Ideas - Healing and the Healer: Dr. Jillian Horton on compassion in health care

Episode Date: August 14, 2024

In her book, We Are All Perfectly Fine: A Memoir of Love, Medicine and Healing, Dr. Jillian Horton shares her personal story of burnout and calls for developing a compassionate medical system, with a more balanced and humane understanding of what it means to heal and be healed. *This episode originally aired on Jan. 18, 2024.

My name is Graham Isidor. I have a progressive eye disease called keratoconus. Unmaying I'm losing my vision has been hard, but explaining it to other people has been harder. Lately, I've been trying to talk about it. Short Sighted is an attempt to explain what vision loss feels like by exploring how it sounds. By sharing my story, we get into all the things you don't see

about hidden disabilities. Short Sighted, from CBC's Personally, available now. This is a CBC Podcast. Welcome to Ideas, I'm Nala Ayyad. Read online patient reviews of doctors, and you're bound to find the following criticisms. Doesn't listen. Terrible social skills. Didn't smile once. I felt dismissed. Long before the pandemic, many healthcare workers were burnt out. Jillian Horton is trying to change all this.

Jillian's a doctor, a teacher, and writer, and she's helping doctors understand that in order to care better for their patients, they must care better for themselves. And to do that, they need to connect their present practice of medicine back to why they chose to practice medicine in the first place. And one thing that the literature on this subject tells us is that a connection to our meaning and our purpose is absolutely critical to our professional well-being. Dr. Jillian Horton traces her love of medicine to her sister. My sister's name was Wendy.

She had a brain tumor when she was six years old, followed by nightmare post-operative complications. Her story is actually the central story of my life. She's the reason I became a doctor. She's also the reason Jillian began rethinking what it means to be a doctor. Surgery took away Wendy's hearing, sight, and her ability to walk. It was then that Jillian saw how dehumanizing the healthcare system could be. One story I will never forget. 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.

Jillian says that such encounters are a natural outcome of a system that leaves no space for doctors to show any authentic human emotion. Teaching young medical students that professionalism means steering clear of all feeling has left patients and doctors in what she calls emotion-free zones. Changing the status quo means creating a new space. The great humanist psychologist Rollo May said, between stimulus and response, there's a space. And in that space, we can choose the response we wish to throw our weight behind. Gillian Horton has written about all this in her book,

We Are All Perfectly Fine, a memoir of love, medicine, and healing. It recently won the Edna Stabler Award for Creative Nonfiction, based at Wilfrid Laurier University. It's where Jillian spoke in front of an audience at the awards ceremony. We're calling this episode Healing and the Healer. So I'm going to have a sip of water and then we're going to begin. Gosh, that was a suspenseful sip of water. It's intense. So I'm going to begin today by saying something that I know is painfully obvious. We are in the midst of a truly terrible time in medicine. And I often think of this in some ways as a crucible time.

And coincidentally, when I was an undergraduate in the Faculty of Arts at Western University, The Crucible was the first play that I ever really fell in love with. Sometimes people are surprised to hear a doctor like Jillian talk about plays and literature, but she believes that the dichotomy between the sciences and the arts is a false one, as she makes clear in her book. My book is partly about the crisis of physician burnout. And one thing that the literature on this subject tells us is that a connection to our meaning and our purpose is absolutely critical to our professional well-being. Now, long before the pandemic, many healthcare workers were burnt out and suffering physically and emotionally and trying to remind ourselves of what our meaning and our purpose in

healthcare really is. And if we think of medicine as a quest to preserve life, maybe we can agree that art is about helping us to find that same life's meaning and purpose. Good, well-told stories command our attention for reasons that are totally beyond our control. They are the best way for us to teach, to shape people's thoughts, and for us to learn. And even bad stories create narrative tension, and our brains light up at that tension because we are hardwired to believe that it means we might be about to learn something really important, something that will help us to survive. So today, in homage to Edna Stabler, I'm going to lean heavily on that hardwiring, and I want to begin our journey together by telling you a story about a painting.

