Comfortably Numb?

I have heard all through medical training and before I even went to medical school about the "emotional distancing" that you would end up having to do. People always said things to me like, "Of course, you have distance yourself from many of your emotions just so you can cope with some of what you must do" and things like "you must get desensitized to the heartache" or "you have to be detached in medicine". Well, so far in medicine I have never felt that I needed to "build a shell" or "distance my emotions" but I am starting to see more and more that they are at a distance in many areas of my life. Perhaps, not so much as at a distance but muffled. It was not always this way though.

I had been an EMT previous to medical school and honestly, the horrendous scenes I witnessed at times never really bothered me as much as I was amazed and humbled by them. At first I wondered why they didn't.... but later I assumed it was part of my personality to detach a bit when things got intense and that it would be a good trait in medicine. I often processed the emotions after the fact, on my own time, but usually never while it they were happening. When we were in the middle of an emergency I always had a very detached perspective and focused on my job and it was not an effort, just a reaction. If I did have an emotional response it was often more existential. Awe of the event perhaps. A sense of witnessing almost. The rest of my life was normal though. I found a new motorcycle exciting, a new love enthralling and the loss of that love heartbreaking, etc...Life still affected me and I swung as far up with my highs as I did down with my lows. There was still drama.

A recent event made me think more about this. Several med students and residents I know have had babies this last year. During a conversation with one of them I noticed she did not seem as "giddy" as I expected and I asked her about it. She started telling me how it was a great experience and that she loved her baby but that she had not yet really comprehended what it meant to be a mom. She did not feel the profound shock of the event she thought she would feel. She told me how her husband was so elevated by the whole event. When he came home and could not stop adoring the baby, completely infatuated grinning ear to ear, but she did not yet seem to feel this level of bliss. For him it was the most amazing experience he had ever had... for her it was a good thing but not earth-shaking. I later asked her if she thought her medical training had affected her reactions and we both thought about it for a while.

We see and experience so much in medical school and residency, how could it not affect our experience of our emotions in all areas of our life? We see people heartbroken over their loved ones dying. We see families ecstatic over the birth of their first baby as we deliver the child. We see so much horror and beauty... over and over, again and again. We don't just see it, we are experiencing it as integral parts of the drama. We are in lead roles. People ask us for reassurance. People trust us to cut into their bodies with knives while they sleep in the hope they will be better for it upon waking. We watch people die and it becomes routine. Is this emotion-numbing self-protection or simply just something that happens through repetition?

Recently, I think I am noticing this blunted emotional response bleed into all aspects of my life. Every year that goes by I find myself less and less joyful or despondent. The highs are not as high and the lows not as low. Sounds stable, like a good thing, but honestly I am starting to miss the innocent wonder of being amazed, astounded, surprised or infatuated. Few things make me nervous with anticipation any more. I can't say I miss the searing heartbreaks or despair that some events can evoke. I am not saying I am emotionally immune of course, but when I look back in my life to my younger years, especially those before medicine, I see that I had more enthusiasm. I was more excited about the new experiences and felt that events in my life had more of a direct and immediate impact on me. Now they seem to wash over me slowly. Is this because I am now almost daily an integral part of experiences of such amplitude that my scale has grown too large? Have I run out of emotional energy? Am I depressed? Am I just too tired and busy for the drama? Does anyone else in this training process ever feel this way? I no longer seem to experience my emotions as the sharp spikes and dips of some Richter scale but more as an ebb and flow of the tides. Predictable. Not too quick and not too extreme. The good is still good but rarely does it feel "great" or "amazing". The bad is sill bad, but rarely is it "tragic" or "shattering". I feel more and more somewhere in the middle and for some reason....that bothers me.