In Shock: How Nearly Dying Made Me a Better Intensive Care Doctor

by Dr Rana Awdish

The patient, even the accusatory and fearful patient, is doing their best.

A humility that dictates that while we cannot possibly understand every patient’s story perfectly, we can trust them to tell it, without imbuing it with our own biases.

The truth was, I didn’t know if everything was OK. In fact, I knew something was probably very wrong, but I wasn’t yet ready to face it.

“Difficult” was a shorthand for “The patient is not going along with the plan. I have a good solid plan, and they aren’t on board.”

Our assumptions about others said so much more about us than about the people we were judging. We didn’t know. It’s no one’s right to define the parameters or prerequisites of someone else’s suffering.

found I was still telling time by last year’s calendar. I’d peel up the square on any day, and there was the loss, the due date, the scar.

I noticed things I hadn’t before, when I was just a doctor.

And yet I’d exit the elevator ten floors early if an instrumental of “Ring of Fire” came on over the speakers. I’d become nauseated by certain combinations of lab values, or groups of organs failing. I was suffering again from nightmares.

When I was sick, I believed my team had complete control over my outcome. But here I felt I had no control.

The message imparted to us was that in order to have clear judgment, one must maintain distance and coolness. We were taught that to be a good physician, we had to cultivate a certain reserve.

Despite their fatalism, we suspected they must have once been just as open as we were. So we were left to wonder, had they learned the lesson by feeling every sadness, only to be helpless and paralyzed as a result? Or had they entered training with a wall already constructed? We didn’t know. We only knew we couldn’t ask.

We were told the goal was to conquer, suppress and internalize our emotions. We had no idea that there might be an alternative. We did not know we could cultivate a space for those feelings to be unpacked, understood and allowed to foster connection. That there was reciprocity in empathy.

Shame doesn’t strike like a fist. It rots its way in. Shame unravels us at our most fragile seams.

We may try to delete the feeling, like an unflattering photo. We may dig a hole and try to force it in, like a rigored corpse. Some of us may attempt to submerge it, or rebuild the tower of ourselves on top of it. But it remains the foundation, contaminating the groundwater and corroding through every layer.

As if resilience were a binary trait that one possessed or lacked. As if resilience didn’t require a culture that is committed to fostering dialogue, building spaces for shared disclosure, and empathy.

Our patients would die; it was an unavoidable reality. So if we knew this, then why hadn’t we built resiliency into the system? Why was each person’s grief treated as an unexpected aberration?

Loving each other through the darkness is the thing to look for and to mark. It’s there, in the shadows, where we find meaning and purpose.

I can’t say “it took me two years to recover,” because that implies some aspect of completion, that I arrived at some predetermined destination intact and whole. I didn’t and couldn’t become myself again, because that self no longer existed. Instead I found that with each incident, each organ failure or surgery, I was reshaped into a new configuration.

I saw how much we all hurt in the same vulnerable places. The shame of doing your best and never having it be good enough left its mark on each of us.

children have the remarkable gift of being unified in feeling and in body. They innocently express what they feel. If Walt was frustrated with the discoordination of his walking, he showed frustration; if he was sad because falling hurt, he cried. This honesty was so pure, and stood in contrast to the adults around him who seemed not to know what to do with feelings except to hide them.

I was frankly tired of being in the hospital, having found myself there so many times already. But more often than not it proved to be unavoidable.

But I learned that if I came in early, at the first hint of a problem, rather than being credited with making a good decision, I was regarded with a thinly veiled skepticism. That subtle dismissiveness left me feeling ashamed, and thus I was more likely to wait until I knew I had no choice.

Doctors bring their own ghosts to every encounter, and they come in many different forms.

It is almost always true, the patient is almost always telling you the diagnosis, but listening is harder than it seems. The story the patient relays can be circuitous,

That we see terrible, awful, bloody things and it hurts? And we don’t feel we have a right to hurt, because we are in the outer circles of the diagram and everyone around us is right in the center of it and it hurts so much more for them. So feeling anything that resembles sadness or grief feels terribly selfish and entitled.

“That’s the thing, we can’t stop it. We don’t ‘let’ people die, they just die. We can’t stop it.”

That orientation—turning together to face what our patients face—is what allows us to not only bear witness, guide our patients and treat disease, but also to bring more compassion to each moment, a compassion that extends even to ourselves.

We can be wounded and in that space find more cohesion and wholeness than we knew possible. But only if we are willing to acknowledge and confront the cracks.

It is entirely possible to feel someone’s pain, acknowledge their suffering, hold it in our hands and support them with our presence without depleting ourselves, without clouding our judgment. But only if we are honest about our own feelings.

There I was, onstage, representing what I was—a visible, tangible post-sepsis success story, one that was disfigured by all the ways we fail our patients on a daily basis. Two seemingly contradictory truths.

Medicine is a culture that does not indulge suffering, though it is everywhere.

in the same way physicians had denied the primacy of the patient voice, medicine had also silenced physicians. We’d been trained to believe that the burdens we carried, the suffering we witnessed was meant to be borne in silence.

We learned together how to honor our respective brokenness, the vastness of the wound and the primacy of the patient’s perspective. We work each day to add another layer, to make hope visible, to make the space whole again.

But to engage any patient in health outcomes, we first must find out what is important to the patient.

It is only by building a community that is engaged and active that we can hope to effect true change.