264 Interacting with Their Patients
Conversely, closeness and hazy boundaries between patients and
friends could exact psychic costs. Juan, who had HIV, was friendly with
some patients, but later that closeness made it harder for him to treat
them. He felt emotionally attached and, as a result, was more affected.
At times, I felt calloused from death—I’m used to it. But with two
patients who invited me to dinner—we weren’t close, but con-
sidered each other to be friends besides doctor-patient—it was al-
most as if one of my close friends was passing.
To a certain extent, training as a physician numbs one to patients’
suffering and death. Juan went on to describe this dullness of feeling,
which often manifested itself as a delay in, and muting of, reactions. For
instance, he was not upset by one patient’s illness until after the patient’s
death. Only much later did he feel grief.
There’s a lag time. A patient passed, and it didn’t hit me for three
days. Then it hit me, but not as hard or intense as I thought it
would. That’s numbing—it’s anesthetized. Once, I had a small sur-
gical procedure on my toe, and they numbed part of it. In spite of
the anesthesia, I felt part of it. But most of it hit me after the
anesthesia wore off. This patient not being there anymore, his next
scheduled appointment was removed from the books. I missed
him, thought about him, reminisced about what we had gone
through.
Over time, such grief can compel doctors to distance themselves further
from patients. With patients, doctors had to titrate closeness versus
separation.
Physicians’ reactions to colleagues’ deaths also further illuminated this
chasm between dealing with death and loss professionally versus per-
sonally. Ronald, the suburban radiologist, said, ‘‘If a patient dies, I feel
bad; but if it’s a colleague, it’s more upsetting.’’
Doctors appeared to handle death by separating themselves from the
patient, not by having magically inured or inoculated themselves against
death in general. Rather, they hardened themselves against a patient’s
demise by seeing the patient as one of ‘‘them,’’ not one of ‘‘us.’’ Stuart
said, ‘‘Here’s the doctor and there’s the patient, and you have to choose
your side, and we choose to be doctors, so we’ll never be patients.’’ As a
consequence, it was tougher when disease occurred in oneself or a col-
league. In that case, the strong defenses developed against loss of a pa-