• I’ll Sleep When I’m Dead

I'll Sleep When I'm Dead

~ writing my way through motherhood, doctorhood, post-PTSDhood and autism. sleeping very little.

Tag Archives: empathy

christofascism

04 Wednesday May 2022

Posted by elizabethspaardo in addiction, Catholicism, christianity, Evil, kids, love, outrage, parenting, Politics, PTSD, Rape, Sin

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abuse, addiction, death, dying, empathy, Evil, fallen world, family, feminism, forgiveness, good, innocence, joy, Justice, love, meaning, medicine, mental illness, morality, original sin, Parenting, patriarchy, privelege, PTSD, rape, religion, sexual assault, silence, Sin eater, trauma, truth, viktor frankl

Nowhere in the Bible does it say life begins at conception. Nowhere in the Bible does it say 10 year old girls ought to carry and birth their father’s baby if he chooses to rape her which fathers sometimes do. To think this is what God would want says an awful lot about a person. And it isn’t good.

Howard Zinn says you can’t be neutral on a moving train and so I want to hear from my Christian sisters today. I want to hear them screaming for the women who will die, the girls who will die, for the dreams that will die. They asked Jesus the most important commandments and he said love God and love one another. Why is that so fucking hard for so many ChRiStIaNs?

Contraception is next. Do you know I didn’t use contraception for years and I’ve never been a fan and it’s failed me on occasion and I still will give my all to defend our right to it. Do you know the horrors I have seen come of lack of access to effective contraception? Where are you my fellow Christians? With your youth groups and your worship songs and your testimony? Jesus hung with the prostitutes and the lepers. She had two beautiful kids and a hole inside of her so wide and so deep because she’d never been loved and only ever been hurt and that third baby done did her in and now all three of the babies are with someone else and she is in jail detoxing meth psychosis and I miss her so damn much. She chopped wood at 8 months pregnant to try to make enough money to keep the water on. And where were you? At yOuTh GrOuP

I sat in my car and cried for the world we’ve given our kids. I tried. I believed. But here we are. Poor lost children of Eve banished from Eden. But Eden wasn’t enough. Or maybe it was too much. We wanted that apple and who could blame us? How boring a perfect life must be. So huddle together in this Whale with me and let us tell each other tales until the light goes out.

addicted

12 Tuesday Apr 2022

Posted by elizabethspaardo in addiction, autism, Catholicism, christianity, empathy, kids, residency, Sin

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addiction, autism, beauty, children, death, empathy, fallen world, joy, laughter, love, medicine, original sin, Possibility, religion, residency, silence, trauma, true love, truth, viktor frankl

all of my patients are physically dependent on opioids. ICD 10 F11.20. some of them are addicted to opioids. a lot of them aren’t.

maybe you’re physically dependent on something. for which there is no ICD 10 code. caffeine, zoloft, dopamine, adrenaline. maybe you’re addicted. coffee, zoloft, social media, shopping, toxic relationships, speeding, gossip, little debbie Christmas tree cakes, work, success, sex, HGTV.

maybe you think I’m being cute. or metaphorical. just making a point. no one goes to rehab for gossip addiction (maybe they should). no one goes to jail for possession of little debbie Christmas tree cakes (maybe no one should go to jail for possession of anything. maybe the jails are a crime)

addiction is an escape from the pain of being human. being human is more painful for some than others. but it is painful for all of us. and if someone tells you it isn’t, that is because they are so deep in their addiction, they have lost touch entirely.

eve and adam ate that apple and it all went to shit, you see. our eyes were opened and sickness and pain and toil entered the stage. we all fell down, down, down. and ever since, we have very logically sought to numb the pain of it. because there is no way up, up, up. not in this life anyway.

we are afraid. to hope, to love, to ask for love, to speak our truth, to share our pain, to need or be needed, to want or be wanted. we are afraid to take up space and that we might disappear, to be silenced and to be heard, to be alone and that we might make a genuine connection. we are afraid we are unlovable and that to be loved would be the most unbearable pain imaginable. or perhaps, worse than that, ecstasy.

in addiction we connect with other people. no we don’t. we are with people and we are less lonely and so we think we are connecting. logical. understandable. but let me tell you a story about the time my friends let G die when he overdosed because they were high too and didn’t want to get in trouble and i knew they loved drugs more than they loved me or each other. and the time i went back to my dopamine adrenaline filled emotional intimacy free relationship because right at that moment i loved it more than my kids and i do not want to tell you that but how else can we do better?

