The cries of accident victims, the overcrowded stretchers, nurses yelling instructions, the stench of blood and disinfectants - you know where you are, it’s the emergency ward of a hospital.
Just when the chaos gets too much, you catch a sight, like a clear light in the storm - a calm, almost stoic doctor deftly carrying out their duties.
But could the calmness be for real? How do doctors keep their cool when the stress, long hours and seeing people in pain gets too much?
FIT speaks to emergency and trauma doctors to find out how they really deal with seeing the trauma on a daily basis.
Inside the Mind of Emergency and Trauma Doctors - Burnout, Emotional Attachment and Being on Auto-Pilot
We always think of doctors as god-like figures who feel no pain themselves and selflessly give of themselves.
Think about this a little longer and the image shatters - doctors are human, and feel pain, fear, trauma and burnout too, at alarmingly high rates.
FIT spoke to Dr Sandeep Jain, head of accident and emergency at Max Hospital, who recounted an incident in the emergency ward that shook him.
“I remember a case of two young boys riding a bike, they followed all the rules and stopped at a red light in Delhi NCR. But then a private bus rammed into them from behind. One boy died on the spot, and the other was rushed in. We were able to save him and what he said really shook me. ‘I followed the rules, I did what I was supposed to, but why did this happen, why did my friend die and why am I crippled?’ I had no words.”Dr Sandeep Jain
He was deeply affected by this case, he recalls and told me he copes best by talking. “This is what we encourage in our team at work as well - talk, vent out your feelings and we will give you space, support and console you.”
He’s lucky, his wife is a doctor too and understands the specific stress, the overburdened lifestyle and the physical as well as mental toll the job takes. “My wife is my best friend, we can and do discuss cases and difficulties.”
Government Doctors and an Unparalleled Rush: How Do THEY Cope?
But these are private, tertiary-care hospitals, what happens in government hospitals that are often the first place an accident victim is taken to? What happens when you see hundreds of trauma patients in a day? FIT speaks to AIIMS doctor Vivek Chaurasia who works in the emergency ward and is doing his MD in emergency medicine.
We’re lucky we caught Dr Chaurasia on an off day, he is currently working the night shift and gets an off in the days.
“When I first joined, I was thinking of these things in my mind - I was so stressed.How would I do this when one decision I make can affect an entire life?”Dr Vivek Chaurasia
“When you are new to emergency and trauma, you haven't experienced accidents, blood, open wounds etc, and that can definitely stress someone out,” adds Dr Hasnain Reza, head of Emergency at Fortis Memorial Research Institute to FIT. But the good thing about emergency is that unlike in an OPD, the doctors work in a team so you are never alone to deal with the high pressure. “Your teammates are holding your hand.”
Dr Chaurasia adds he got over his fears as the process to work in emergency begins slow - you observe for a long time. “But then soon, you have to make quick judgments, and keep trying, keep trying to save a life. Maybe the patient won’t survive, but you have to keep doing CPR, keep trying and monitoring the whole time.”
He tells me about standing for 12 hours on the night shift, and when I ask about the toll it takes on his health, he says laughingly,
“Our health worries go away when we save a life, That gratification is instant, it happens only in our department. It’s like a nasha , in a good sense.”Dr Vivek Chaurasia
“Of course,” he adds, “we are also human, we also get attached to our patients but we can’t get stuck, there are too many others waiting. We discuss the sad cases with our friends, vent and then have to get back to our duty.”
He tells me his motivation to go on despite the stress and high stakes environment is chasing that nasha. “It keeps me moving, once you save a life immediately it is amazing.”
If the stress does get too much they can take a break or leaves from work - but he says he gets enough so far and has classes in the middle as a break from the pressure zone.
Vent, Take a Break and Take Care of Yourself- Protocols for Doctors
Yes there’s guilt, stress and pain but Dr Jain tells me the hospital has specific policies to deal with this - we do a lot of team-building exercises so we become closer, enough to talk about problems and not burnout.
That’s true, burnout rates in the emergency department and among emergency workers are much higher than those in other medical departments, and there are mechanisms to deal with this.
Do doctors dealing with trauma patients freeze? There are protocols to avoid this, stimulations, years of medical training in the same atmosphere. But doctors are human and can they be truly immune to human attachment and emotion given enough training?
“We try to prepare for this but yes, there are times when a doctor gets too affected. I had a junior doctor who was treating an elderly couple, in their 60s, and the husband could not be saved. The wife had brought him in alone and hearing her story, the doctor broke down,” says Dr Jain,
“First, we let the doctor vent. She explained that the patient reminded her of her father, and the story of how alone the elderly couple was without any support made her feel bad for her father who also only had his wife. We then understood her reaction better and counselled her. She was able to then cope, follow the protocol, rest and recuperate and get back to action when ready.”Dr Jain
When I ask about therapy, Dr Jain tells me that their job is to assess their junior doctors and try and pre-empt problems through get-togethers, frequent granting of leaves and even meditation sessions to relieve stress and improve mental well-being. “If we identify a problem,” he adds, “we do try to get them to a psychologist or other mental health professional.”
‘Compassion Fatigue’: Burnout in Care Giving Professions
There is little understanding of what seeing so much trauma on a daily basis does. Surely seeing traumatic wounds, hearing stories from families and victims, and trying to heal them can cause vicarious trauma - where doctors feel so much for the patients they take on their pain.
This phenomenon called ‘compassion fatigue’ happens to other caregiving professionals like social workers too.
Doctors need to be allowed to be human and process and ask for help. Dr Reza tells me, “Think of a young man who comes in after a motorbike accident. We get many such cases. Now if, despite our efforts, he loses his life, how would anyone feel? Especially when we discover their stories, we feel bad because a life was lost and others are impacted. Whether you are a doctor or not you will still feel bad because a life is lost.”
“Yes, seeing patients in distress is part of our daily routine but we all get attached to them, their relatives, their families - it is our own humankind that is affected.”Dr Reza
Dr Jain tells me that misunderstandings over a doctors capacities often cause increased stress. “There was a road accident that happened in bad traffic, the victim was lying on the road and no bystanders were helping for a long time. By the time someone got him to the hospital, there was a ton of blood lost already. So much time was lost. It took one and a half hours of effort but he could not be saved. That itself was so disheartening as a doctor’s main goal, our only endeavor is to save lives.”
“We can’t always save lives, and the people with the victim started yelling at us and abusing us. That was when we felt really low, and a lot of doctors do say ‘Aree, the society is ungrateful why should we do this?’ There has been an increasing faith and trust deficit but you have to understand - we are trying also and feel bad when the life is lost.”
It’s a raring job, constant, hectic and much critiqued, but perhaps patients will be better helped if we recognise that doctors are as human as the rest of us and need the same mental, emotional and physical care.
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