’’ often in a heartfelt way. But I
expected some translation that I didn’t hear.
In fighting patients’ disease, helplessness, rather than cures, contributed
to this frustration.
Should Doctors Not Cry? Coping
These physicians found it hard to access or use external supports that
commonly aided their lay patients. Rather, they felt they had to avoid
burdening others. Revealingly, having been trained to be ‘‘unemotional’’
when confronting disease, several feared that weeping would be ‘‘weak.’’
‘‘I wasn’t sure if I was supposed to cry or not,’’ Deborah said about her
reaction to bad test results that she received one day while at work. ‘‘I
didn’t cry. When I got to the clinic, I broke down.’’ Professional norms
mitigated against displays of emotionality.
Similarly, in describing the pain of her struggle and secrecy, Suzanne
faltered, barely able to articulate the complex loss and shame she felt. She
broke into tears, though she had never allowed herself to weep with col-
leagues. ‘‘I’ve never cried in front of anybody in my program, but I’m
always a little bit ready to.’’
These physicians felt that their own doctors reinforced this norm of
not expressing emotion. At times, physicians-of-record ignored patients’
emotional distress, or handled it poorly. For example, Nancy, the en-
docrinologist with metastatic cancer, commented about her oncologist,
‘‘She immediately tried to medicate away my distress’’ with anxiolytic
medications. Yet Nancy wanted to confront and discuss her terror of
dying.
As a defense against distressing aspects of their disease, many physi-
cians engaged in intellectualization. For example, Bradley, the internist
who was treated for depression after his MI, decided to consult a neu-
ropsychologist to test for any new, ongoing cognitive deficits.