and they told me my son played next to other children but not with other children and that he was too old for parallel play. but tell me how much time adults spend engaging with other people and not engaging next to other people? are we connecting spiritually or are we churching next to one another? and those residents we work 90 hours a week with that we save and lose lives with, do we know them at all? and so pass the pipe and hand me that spoon and we will share a hit of Netflix and yoga and pumpkin spice latte next to one another in this Fallen World.

there is no ICD 10 code for the unbearable lightness of being but maybe there should be

The surprising mathematics of shame

05 Monday Jan 2015

Posted by elizabethspaardo in christianity, empathy, kids, love, medicine, parenting, PTSD, Rape

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empathy, forgiveness, trauma, truth, wounded warrior

I came home from working a 24 hour shift and thought, I should relax and watch something funny before I head for my nap. I have a tendency not to follow through on such intentions very well. I tend to wind up watching a documentary about something heavy instead. My therapist Dr. O said my main hobby in life seems to be thinking and that has its benefits and its drawbacks. One of the drawbacks being my insomnia largely caused by my unending pondering. So I knew logically that I really should put on something lighthearted to unwind and then go take my nap, but logic rarely dictates what we do in this world and I am no exception.

In my defense, I did go to the Search area of Netflix and begin to type in “Sex and the City.” I can’t be blamed for Netflix suggesting I might enjoy the TED talks on the topic of sex and love.

The first talk was “eh.” It was about parenting taboos I didn’t exactly find earth shaking. Maybe because I entered parenting via the special needs route. I was doing calculus when the parents giving the talk were still learning to count. Not to say their talk didn’t have value. Sesame Street has a lot of value, for instance. But I digress….

The second talk was different. It was by Brene’ Brown, a PhD in social work, and it was titled “The Power of Vulnerability.” She talked about the most basic human need being connection. She said it was the meaning of life. She talked about the thing that keeps us from it too: shame.

She described shame as the fear of being disconnected. Our fear that if people really knew us, they would reject us.

She said something else too: the less you talk about shame, the more you have.

She said the key to happiness in life was vulnerability. Being willing to sit with uncertainty, taking risks worth taking.

She said that the difference between people who feel loved and connected in this life and those who don’t is whether or not you feel worthy of being loved and connected.

She said we numb vulnerability with food and buying stuff and drinking and medication but when we do, we also numb joy and happiness and make ourselves more and more miserable.

She said more in 15 minutes that is worthwhile than I learned in four years of medical school. My husband says I’m exagerating a bit when I say that. I’m prone to exageration, so I guess I’ll rephrase: what she said launched an epiphany for me that will make me a better doctor and a better person.

You see, PTSD is about disconnection and not being able to be vulnerable and numbing and shame. And shame. I’ve been trying to figure a way out of the disconnection and numbing and avoiding vulnerability piece. It didn’t occur to me that the key could be shame. And it didn’t occur to me there might be a simple mathematical solution:

Talk about the shame –> less shame

I always thought it was the other way around. Maybe that’s why therapy hasn’t done a lot for me over the years. Maybe.

So I’m on a mission to talk about my shame. Every last bit of it. Everyone has it except for psychopaths, so there’s no shame in admitting you feel ashamed.

I had a grrl band when I was in college called Dum(b). Don’t ask about the parentheses. I named the band Dumb because we were a grrl band giving voice to women’s and girls voices (dumb used to mean mute in addition to meaning stupid FYI). I used to be an oral historian trying to give voice to marginalized people (thank you Howard Zinn, God rest his soul). But it’s time to look at myself now.

I need to talk about the things I’ve kept silent so long. The things I have tried to stuff down with food, to forget in the rush of infatuation, have tried to bury under a pile of things bought with credit cards. The things that have kept me from being fully present, that have made me afraid to be vulnerable.

These things that keep you from being alive. The opposite of life.

When I look at my children it is so easy to see that they are extraordinary just as they are. So easy to know in my bones they don’t deserve to feel shame. What I have come to realize is that I need to feel that way about myself.

I have spent the past seven years surviving. Surviving for them, because I had to. But survival isn’t life. It’s a holding pattern. I need to live and not just for them. I need to be fully alive again for me too. Because I deserve to be alive and joyful and self-confident and full of plans and hope and possibility.

Possibilty. It’s been so long since life seemed to hold real possibility.

I went to sleep for a few hours last night during a lull in admissions for the first time in so long. I prayed and thanked God for what the Holy Spirit has revealed to me through a TED talk. And then I stopped thinking and went to sleep. Because I deserve it.

