Frankie's Story: My Experience of Shame in Medicine

And how to practice self-compassion

To date, I’ve never experienced any feeling worse than the fear and  impending doom that develops when I realize my patient’s heart hasn’t stopped yet, but it’s damn close and there are few options to  prevent the inevitable. Once their heart has already stopped, I know exactly what to do, but while you’re waiting for that to happen or successfully keeping it at bay is a deeply unsettling feeling. 

The best case scenario? I keep that person’s heart from stopping for long enough to get them to an ICU, where they work to keep that heart going for long enough that it can beat on its own without medical intervention. More than likely, though, it’s going to go the other way. Their heart is going to stop. You are going to try to prevent that. You are afraid to do something to make it worse, but the situation simply cannot get better unless you do something. The things you do are unlikely to succeed. That means, whether or not I caused that heart to stop, it sure feels like I did. 

And as far as I can tell, humans never feel more alone than after someone dies and it feels like (or actually is) your fault. Especially the first time. 

When the internal medicine residents stepped out of Frankie’s (not his real name) room and said, “Has he always been purple?” I ran to his room. My attending (supervising doctor) and senior resident (someone farther into their training) followed me. I had been a doctor for 10 months, an intern, brand-new in the prolonged time frame of medical training. I stepped into the room, realized that the treatment plan I had for my patient was completely wrong, and my patient was crashing. Everyone around me flew into a flurry of activity to begin the resuscitation, put in a breathing tube, drain the fluid from around Frankie’s heart, and start medication to raise his blood pressure. These were all tasks I was supposed to be learning to do. Any other time, I would have jumped at the chance. Instead, I froze. I watched as all of these things happened mere steps away. In a daze, I witnessed my supervising doctor and the cardiologist arguing about when and where to perform the procedure to remove the fluid around his heart. I watched as his heart stopped and they performed CPR. Then, they wheeled him up to the cath lab to try to drain the fluid around his heart with more equipment to guide them. 

Frankie’s heart never started again. He was 28. The same age I was at the time. The only small blessing was that by the time they announced his time of death, my shift was over. I didn’t have to pull it together and see more patients or admit to someone I was unable to do so and have someone cover for me (a shame beyond shame in medical culture). 

A kind supervising doctor whose shift had ended in another work area pulled me aside to talk about the case. That conversation is probably a big reason I showed up for my next shift, because I felt that I was not—and could not—become a competent doctor, much less a good one. And Frankie was proof that I definitely could not hack it emotionally either. 

After that, things got rougher. The one doctor I knew would advocate for me after this heartbreaking case had moved to a different hospital a month prior. I felt I would be penalized if I shared how I struggled with the case with the leaders of our residency program. There were many people who asked me, “What happened?” None after that first night who asked, “Are you okay?” The message I took from that was, “You’re fine. And if you’re not fine you better f*%$ing figure it out.” 

When these kinds of catastrophic things happen in training programs, we discuss the case at a “Morbidity and Mortality” conference. The purpose is for everyone else to learn from your mistake, but the way it is typically carried out has the side benefit of publicly shaming the errant party. For me, the part of the Morbidity and Mortality conference regarding Frankie’s case, I remember most was the discussion that followed after the discussion of my case. The presenter then gave a similar presentation regarding Jonathan Larson, who wrote the musical RENT, who also died of an aortic dissection that was also missed by an ER doctor. I’m sure the lecturer wanted to make aortic dissections extra memorable for my peers so they wouldn’t miss one in the future. I left feeling as if I were responsible both for Frankie’s death and Jonathan Larson’s. 

The way I tried to figure it out—to become “fine”—was to educate myself and others on how medical personnel are impacted emotionally by medical errors and adverse medical events. Noble as that was, I was basically “brightsiding” myself to avoid feeling grief, fear, and shame about this terribly tragic case. 

I honestly don’t know how much self-compassion I had when I started life, but I know that feeling alone at this pivotal and emotionally-charged time in my training made me feel that experiencing these difficult emotions and showing myself compassion were incompatible with a career in medicine. I am just now re-learning to show myself compassion and I’m still not sure it is (or ever will be) compatible with a career in medicine. 

How to Build Self-Compassion

If you, too, find yourself being hard on yourself, try these exercises, which are based on the work of Kristin Neff, Ph.D., a notable research psychologist, associate professor of educational psychology at the University of Texas at Austin, and author of Self-Compassion: The Proven Power of Being Kind to Yourself: 

1. Imagine a dear friend or beloved child came to you in the same situation. How would you respond to them? Compare how you would respond to them to how you talk to yourself. If they don’t match up well, try to shift your self-talk toward the more compassionate response you would offer to others.

2. There is research that shows that offering yourself compassionate touch can have the same physiologic effect as receiving loving touch from others. Placing a hand on your heart or giving yourself a hug can be very soothing when you need to receive compassion (though don’t underestimate the relationship building benefits of vulnerably asking for this from a friend or family member). 

3. Recognize that caregiving (both in your professional and personal life) can deplete your batteries, so to speak. Offering yourself soothing words of support that validate your feelings (e.g. “Things are hard right now. It is natural to feel stressed. I am here for you.”)  or the compassionate touch mentioned above are ways to care for yourself when you’re “on the job”

4. Do you use self-criticism as a motivator? Can you think of a kinder, more nurturing way to motivate yourself to make change if needed? Can you catch yourself using self-judgment and offer yourself compassion instead? Love is a more powerful motivator than fear. 

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