Now, a few years ago, I visited a friend at Columbia University in New York. Now, Columbia is a leader in a field called health humanities. And that is using art to teach students in health professions how to be more caring and more connected and more competent. But the discovery of the relationship between arts and medicine is not one that was made at Columbia. Sir William Osler, who we often call the father of modern medicine, read the classics for an hour each night before he went to bed. And it's a more recent shift in modern, modern medicine that we have focused so purely on the life sciences. Now, since I graduated from medical school in the year 2000, the pendulum has swung backwards towards an embrace of Osler's nighttime

routine. And there's actually evidence that using humanities in medical education produces better healthcare professionals. A doctor at Columbia by the name of Rita Charon coined this term narrative medicine. And narrative medicine embodies the idea that honing your skills and storytelling and defining the meaning of those stories is another thing that can make you a better nurse or doctor. But Columbia doesn't just deal in stories. The school is also a leader in

the use of visual arts in medical education. And this concept is called visual literacy. The idea is that if a healthcare professional is trained to notice the fine details of a painting, they might also notice more details about a patient when they go to the bedside. And the research tells us this is actually the case. So I was visiting Colombia to learn about this work, and a friend of mine, his name is Dr. Dipu Gowda, was doing a workshop for a group of doctors at a public clinic, and he invited me to tag along.

So Dr. Gowda opened the workshop by showing the group a picture of a painting. And I'm going to put that painting up here for you right now. He said to the group, Tell me what you see. Now the painting that I'm showing you is by Andrew Wyeth. It's called Christina's World, and it's a picture of a woman with long dark hair in a pink dress sitting in tall grass in a rural landscape looking off into the distance at a house. Wyeth painted it in 1948.

house. Wyeth painted it in 1948. It hangs in the Museum of Modern Art in New York City. Now, when Deepu put that picture up in the dark room, for about a minute, I felt like I couldn't breathe. But that's because I saw something else. I saw my late sister in her favorite color, pink, I saw my late sister in her favorite color, pink, with long dark hair just like Christina's, sitting in a familiar prairie landscape where we grew up together, looking off into the distance and searching for something she would never find. Now my sister wasn't actually in this painting, of course. The woman in this painting, the Christina, was Christina Olson. Christina had a disability. It might have been a peripheral nerve disorder

or something called Charcot-Marie-Tooth disease. We'll probably never know. But Andrew Wyeth said that he painted it to do justice to Christina's extraordinary conquest of a life which most people would consider hopeless. Now, I don't know if Christina's life was a conquest, but I know that my sister was like her in that she had a disability, and my sister's life was hard. and my sister's life was hard. My sister's name was Wendy.

She had a brain tumor when she was six years old, followed by nightmare post-operative complications. Her story is actually the central story of my life. She's the reason I became a doctor, and if medicine is a calling, she is the reason I got that call. And when Deepu put up this painting in that dark room, I saw Wendy. But I want to tell you that I don't just see her in this picture. I see her in patient rooms. I see her in empty wheelchairs and in the faces of my children. The French-Cuban writer, Anaïs Nin, once said,

we see things not as they are, but as we are. And in the rest of our time together, I want to tell you some stories about art and medicine and life that I hope will remind you of another picture. That's the big one in which my healthcare family and I have to psychologically coexist with the extraordinary demands of our jobs, now more so than ever. And it is a picture in which I hope we can find our way back to our meaning and purpose, and maybe even a truer version of ourselves.

Now, I often say that growing up with a person with a disability was my real medical education. I saw how Wendy was treated. And too often what I saw was a lack of compassion. I heard the things that people said to her and to my parents. It often felt like people didn't even see her as human. And some of the worst comments came from doctors. Now Wendy was diagnosed with a brain tumor when she was six. One story I will never forget. 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. Well, that girl with no brain left was 12 years my senior. And by the time I was born, she already had a disability. I never knew her any other way. I told you about the mysterious Charcot-Marie-Tooth disease that Christina Olsen might have had. Well, Wendy probably had something called Lynch syndrome. I say probably because she died in her sleep at the age of 52, literally the night before she was going to have genetic testing. But years after she had brain cancer, she had endometrial cancer. And in the years before her

