In life, we are confronted with many negative feelings – anger, sadness, anxiety, jealousy… and guilt, which is my topic for today. A lot of people feel guilty about something they’ve said or done and find it hard to let go so I thought I’d discuss this topic in the context of my profession.
Firstly, let’s talk about why we feel guilty. Everything that we say or do first gets filtered in the front of the brain (the ventromedial pre-frontal cortex, in case you were wondering… No? Okay then…) How we feel about our behaviour then depends on how it is next processed in the emotional part of our brain – the limbic lobe. This process is complex and it is influenced by other factors such as your personality, any co-morbid mental illnesses as well as past life experiences.
Whilst some people may feel a tremendous amount of guilt (such as those who suffer from depression), others don’t feel any guilt when perhaps they ought to (like sociopaths and psychopaths). Hell, I was stalked by one so I know – some people do bad shit and they feeling nothing! Read about that story here.
I’ve recently opened up about my resignation from surgery (here). It’s a tough profession, and a lot of doctors feel guilty for all sorts of reasons. Sometimes, a patient does not respond well to a treatment despite our best intentions. Even though we follow current, evidence-based guidelines, things don’t always turn out the way we want to for our patients, and somehow it becomes our fault, or at least we take on that burden of guilt.
Doctors also feel guilty about being bad family members or friends. We work such long hours, including weekends and public holidays, so we end up missing important social events like birthdays, engagements, weddings, baby showers… you name it! After a while, some of us stop getting invited to things because our friends are used to us saying “no” so they pre-empt our RSVP response and don’t bother inviting us anymore, which leads to social awkwardness, and ultimately strains our friendships, or even ends them.
I have also seen marriages and relationships break down because doctors spend more time at work than they do at home with their partners and/or children. It’s not uncommon that doctors are described as “married to their jobs”. They are made to feel guilty for this, even though they’re just working hard and/or studying for exams, and it’s not exactly like they’re neglecting family life to go out partying.
I first experienced guilt at the start of my internship. It still kills me to think about it, so writing this is so hard. I was on my first ward job on General Medicine, and I wanted to be a good intern so I would ignore personal texts and phone calls so that I could focus on the (never-ending) ward round. I was a fresh intern, and I wanted to make the best first impression possible.
One day, my dad was ringing me multiple times. I initially felt annoyed. Why is he calling me? He knows I’m working. He kept calling. This should’ve been a sign that maybe he’s calling me because it’s something important… but my concern about my reputation took over and I kept ignoring his calls.
When I got home, I listened to the voice message from my dad. There was a quiver in his voice, and I felt his pain through the phone straight to my gut. “Grandpa’s died…” his voice trailed off. He was too distraught to keep talking and that was the end of the voicemail. I rang him straight away. I was totally devastated. I felt like such a dick.
Grandpa knew he was dying. He suddenly couldn’t breathe and had been rushed to the hospital, and straight to ICU. I don’t know the details because he was in Japan, but he apparently had an undiagnosed lung condition called idiopathic pulmonary fibrosis. We knew he had a few breathing problems, but his sudden deterioration was unexpected. What a horrible way to die… how scary to feel like you can’t get a breath in. I’m so sorry, Grandpa.
I was always close to my Grandpa. The zodiac is a big thing in Japan, and we were both born in the Year of the Rabbit, so we always had a special bond from when I was a little girl. We “rabbits” got along like best friends. My whole body was consumed with guilt as I reflected on my joyous and pure relationship with him. Why didn’t I just pick up the phone when my dad was obviously trying so hard to get through to me? Why did I have to be such a stubborn bitch? Who cares if I left the ward round for just a few minutes to pick up the phone? I just missed out on hearing Grandpa’s last few words when he told my dad he wanted to talk to me.
I slumped into my bed. It was 2011 and I was listening to Adele’s album “19” on repeat. In the background was Chasing Pavements and in my head I was chasing after all these questions and punishing myself for them. I needed this time to be alone, but unfortunately at the time I had a housemate who had no concept of personal space. She knocked on my door but I ignored it. She came in anyway and sat on my bed. FFS. She asked why I was sobbing, so I reluctantly told her between gasps of air.
I knew that Grandpa loved me, and he knew that I loved him… but in his final minutes of his life I wish I had been there to comfort him over the phone and remind him of my love. And my dad. I’m so sorry, Dad… I’m sorry that I didn’t pick up the phone when you were trying so hard to reach me.
That was the last time I ever ignored a phone call from a family member. I lived with this guilt for a very long time. I still tear up when I think about it now. Grief, bereavement, and guilt are themes I have been talking a lot about with various people over the last few months, and it made me think of all the times I felt guilty during the eight years that I’ve been a doctor.
This lesson taught me that first I am a human, then I am a doctor. That day I was not a human, or at least not a good one. Since that day, I’ve always made sure that I make myself available to my family as best I can, and when I became a registrar I always made sure to ask my students, interns, and residents not only how they are, but how their families are going. If there were ever any issues in the family, I made sure to give them some time out to make the calls they needed to make, and take the time off that they needed.
Being a doctor is a wonderful thing. There is so much opportunity to give your heart to people who are sick and vulnerable… but I have to remind myself that those I love can become sick and vulnerable too, and I myself can become sick and vulnerable.
Guilt. It’s a strong feeling that doesn’t leave your body for a very long time. I forgive myself for what happened in 2011, but I won’t forget it. You won’t regret missing the plan for Mr X on ward 4 East bed 12, but you’ll regret missing an important phone call from a family member who really needed you. Put your family first. Be a human first.