I Know You Feel Like Your Doctor Doesn’t Care, But That’s Just Because He Doesn’t

27 Tuesday May 2014

Posted by elizabethspaardo in medicine

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empathy, medical school, residency

I often get patients telling me they feel like I’m really listening, like I really care. Unlike that other doctor, Dr. So-And-So. Sometimes I’m surprised by the name they drop as so many of my colleagues genuinely care about their patients and have, as far as I’ve observed, a good bedside manner. Some patients will always complain, regardless of how physicians behave. We tend to hold our doctors to a pretty high, oftentimes impossible standard. Other times, I’m not so surprised to hear Doc So-and-So has rubbed them the wrong way. Some physicians certainly have a gruff bedside manner. And others, probably more, are nice enough to patients, but don’t really feel the kind of empathy and concern patients expect from their doctor. They follow the script, but you feel like they don’t care the way you want them to. Having spent time behind closed doors with medical students and residents, I can tell you, you’re probably not wrong.

Multiple studies on the empathy levels of medical students, residents and practicing physicians have shown we tend to have less empathy than the average person. One study in the journal Academic Medicine showed that empathy levels actually decrease as medical students move along in their training. Cynicism goes up, compassion goes down.

The widely accepted reason for this is, basically, that medical training is a real bitch. The first two years, where students are taught the science of medicine in a classroom setting, are competitive and stressful. Actually, the words competitive and stressful do not convey what we go through. I’m talking people crying in the halls after exams, weeping and gnashing of teeth. Eating disorders and binge drinking galore. Keep your grades up or get the hell out. I once asked for an extension that I thought was pretty reasonable. My son was in the ER getting IV fluids for dehydration and would possibly need admitted to the hospital and the exam was the next morning. It was the only time I’d ever asked for an extension. I knew leaving sick toddlers at home with my mom, no matter how sad and guilty it made me feel, was part of the deal when I started medical school. I thought the fact he was in the hospital and that I wasn’t one to ask for special treatment might cause them to grant the extension. The professor refused my request and went further. He said, your scores haven’t been that great lately, you’d better do very well on that exam or maybe you’re just not cut out for med school. Damn.

Empathy levels drop even further after the third year of medical school. That’s when you finally start seeing patients so you’d think the battle weary medical students would become more compassionate, not less. That thinking ignores what third year of medical school is really about: pimping. I recall the confused look on my husband’s face the first time I mentioned getting pimped on rotation that day. I’d forgotten the term has another meaning altogether outside the medical bubble. Pimping here refers to a style of teaching employed by attendings with medical students and residents. Oh, how civilized that sounds! The attending, generally an intimidating person who makes no effort to make you feel comfortable in the least, asks you a series of questions about medical facts. A surgeon might ask you to list off the blood vessels and nerves that run through the area he’s currently operating on (as you stand in an awkward, turned and bent over position holding a retractor with each hand). He then might move on to having you trace the blood vessels back to their origins. You’ve just spent two years drinking from the proverbial fire hydrant of medical knowledge, so you search your cluttered, fact-saturated mine desperately looking for the answer. If you fail to produce (which every one of us does at some point), you’re made to feel very small.

As you progress, your wrong answers or, worse yet, no answer at all, move from eliciting comments and looks that merely make you feel like a moron, to comments like, “You’re going to be a resident next year. What if a nurse calls you in the middle of the night with a patient in such-and-such a condition and you don’t know the answer? People’s lives are going to be in your hands. Haven’t you thought about that?”

This is part of the explanation used to defend pimping. If we’re going to be in high presure situations with patients’ lives hanging in the balance, then hadn’t we better learn to deal with pressure? I’ve yet to see the research showing that idea is valid and I doubt I ever will. Because it’s not. What I do see is the culture of physician training where change is resisted and the hierarchy fiercely protected. New doctors really ought to show appreciation for their suffering. It’s how mere humans become physicians.

I have to admit, I’m guilty of it myself. My residency recently moved from 24 hour call shifts to 12 hour ones. It really bothered me. I mean, really bothered me. And I couldn’t figure out why. We know from the research that sleep deprived residents make more mistakes in patient care and also get in more car accidents on their way home. The work hours of residents have decreased in recent years as new guidelines were instituted. We cap out at 24 hours of direct patient care now (no more 30 or 36 hour shifts). First year residents aren’t even allowed to work 24 hour shifts anymore. There’s also a minimum number of hours you must be given off between shifts and a weekly cap on total hours. (An average of 80 hours per week over a four week period). We’re also supposed to have at least one 24 hour period off of work each month. Are these guidelines followed to the tee across the board at all residencies? Oh hell no. But, the point is, the times they are a-changing. Now, back to me and my own old fashioned ways. I was really bothered by the end of 24 hour shifts at my residency and I couldn’t figure out why.