death, my mother and my other sister had endometrial cancer too. So it became clear there was something in our genes that was making everybody get these cancers. And in my family's case, that something turned out to be Lynch syndrome, which predisposes people who carry the gene to developing certain types of malignancies. Now my family's defective gene is called MSH6, Mutz homolog 6. It's what's called a mismatch repair gene. It encodes proteins responsible for repairing errors that occur during the normal replication of DNA. Cells are always making copies of themselves, going from 1 to 2 4 to 16 16 to 32 to 64 and so on

and the way i like to explain it to people is if your mismatch repair gene doesn't work then you don't have a proper protein toolkit to repair the mistakes those cells sometimes make when they're doubling. And if just one error gets through, it begins to double. And then we know what happens. Cancer. And this is why I say to my patients, disaster happens slowly. So that's how by the time Wendy was six years old, she had a tumor the size of an orange growing in her brain. Now you think, an orange? Didn't somebody notice? Well, yes, actually they did. My parents noticed.

And they kept taking Wendy to doctors saying, something is wrong with our daughter. She has headaches. She vomits in the morning and it goes all the way across the room. She can't hop on one foot. Now, those doctors, they were kind enough, but they said, she's anxious, and you're anxious too. And you know, it's funny,

because even before she was diagnosed with that orange-sized tumor, Wendy's kindergarten teacher used to say, Wendy has such a big head. You can see it in her pictures if you just look. And so this was a question that I asked myself after becoming a doctor. Why could Wendy's kindergarten teacher clearly see something that was missed by a series of highly trained specialists. I tell you all of this so you can see how it happened

when I became a medical educator that I would become passionate about this idea of teaching doctors visual literacy. But there's another kind of literacy that might be even more important. It's the literacy that allows us to understand our emotional state, to decipher our most private reactions to other people and our inner most secret lives. We don't get training in that literacy to become physicians. It's the literacy that might make you notice your gut is trying to tell you that something isn't quite right about the little girl in front of you. And it's the literacy that would allow you to self-regulate

so your fatigue or frustration could never let you scream at the family of a little girl with a brain tumor on one of the worst days of their lives. And it's the literacy that would allow you to notice that you are not okay. You're overwhelmed. You're burnt out. You're numbed out and in over your head. Emotional literacy might actually be one of the most important skill sets in all of medicine. So why have we left it entirely to chance? I give a lot of talks about burnout these days. And organizations always ask me with a hint of desperation, tell us one thing we can do to address burnout Dr. Horton. Where do we start? Well even pre-pandemic the literature told us that organizational

factors are the primary drivers of burnout. Now if we look at the Stanford professional fulfillment model, we can start with our organization's culture or improving the efficiency of practice or our personal resilience. But better still, we can be strategic and start chipping away simultaneously in all three areas in the hopes that our efforts will be synergistic. One problem is systems change at a glacial pace, and in the meantime, day after day disappears of our one and precious life. So I dove into personal resilience, namely that piece I just mentioned, emotional literacy, my own emotional literacy, and its close cousin, emotional self-regulation.

But let me be very clear. I did not start there because I wasn't resilient enough. The literature also tells us that physicians, like other healthcare workers, do not have a resilience deficit. I stumbled into working on my resilience because I was choosing to control one of the only things I can directly control in medicine, how I respond to that very stressful work environment. Well, I also work on other fronts, including in leadership roles, trying to help change it. The great humanist psychologist Rollo May said,

between stimulus and response, there's a space. And in that space, we can choose the response we wish to throw our weight behind. Because that is where our freedom lies. Now, I don't want to suggest that this is easy. I have struggled to find that freedom. 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, and it was 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 healthcare 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. And the bottom line is, it does help doctors reduce their burnout and find a sense of meaning and purpose again. And I teach this program now all over the country because it lifted me out of a big black hole. I mean, it's great that I had art and literature and music as a strategy for finding meaning in my work and dealing with

