Physician calls for compassion in health care — for ailing patients and burnt-out workers
'I don't think people want to know what doctors feel,' says Winnipeg doctor Jillian Horton
*Originally published on Jan. 18, 2024.
Jillian Horton traces her love of medicine to her sister, Wendy, who was diagnosed with a brain tumour at age six.
Wendy's surgery took away her hearing, sight, and her ability to walk. It was then Jillian Horton saw how dehumanizing the health-care system could be.
"After her surgery, my parents asked the pediatric neurologist about her prognosis. And that doctor put Wendy's scans up on a light box and he shouted at them: 'Can't you people get it through your heads? This girl has no brain left!'"
Dr. Horton is a specialist in internal medicine in Winnipeg. She says the health-care system leaves no space for doctors to show any authentic human emotion, requiring medical staff to steer clear of all feeling — but she wants to change that.
In her book, We Are All Perfectly Fine: A Memoir of Love, Medicine and Healing, she writes about what she's witnessed as a doctor and the necessity for compassion for both health-care workers as well as those on the receiving end of health care.
Horton recently won the Edna Staebler Award for Creative Nonfiction, based at Wilfrid Laurier University. She spoke in front of an audience at the awards ceremony.
Here is an excerpt from her talk.
I've experienced all the cardinal signs of burnout: depersonalization, emotional exhaustion, and a low feeling of personal accomplishment. And sometimes I had them at work. But for doctors, high performance at work is like blood flow to the brain in trauma. It's the last thing the body hangs on to at all costs. So where did my burnout show up? It showed up with my family, with my small, precious children, and with the people I love the most. I came home from work some days, a burnt-out, empty husk of a person. And after a while, as I wrote about in my book, I hit a point where I knew that something had to change.
I ended up going to a retreat near Rochester, New York — a mindfulness retreat for doctors. It's held at a Zen center in the woods called Chapin Mill. That program is run by other doctors who have made a career out of teaching mindfulness to health-care workers. It's evidence-based. It's been published in the Journal of the American Medical Association, and the results have been replicated in centers around the world.
The bottom line is it does help doctors reduce their burnout and find a sense of meaning and purpose again. I teach this program now all over the country because it lifted me out of a big, black hole.
Now, I've been back to that Zen center in Rochester more than once, but the first trip I made there was from Toronto in a very small plane, the kind that feels like a soup can with propellers. I found myself sitting next to a man who was a filmmaker. He told me he was going to a film festival in Rochester to screen a short film that he'd made. I said, 'Oh, that's so amazing.' And he said, 'Oh, thanks. What are you doing here?' And I said, 'I'm going to meditate at a zen retreat for burnt-out doctors who are suffering from repressed trauma. But tell me everything about your film.'
He stopped me and he said, 'Wait, what?' He was totally enthralled. He could not believe that doctors are hurting so much en masse that there would be enough of us to make a pilgrimage to a retreat in the woods to learn to meditate. He said to me, 'Jillian, we need to make a film about this. The public needs to know what doctors feel.'
I turned to the filmmaker and I said, 'You know what? I don't think people want to know what doctors feel.' And he was about to argue with me but I pointed into the cockpit and I said, 'do you want to know if our pilots are nervous?' In that moment for me, something really important clicked. Even then, when we were already in a crisis of physician burnout, the public didn't want to know about it. People don't want to know about physician suffering or nurse suffering or health-care workers suffering or pilot or police suffering. But it isn't because they don't care. People don't want to know about it because it is terrifying, because we depend on those pilots to land the plane that we're on, no matter how they feel. So it's easiest for us to go on believing those pilots feel nothing. Who does that actually help?
One of the iconic images of suffering in art [by] Vincent Van Gogh [shows] a man hunched over in abject suffering, his hands just barely shielding his face from the world. And this painting, of course, is known as Old Man in Suffering or At Eternity's Gate. Now we know in medicine, if there is a crucible of suffering, it is the intensive care unit. It's a place where our most intense dramas play out with unbearable consistency.
A colleague shared a powerful story with me a few years ago, and she let me share it in my book. It's about something that happened to her when she was a resident. She was looking after a patient. Let's imagine that it was a woman with a brain aneurysm. Whatever the diagnosis was, it was a devastating illness. The woman was a mother with small children, and she collapsed at home and her brain had been starved of oxygen. So my colleague went in to examine this young mother because the doctors in the ICU were in the process of declaring her brain dead. My colleague, the ICU resident, had to document that there was no change in the woman's condition, that she had lost what are called brainstem reflexes. So my colleague went into that room where a woman's small children were saying bye to their mother for the last time, where a husband was saying goodbye to his wife, where two elderly parents were sobbing, preparing themselves for the worst thing that was likely to ever happen to them in their lives.
Now, my colleague didn't cry in that room. She'd been taught that crying was unprofessional. But after she stepped out, she was overwhelmed with emotion. And she stood by the front desk of the ICU in that same pose as Van Gogh's Old Man in Sorrow, tears pouring down her face. A staff physician came up behind her. He had his arms crossed and he looked at her intently. And you know what he said?
'This is an emotion-free zone.' And then he walked away.
Now I want you to think about those pilots. Do you think that cockpit is an emotion-free zone? I know that I don't want a pilot who thinks their cockpit is an emotion-free zone. And no, of course, I don't want a pilot who screams, we're all going to die at the first sign of trouble. I want a pilot who can recognize and manage their emotions. I want a pilot who can name and work through uncertainty, the precursor of crushing fear, who can name that gut feeling that something isn't quite right and respond to it accordingly. Isn't fear valuable? Isn't grief valuable? I mean, don't we believe these intense feelings show up to tell us something?
Think about these statistics. In Canadian data, about one in 10 physicians have considered attempting suicide in the last 12 months. I mean, what do you think happens when somebody says to you, 'this is an emotion-free zone?' One message is shame. You and your feelings are disgusting. But there's another message too. This doesn't concern you. You aren't part of this. You're not part of this picture.
But that is a delusion. We absolutely are part of that picture. And this is why there is a retreat in the woods at a zen center where people like me need to go to try to undo two decades of unmetabolized professional trauma.
But what if there were another way?
Listen to Dr. Horton's full talk wherever you download your favourite podcasts, or through the CBC Listen App.
*Excerpt has been edited for clarity and length. This episode was produced by Naheed Mustafa.