After much soul searching, and many discussions with my fellow residents (none of whom minded the change at all) that ended with “You’re seriously not upset? Really?!”, I came to realize I was so upset because it took away some of what makes being a physican special. There aren’t too many professions out there who work 24 hours shifts on a regular basis for several years straight. Residency is grueling (and mine is one of the kindest ones out there) and people know it. For me, we endure this because medicine is a calling. Not just a job or career or profession. I wouldn’t give up so much time with my husband and children for a mere career. I wouldn’t ask them to make the sacrifices they do for my profession. I do these things because I have been called.

There is no clocking out when you’re a doctor, especially not during residency. I remember the time intern year when I needed to talk to the family member of a patient about placing the patient on hospice for her terminal condition. I’d been there since 6am when I placed the call to the patient’s son at 4pm that afternoon. I’d already spoken to her older son and he felt hospice was the best thing for her, but he wanted me to talk to his brother and him together before making the decision. Her younger son was audibly upset as I told him what I needed to discuss with him. His mother hadn’t been doing well for a while, but who’s ever ready for their mother to die? He told me he was at work, but he would be getting off at five and could come over right after. I was supposed to be done at five o’clock, barring any disasters (always a possibility when you’re working inpatient service), but I told him I would wait. He said he worked about twenty minutes away, maybe half an hour with traffic. I was missing my babies, ages 8, 6, and six months and I knew they were missing me (not to mention how my mom, the one who’d been watching them for twelve hours, felt). But I also knew this family needed me to stay. This was not something I could sign out to the intern coming in to begin night shift. This was something I needed to do for my patient.

Traffic was heavy and then there was an accident. He didn’t make it in until 6:30. I sat at the computer in the ICU, going through emails, finishing up notes from the day’s admissions, waiting. He eventually got there and apologized for being late. I told him he didn’t need to. And I meant it. We talked about his mom’s condition, about their options. Her sons talked about what they thought she would have wanted. The younger son cried on his wife’s shoulder. And then they made the decision to make her hospice. They thanked me. I told them how much I’d loved taking care of her and assured them of how loving and brave their decision was.

I left then, headed home to my family. Soon after, the upper year on night shift called to let me know my patient had passed. She lived less than an hour after the uncomfortable BiPap machine was removed and the morphine drip started to make her comfortable. She passed peacefully with her sons at her side. I cried a little, but there was dinner to be cooked and homework to be done. The baby needed a bottle. I needed some sleep.

I look at the changes being made in medicine these days and I worry it is losing its identity as a calling. Family doctors once saw their hospitalized patients in the morning before going to the office. If their hospitalized patients needed something in the middle of the night, they fielded the call. Now, family medicine is being divided into hospitalists and outpatient docs. Small practices expand bigger and bigger, cutting down on the frequency of call for each doc. Graduating medical students look at the lifestyle a particular specialty will provide as much as the kind of relationship they will have with their patients. Will medicine soon be little more than a job? A paycheck you put your hours in for? Clock in, see patients, clock out.

Perhaps this is what the older physicians worry about when they think about giving up things like pimping and 100 hour weeks. And perhaps, in order to hold onto our humanity,we must remember that not only are our patients feeling human beings, but so are the young doctors we train. We are human beings with limits. Limits to what we can do physically and to how much we can take emotionally.

In the end, it is not 24 hour shifts that makes medicine a calling. It’s certainly not the battle scars of impossible exams and pimping. It is the compassion we feel for our patients. What determines if it is a calling is the motivation that brings us to this job with its blurred borders of where it ends and the rest of us begins. You can go without sleep and endure overhwhelming stress with a hardened heart. You can bring this sacrifice and an abundance of medical knowledge and procedural skill to your patients, but if you don’t really give a damn about who they are, you aren’t really a physician. All the technology and constant outpouring of new medical knowledge and developing of drugs doesn’t change what is most important about us. We are healers, much more powerless than we like to admit. If we can serve with a humble heart and keep from doing too much harm along the way, I’d count that a worthwhile medical career. And I bet my patients would too.

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