human suffering. But again, let me be crystal clear. Those things can only take you so far. And after that, not only do you need some additional skills, you need widespread system change. But when you brace people and help them to be even stronger in the face of a soul-crushing system, maybe then they can stick around for long enough to make some of that change. 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. And I would always introduce myself to the other passengers

because I assumed that we'd be working together to open at least one emergency exit when we went down over Lake Ontario. On one of those trips from Rochester, 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, 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! And 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. And you know, just as he said that, I happened to look into the cockpit where the door was still open

before the crew had started preparing for takeoff. The pilot and the co-pilot looked so young. They wouldn't have been out of place at a 4-H meeting. And they looked to me like our young medical students and residents, such young, youthful people doing a very high-stakes job. And as we watched them go through those pre-flight checklists, 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 healthcare worker 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. But who does that actually help? This slide that I'm showing you is one of the iconic images of suffering in art. Vincent van Gogh, or Van Gogh, depending on where you live,

you see 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, as 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 do you know what he said? This is an emotion-free zone. And then he walked away. Now, I want you to think about that cockpit and 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 ten 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? Thank you. XM, in Australia, on ABC Radio National, and around the world at cbc.ca slash ideas. Find us on the CBC Listen app and wherever you get your podcasts. I'm Nala Ayed. Hey there, I'm David Common. If you're like me, there are things you love about living in the GTA and things that drive you absolutely crazy. Every day on This is Toronto, we connect you to what matters most about life in the GTA, the news you gotta know, and the conversations your friends will be talking about. Whether you listen on a run through your neighbourhood, or while sitting in the parking lot that is the 401, check out This is Toronto, wherever you get your podcasts.

Western philosophy has long elevated reason over emotion. The ancients believed the ability to reason is what made humans human. But without emotion, our moral selves would remain profoundly alienated from the world around us. Without emotion, we'd be doomed. We'd never act. This concept of hiding emotions and emotion-free zones leads me naturally to the concept of professionalism in medicine. It's a word we've talked about in medical education for about the last 25 years. Dr. Jillian Horton received the Edna Stabler Award for Creative Nonfiction in November 2023. As part of the event, she gave this talk at Wilfrid Laurier University. It's supposed to get at the root of the essence of being a doctor. It encompasses ethics and

boundaries and basic conduct, and we teach courses on professionalism in medical school. And yet one of the problems is nobody really agrees on the meaning of that word. I mean, doesn't it sound like it's a better fit with your accountant than your physician? I hate the term. It's a sterile word for a fertile concept. And I think that word has misled an entire generation of young physicians and pushed them towards a fundamental misunderstanding of what it means to be a doctor. I gave a lecture to medical students a few years ago. They were in their third year, new to the medical wards

and just acclimating to the environment. And they have a really valuable perspective in the sense that because they are not yet saturated in the medical environment, they aren't yet blind to it. So that day, I talked to them about the way we so often round on a medical ward. I call it swarming, bursting into a patient's room like it's a holdup, surrounding patients' beds and talking over them and about them, sometimes barely even acknowledging their existence. I said to my students, who here has seen what I'm talking

about? Several hands went up. I said, who hates being a part of that and wants to do something about it, but you have no idea what to do? Again, more hands went up. And so I asked this class, what can you do as a small act of resistance against this? Is there a need that you see that you have the power to fill? Well, they talked about smiling at the patient, including them in rounds, using their names, all basic but good human stuff. And then a young woman put up her hand, and she made a comment I just loved. She said,

made a comment I just loved. She said, Dr. Horton, I have a patient with an infected heart valve. And I told my patient he should take better care of his teeth since that's where some infections of the heart valves can start. And then he told me that he couldn't. And I asked him why. And he said he didn't have a toothbrush. And the ward doesn't provide them anymore. She couldn't believe this. And so she said, you know what, Dr. Horton? I'm thinking that tomorrow I'd like to buy him a toothbrush. Well, I loved that. It was tangible, small, but it was very human and gracious. It was this young woman saying to that man, I see you.

