Our training as physicians teaches us to bury our emotions, to remain objective and detached, and it has become clear that patients can perceive doctors as lacking empathy by hiding this aspect of themselves. The complexities of this dynamic are explored in Walter M. Robinson’s What Cannot Be Undone: True Stories of a Life in Medicine, a collection of essays examining the self-destructive results of detachment from the physician’s emotional responses, published recently by the University of New Mexico Press. When physicians cannot tolerate the pain and suffering of their inner life, compassion-fatigue, burnout, substance abuse and suicide are possibilities.
Walter M. Robinson
Photo by Stephen Cullar-Ledford
With a renewed emphasis on a connection in medicine, physicians began to feel more comfortable expressing their feelings and sharing them with the public. Excellent memoirs appeared, such as Danielle Ofri’s What Doctors Feel and Internal Medicine: A Doctor's Stories by Terrence Holt. The Healers Burden: Stories and Poems of Professional Grief, edited by Melissa Fournier and Gina Prabaz, zeroes in on one of the more difficult emotions clinicians confront.
What Cannot Be Undone strips naked the author's uncertainties, inadequacies and fears in compassionate but uncompromising examination. Walter M. Robinson is a physician and a writer in Massachusetts and founding editor of EastOver Press and Cutleaf, an online literary journal. In his opening essay, the author, ethicist and pulmonologist transports us into the surgical suite where Henry, a teenager with cystic fibrosis, will undergo a lung transplant. With clear and vivid language, Robinson walks us through the entire process—the decision of the donor family, the harvesting of the lungs and Henry's operation, stopping along the way to explore his reactions and those of the people and families involved. Explicit details merge with many emotions, and Robinson is not afraid to present himself as human. When they cannot finish the transplant because of damage to the donor's lungs, and the team cannot complete the operation, they know the boy will die. Robinson movingly reflects on his feelings, "…I am wounded and full of rage at the death of this dream." What deepens his reflection is he is also filled with concern for the surgeon, "…what this man beside me must feel, how his hopeful heart must be breaking."
The young doctor in the essay "The Necessary Monster" struggles with the paradox between causing suffering and providing appropriate treatment. After a particularly unpleasant time with a patient, the intern says, "I hate this boy. God damn him for making me be the monster." How often in my training had I felt this way? Later, the doctor sees two parents refuse any more treatment for their suffering child and comes to a place of equanimity with his role. The author beautifully says, "He knew he was responsible for saying out loud what others were thinking: miracle becomes tragedy, cure becomes torture, hope becomes sorrow."
A member of the Ethics Committee, Robinson faces the question of what makes a life worth living in the honest and scathing essay "Cognitive Sparing,” where he tackles the typical thought process in medicine that uncertainty about an outcome determines the morality of our actions. He tells the story of Luke, a baby born with a catastrophic brain injury. He would never see, hear, speak or walk. Although the parents were comfortable letting the baby die peacefully, the medical machine moved forward, and doctors placed a feeding tube. Luke remained unchanged for years in a pediatric nursing home, and the author states, "I am clear about it now; we should not have placed the feeding tube."
In the other essays in this collection, the range of his experience becomes clear and provides us with moments of reflection and knowledge. We follow Robinson as he deals with his mortality after a diagnosis of malignant melanoma, watches an irritating clown get his comeuppance from a little girl, connects over sputum with a moody teen, provides compassionate care that perhaps lessens the patient's life by a few hours, and follows mothers through the history of cystic fibrosis testing and diagnosis.
In the final essay, "White Coat, Black Habit," the author presents a few vignettes investigating his time in a monastery that enabled him to realize the necessity of his role in caring for children with an incurable disease.
Robinson's prose is both beautiful and painful. He shows us the ugly damage of cystic fibrosis and the suffering it causes and gazes unsparingly at the moral confusion involved in treatment. But he also shows us hope when describing the technical details of advanced treatment and the joy of the possibility of an improved life.
We see the difficult moral choices by physicians and families involved in the care of these patients and how, at times, treatment can be worse than the disease. Robinson indicts the cowardly inability of medicine to accept death as a natural and even desirable outcome for a sick child.
Throughout this collection, the doctor’s humanity remains front and center. It resonated deeply with my flaws, fears, fantasies and pain as he examined his own in shocking clarity. His acceptance of all those qualities and his skill, compassion, and empathy are comforting.
What Cannot Be Undone shows the truth of medicine laid bare yet looks clearly and compassionately at the suffering of the physician trying to practice it with loving kindness for all, including himself.—Maureen Hirthler
Maureen Hirthler is a retired physician who holds an MFA in Creative Writing from the University of Missouri-Kansas City. She is the Managing Editor of Intima: A Journal of Narrative Medicine. Her writing has been published in Creative Nonfiction, the International Journal of Whole PersonCare, the Examined Life Journal and others. She resides in Florida with her husband and very sweet dogs.