The lacrimal dilemma

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Dear Jeannette,
I’m a third year resident who was recently ending a difficult busy shift and was stuck trying to admit my final patient – an elderly male with diverticulitis. I was caught in a stalemate between the surgical and medical team and after four calls felt like I was hitting my head against a wall. As I turned around to ask my attending for help he snapped at me because the booking wasn’t complete. I could feel my eyes well up and made a quick escape to the bathroom where I sobbed for a few minutes, and then berated myself for a few more. I’m a good physician but worry that crying at work may negatively affect my reputation.

Dear Lacrimal,
Crying is a totally natural human emotion, but let’s face it, that’s not how our EDs operate. Most men turn into a stuttering impersonation of Rain Man around a crying coworker, and many women are no better. In many work environments crying is even considered an unprofessional taboo.
We cry for many different reasons, from joy to sadness to sheer exhaustion. When someone cries at work, it’s important to look at the context. Personally, I think that it’s fine to get a little teary eyed when you are at the bedside with a family member after an unexpected code-it shows that you are a human being.
That said, in the case above, it appears that tears were a substitute for what you really wanted to do, which was to tell the consultants to go do their job and your attending to get off his butt and help. And whether you like it or not, a pattern of crying at work – especially if the tears are shed over conflict – will most likely have a detrimental effect on your reputation. Colleagues may perceive you as emotionally vulnerable and question your ability to perform and lead under stress.
Stemming from personal experience, here are a few words of wisdom:
Before the tears…
1. Take a deep breath and try to consciously label the emotion that you are feeling.
2. Have an out of body experience. Distinguish the actual problem from the emotional milieu of the setting. Focus on the concrete series of events that needs to occur.
3. Compartmentalize. Give yourself permission to leave the troubles of home (if only for 8 hours) in the parking lot.
4. Learn to delay your response to an upsetting event for several minutes (like until the end of a meeting). Even if you can’t control the actual tears, you will feel empowered by having more control of their timing.
5. Identify patterns. If there is something that is a consistent trigger, practice the scenario in your head and develop strategies to deal with it.
6. Body tricks. Jutting out your lower jaw, chewing gum, drinking ice water, running up stairs and hypnosis have all been proposed to help keep the lacrimal ducts barren.
7. Do a gut check. Is this an anomaly or recurrent response? If you notice a rapidly escalating amount of outbursts at work, question whether you may be burned out or depressed.
8. Practice wellness. Give yourself a little reserve by engaging in outside activities that lift your spirit – meditation, yoga, karate, running, cooking, reading, etc.
After the sniffle and gulp…
1. Excuse yourself (unless you are running a code). If you are in the middle of a conversation (and can still actually talk) say something like “Excuse me I really need a moment to gather my thoughts.”
2. Accept the moment as it is. Don’t let your own inner critic launch a second attack. Ok, so you are sobbing in a stall. Sometimes your body just needs the cathartic release.
3. When you are done, get a drink, wash your face and do a voice check. Some female professionals actually suggest having a readily available “kit” complete with ice bags, make up, etc… My impression: If you need a kit, find a new job.
4. Resolve the immediate situation. If the event revolved around a clinical care issue, you will have to make some type of fix in real time. If you have really hit a wall, ask for help from a colleague, chief or administrator on call.
5. Regroup. Let things settle until the emotional sting is gone. Then set up a follow up meeting or send an edited email which concentrates on the issue at hand and not your emotional response.
Jeannette Wolfe, MD, is an assistant professor of emergency medicine at Tufts School of Medicine and a practicing physician at the Baystate Medical Center in Springfield, Massachusetts.


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