But I noticed something. Just a few beats of silence and some confused looks, a funny energy in the room. And remember I said you want your doctor to be like a pilot picking up on a gut feeling before it has time to become an emergency? So I had a gut feeling that something in the room was going unsaid, but I didn't know what it was. I went home that night still thinking about it, and then it hit me. They think it's a gift, and gifts are unprofessional. So I emailed a student in the class, and I asked him if he could informally survey his peers about the toothbrush. And guess what? I was right.

Almost half of them said, it's a gift. They thought that it was unprofessional to buy a man with no home, no family, no money, no anything, a $2 toothbrush. So then I decided I'd write another lecture to help them with this. And I came across an article about a doctor in the U.S. who had spent hours on the phone with a patient's insurer to try to get her coverage for about $30 worth of medications. And after two hours on the phone, that doctor hung up and handed the patient $30 out of his wallet. It wasn't a loan. He didn't make a big deal out of it. He just didn't know what else to do. By the way, that doctor's name was Gordon Schiff. And as he wrote in the Journal of the American Medical

Association, while he didn't expect to be commended for his simple act of kindness, he also didn't expect to have to deal with the trauma and personal and professional sense of violation at being reprimanded for his unprofessional boundary crossing behavior after a resident he was working with reported at being reprimanded for his unprofessional boundary-crossing behavior after a resident he was working with reported him to his clinic director. Now this reminded me of a story I read a few years ago in the New York Times. It was about an older couple in Italy. They were shut-ins, and a neighbor heard them crying,

and so the neighbor called 911. An ambulance arrived, and the paramedics assessed them. The couple seemed fine physically, but they were weeping. The paramedics asked them, why are you crying? And they said they'd been watching a TV show about the suffering of children in other parts of the world, and they were crying for those children. Do you know what happened next? Did the paramedics say, this is an emotion-free zone, and drive away?

The paramedics actually went into the couple's kitchen, and they cooked this lonely couple dinner. And because this was Italy, they cooked them pasta and sauce, and they served them. Now, I used to think that the best part of that story was the basic human kindness. But now, my favorite part is that nobody hauled those paramedics in front of a regulatory body and accused them of unprofessional boundary-crossing behavior. By the way, paramedics are another group of people with very difficult jobs. A 2017 study put their self-reported suicide attempt rate at 9.8 percent. We generally believe that doctors have the highest suicide rate of any white-collar profession. Doctors have the highest suicide rate of any white-collar profession.

Men who are doctors are 40% more likely to die by suicide, and for women, that risk is more than double. These kinds of suicide rates, I mean, they don't sound like they reflect work in emotion-free zones, do they? They sound like zones where there is deep suffering. And COVID has only made that worse. I have a confession. Considering what happened in my family,

I never imagined that I would be a person who would give voice to the deep suffering of doctors. After all, I became a physician to be unlike the doctors who had been so horrifically unkind to my family. But what I've discovered during my hundred-hour work weeks and emotion-free zones and young mothers dying in front of me and years and years of more grief than I knew how to metabolize is that I'm exactly like those other doctors in some fundamental ways. There's one key difference. I know what it's like when it's your loved one in that bed or that wheelchair, and you so badly need a real live person to show up and care for them and really be with you in that picture.

I know that feeling of grief and abandonment when no one does that, and in many ways, that and in many ways that is actually the worst trauma because when you act like something is an emotion-free zone even if it's just because someone said it's what you have to do people around you interpret your lack of emotion as you don't give a damn and there another, even bigger problem for us as doctors in that equation. No joy. No celebration. No positive emotion. And maybe this is another trauma we've inflicted on ourselves as a profession.

That sometimes we don't feel anything at all. that sometimes we don't feel anything at all. Now, do you remember Captain Sullenberger? In 2009, he landed a plane on the Hudson River in New York. Birds hit both engines, and the engines failed. Captain Sullenberger pulled off a miracle landing and everyone on board walked off that plane alive. But I remember reading something that struck me. In an interview a few months later, Captain Sullenberger said he would still wake up in the middle of the night tortured by one question.

