Numb, Dumb, and Damaged

By Steven Reames, Executive Director, Ada County Medical Society

Last month, I addressed the issue of anger in the face of the Delta Surge, explaining it is a natural emotional reaction that is better not stuffed but must be processed in a healthy way. Although that resonated with many physicians who wrote back or told me in person, I recognize anger is not everybody’s response. Sometimes our reaction to overwhelm is just becoming dumb and numb.

Let me be clear: by “dumb” I do not mean stupid; I mean the opposite of anger focused outward that says everything on its mind, as loud as it can, to anybody who will listen, and for as long as it feels. No, dumb and numb is when our feelings frankly do not have much to say at all.

Whereas anger’s explosions can wreak havoc very quickly in our relationships and professionalism, the absence of feeling can create a slow erosion of our soul that we can easily get used to. Just ask Lisa Simpson, who, in response to Bart’s question, “What it’s like being part of a generation that feels neither highs nor lows?” shrugs her shoulders and says, “meh.”

I fully understand the inclination that doctors might have to numb their emotional pain after the last two month’s Idaho has been through, let alone two years. It may even be a protective emotional response to too much grief stimulus when caring and feeling so deeply cost too much. A dull ache seems better than the sharp anxiety of yet another passing patient, or friend, or their parent, or the numerous deaths summed up in a bar graph.

2000 Yard Stare artwork by WWII artis Tom Lea

This sensation – or lack thereof - was captured perfectly by a World War II artist and correspondent Tom Lea. In “The Two Thousand Yard Stare,” Lea portrays a real-life Marine at the Battle of Peleliu in the Pacific. He described him by saying:

He left the States 31 months ago. He was wounded in his first campaign. He has had tropical diseases. He half-sleeps at night and gouges (the enemy) out of holes all day. Two-thirds of his company has been killed or wounded. He will return to attack this morning. How much can a human being endure?

Does any of this sound familiar?

Unplugging emotionally from this devastation may be necessary for doctors to keep doing the medical and technical parts of their jobs. The danger is that if you stay in that mode long term you are likely to end up injuring your heart. Some may recall the research of Dr. Paul Brand who ran a leper colony studying Hansen’s Disease in India in the mid-1900s. Until then, it was widely believed that the loss of fingers, toes, or feet was due to rotting flesh caused by the disease’s bacilli. But Brand discovered the deformities were actually a result of the neuropathic pain insensitivity.

Simply put: pathologic numbness or desensitization of the extremities led to injury and deformity.

In his book, The Gift of Pain, Dr. Brand described the ways those in the leper colony were taught to deal with their circumstance. First, they would inspect themselves in the morning for sores, gashes, rashes, and the like. Then, they would check each other thoroughly for the same, since nobody can see every part of their own body well; necessary treatment followed. Later on, Dr. Brand went to work in Louisiana, developing methods for the prevention and management of plantar ulcers which are now used frequently in the treatment of diabetic patients with similar problems. Dr. Brand argued that pain was a gift, something we needed to pay attention to that something is wrong and attend to it.

What can we learn about our own hearts from this? When there is no downtime, and losses are piling up around us, and yet still more is demanded, it is easy to check out of our emotions and become numb. And if that is what is necessary to do the job, we must also build in routines to check ourselves out for emotional and spiritual injury and allow other people into our lives to help us with this process.

One good tool I’ve discovered promoting this is the PeerRxMed Buddy nudge. You find your own physician battle buddy, subscribe to the free email reminders that come weekly, and schedule regular times to connect: a brief check-in once a week, a longer check-in monthly, a quarterly check-in that might last a couple of hours. The key is to create spaces and a rhythm to reactivate our hearts, give voice to our hurts, and encourage and strengthen one another.

The potential for a generation of COVID-war veteran physicians is the same that has happened to many military vets. Many vets go on to build families and careers and become emotionally healthy; but over the past few wars, we have also witnessed rampant addiction, homelessness, and other maladies. While it is hard to imagine many physicians roaming the streets 20 years from now, I am concerned that some will choose to disconnect from the community, prematurely check out of medical practice, and maybe even life itself.

Imagine instead growing a local medical ethos where doctors attend to their own traumas in an environment that cherishes authenticity, vulnerability, compassion, and deeper emotional connection with each other. This is the kind of medical community doctors would want to stay a part of, and even invite others into. While we may not come out of this war unscathed there is hope we could at least become more wholehearted.

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