I recently learned a valuable lesson while dropping my daughter off at school about the importance of treating one another with compassion. As I entered the daycare, I realized that I had forgotten the code to sign her in for the day. When I write it, the forgetting looks small and insignificant. In the moment, it felt like a reminder of how much I am not present in her life because of my choice to work full time as a surgeon. I tried to reassure myself that it was not a big deal while hiding my shame from the school Director whom I rarely see. My daughter entered a classroom and oriented me to where her bag goes since I had not dropped her off in her new room before.
I walked down the hall toward the door, wondering how many of the items on my task list I could complete today and knowing it would not be enough to keep up with the constant push to produce more work. Halfway down the hall, the Director stopped me, smiled, and handed me a sticky note with the code. Her face and her act showed no judgment of my failings as a working mother, only kindness and compassion. The only one judging my failures that morning was me. I realized in that moment how often this is missing in my interactions with others at the hospital.
Compassion for one another is urgently needed for those of us in the high-stress work environment of our current healthcare system. Unfortunately, this compassion for others is not something that is always modeled in surgery. Disruptive behavior in the operating room is one example of a lack of compassion which may come for the extreme stress surgeons feel in the moment or chronically. This behavior has significant negative consequences for co-workers and patients.
How can we create a culture where disruptive behavior is not accepted? One way is to look at the systems issues that create unbearable stress on surgeons. Another is to consider how we cope with that stress without punishing our co-workers for it. Modeling disruptive behavior for students and trainees will lead to perpetuating the harmful behavior. I certainly have been on the receiving end of harsh treatment.
As an intern, I once missed canceling a dose of tacrolimus for a recent kidney transplant patient. The attending yelled at me on the phone for my incompetence ending with “…that kidney’s gonna die!” Yes, I had made an error with the potential to cause harm to the patient. When the feedback was given, however, the context was not considered nor was I given the support to feel that I could recover from this mistake to develop a better method for completing tasks and to continue learning how to be a successful surgeon.
What was happening to me that day? How could I miss such a simple order? Did I get paged mid-way through the process? Did I not click a box on the computer? As an intern, that Sunday shift was the first time I had ever taken care of Transplant Surgery patients. During that shift, I was on call for several surgical services and expected to respond to traumas in the Emergency Department. As I steadied myself from the verbal abuse for another 8-12 hours of work, I stared at my list. The checkbox was filled in for cancelling the dose. I don’t know what happened. After a quick cry in the bathroom where no one could see my weakness, I returned to my shift and tried to put my extreme incompetence out of my mind.
For the next week, I checked the creatinine of the patient who had received an extra dose of tacrolimus. It never budged. His kidney was fine, and I felt lucky. What I might have learned that day regarding how to deal with unfamiliar patients and triaging work or better organization was lost in the anguish of feeling like a failure rather than an inherently imperfect human. From this experience, I learned how to be harsh to others rather than how to work with my juniors when they struggled or made mistakes. While I expect to be held accountable for making mistakes, I also expect compassion.
We are all struggling with the burdens of practicing in our modern healthcare system as evidenced by the high rates of physician burnout and suicide. When we ask each other for help in a system that burdens us with more and more work and less assistance, we are often too fatigued to find compassion for one another. Yet we all desperately need it.
How can we find compassion for one another? Is compassion enough to sustain us until we fix the broken system that is leading to so much physician burnout?