How could I have landed the plane better? Now you say to yourself, how can that be? He saved all those lives. How could he think he could have landed the plane better? But I'm telling you, every doctor in the room nods their head so hard when they hear that story, they practically give themselves a concussion. I had a little Captain Sullenberger moment in 2018. It didn't happen when I was in the hospital. I was on my way to work. I was passing through an intersection literally seconds after a pedestrian collapsed. I got out of my car and like Captain Sullenberger, I did exactly what I

was trained to do. Now my situation was quite a bit simpler than his, but still, I ran a code blue in an intersection in Winnipeg in the dead of winter, in my parka instead of a white coat, with a team of civilians instead of medical residents. And after a very long 10 minutes, the ambulance came, and the paramedics took this man away to the hospital. And eventually, he was even transferred to the hospital where I work. He made a full recovery. I got to meet his beautiful family. And this story spread to my friends and colleagues who marveled at the

fact that I'd been in the right place at the right time. And they all said, you must feel amazing. And of course, on one level, I did. I got to play a part in saving a stranger's life in a way that was totally different from the norm. But at the same time, what I felt was also much more complicated. I kept thinking, how could I have landed the plane better? I didn't check for a medical alert bracelet. I usually carry a portable CPR mask in my car, and I didn't have it with me that day.

I never thought of sending someone to the nearby synagogue to check if they had a portable defibrillator. Now, on one level, this is absurd, right? This man is alive today. What did I need to do better? But every doctor gets it. We don't even celebrate what we do well. Sometimes those things barely register. Because you see, when they told us it was an emotion-free zone, it wiped away everything. They didn't know we'd stop feeling the good things, that we wouldn't even be able to distinguish

between our wins and our failures anymore. And by the way, this is why one of the best things I have ever done for myself was get on a plane to Rochester because that was a turning point in my life. It was where I started tapping my own phone, listening to the calls. You should have checked for a bracelet. You should have sent for a defibrillator. You don't know enough. You haven't published enough.

You're not good enough. Everybody's going to know the truth about you. Well, what is the truth about me? That I'm a human being with emotions and strengths and weaknesses like everybody else, with moments of brilliance and moments of deficiency like everybody else. I still wonder if people want to know that because they need me to land that plane. But people can surprise you. can surprise you.

I have one final story to share with you. It's about a patient, a lovely man with a catastrophic illness. He was in multi-organ failure, and each hour he was getting worse. After a certain point, it was clear to me that this was not going to end well. This man was dying. So at the end of the day, his family arrived, and I pulled up a chair and I leaned in. I could feel the deep grief and sadness in that room as I told this lovely man and his family and friends that today or tomorrow was going to be the last day of his life. Now while I was having this very tough conversation, I noticed one family member

standing some distance away from me. His arms were crossed in what I thought was a very skeptical way. And I told you I practice visual and emotional literacy, and so I get used to reading people. I get used to guessing what they do for a living, where they're from, and what they might be most afraid of. And I've gotten pretty good at it, actually, but sometimes I still get stumped.

And I couldn't read this man. Was he angry? Was he holding in his emotions? Or did he think that I'd done something wrong when it came to his family member's care? I had absolutely no idea what he was bringing into that room. So after I gave my condolences to the patient and family and I promised to keep him comfortable, I stepped out of the room. My clinical encounters, by the way, are not an emotion-free zone and there were tears in my eyes that day as

I stood at the sink washing my hands. That is when I noticed that the man with his arms crossed had followed me out into the hall. He was just standing there. He was looking at me. I dried off my hands and I turned towards him and truthfully I was actually a little bit scared. I had no idea what he was going to say to me. And then he said quietly, I don't know how you do what you do. Now, I said what I always say when people say things like that to me about medicine.

I have been on the other side, and it's so much harder. But this man just kept looking at me, and he shook his head, and he said, are you sure about that? Now, I said, that's a really unusual comment. I'm curious as to why you're thinking that. What do you do for a living?

And that man said, I want you to guess. So I looked at him. I had no idea. I thought he must work in health care. I thought maybe he was a teacher or maybe he was a spy, not that he would have told me that. But I had no idea. And finally I said, I give up.

And then he did this. He folded back three fingers, and he left his thumb and second finger sticking out like his hand was a pistol. He was a police officer. My jaw just dropped. A police officer just told me he doesn't know how I do what I do. Now, police culture is imperfect too, and just like medicine, it is in need of change. But few of us would argue that it's an easy job. Police officers get shot. They walk around in parts of town I'm afraid to drive through. They face people and things that are scarier than anything I'm even willing to preview on Netflix. And here's a police officer shaking his head in

awe and saying to me, I don't know how you do what you do. Can I tell you what that police officer did for me in that moment? He gave me a gift. moment, he gave me a gift. He did that just by noticing that I was in the picture. You see, too often, I still write myself out of it. I say, it's harder for you. It's harder for them. It's harder for my sister and my parents, for everyone around me. It's harder. It's so much harder. And it is hard for all of those people. It is so hard. But it's also hard to be right there in the middle of a story of the worst day of somebody else's life

if you are really showing up as yourself. I want to show you one last thing I think this is so amazing near the end of his life when he was deep in the spiral of the depression that would culminate in the suicide attempt that would ultimately lead to the end of his life around the time he painted At Eternity's Gate in the suicide attempt that would ultimately lead to the end of his life. Around the time he painted At Eternity's Gate,

Van Gogh painted this portrait of his doctor. His name was Paul Gachet. Van Gogh wrote a letter to his brother that basically said, my doctor tries to help me, but he's almost as screwed up as I am. So I started reading about Dr. Gachet, and I learned that Dr. Gachet had many patients who were artists, and a number of them had painted him as well. These are images of some of those paintings. Four different artists,

Bernard, Gounet, Gauthier, and Leandre. One patient sees kindness, these large capable hands. Another sees an expression of deep wisdom on his face. And another paints him like a warm, jovial, loving father. What I find striking is these don't even look like the same subject. And actually, I don't think they are the same subject, because Dr. Gachet's patients are seeing him as they are, and also who they need him to be. If we put all these paintings together, we know more about Dr. Gachet than we ever could have learned any other way.

And that's how I was eventually able to answer that police officer, the one who said he didn't know how I do what I do. For me, one thing makes it possible. I've learned to allow myself to be present as myself. We can't live without oxygen or water. Well, we also can't live in an emotion-free zone. Now, I know what some people will say. They'll say, you can't do it. Even if the system we worked in were not totally broken, it's not sustainable. Well, let me tell you, it takes work, but it is sustainable. Yes, doctors who are rated as more empathetic may be at a higher risk of burnout, but people say the same thing about Lynch syndrome. It means you'll get cancer. No,

it doesn't. It means you're more likely to get cancer. But with good care and attention to risk and preemptive measures, you may end up healthier and happier than anybody. Why? Because risk is not destiny. What I want to leave you with is this. Art requires that we put ourselves into it, to understand it, to animate it, to make it relevant and to complete its meaning. The art of medicine is exactly the same. The idea that you have to give up the best parts of yourself to become a doctor or any kind of healthcare professional, that you can't cry in the ICU or tell your patients about your beloved

late sister or buy somebody a toothbrush, those aren't the things that put us in harm's way. The opposite is true. Learning to understand and honor our emotions is one of the few things we can control. It is the place where we find real freedom. And that is the only way we learn to see what is really in the picture. Thank you. You were listening to an episode called Healing and the Healer. Thank you to Dr. Jillian Horton, author of We Are All Perfectly Fine, a memoir of love, medicine, and healing.

It recently won the Edna Stabler Award for Creative Nonfiction. Thank you to Bruce Gillespie, Gavin Brockett, Carolyn Morrison, and the whole team at Wilfrid Laurier University for making this episode possible. The episode was produced by Nahid Mustafa. Our web producer is Lisa Ayuso. Technical production, Danielle Duval. Field recording and additional technical help by Will Yar. The senior producer is Lisa Godfrey.

The executive producer of Ideas is Greg Kelly. And I'm Nala Ayed. For more CBC Podcasts, go to cbc.ca slash podcasts.