Compassion Fatigue and Osler’s Imperturbability

I read with great interest Dr. George Dawson’s post on compassion fatigue. It sounded like his own special beginning of the time of closing off a part of himself so that he could do what doctors have to do for patients if they are to help them through their own horror. His account of one of  his pivotal experiences as a medical student taught him the importance of coping with strong emotional reactions to the misery of our patients. It reminded me of one of my own–and it reminded me of Osler’s imperturbability.

It didn’t involve a live patient. In fact, the patient was dead and my medical student class was the petrified audience viewing the autopsy. It was part of the gross anatomy and pathology curriculum. I was right up front next to the table and really had no opportunity to avoid witnessing the slicing and sawing, the carving of what was once the essence of a human being, the vigorous shaking and thumping of a thing which had a face on the blood-smeared steel in order to loosen up the rib cage.

I still remember the thud of the corpse against the metal table. It was all I could do not to shut my eyes to the nightmare. But if  I had done that, two things might have happened. I might have gotten dizzy and toppled over, then everyone there would have known I was trying to escape the horror.

Then I heard another thud. It was one of my classmates behind me who had fainted. I turned around to peek and I caught a glimpse of his white and glassy-eyed visage as the other acolytes were scooping him off the floor.

That’s one way to escape an intolerable horror. I didn’t faint but lost a small piece of my emotional self that day.

It was not the first time I’d witnessed a postmortem examination. I had actually observed one before I entered medical school. I was finishing up my Medical-Technology course and watching a post was a required educational activity. I noticed that, as the cutting began, one of the experienced dieners (a term often referring to medical school lab assistants) suddenly took a keen interest in the newspaper spread out on a table away from the proceedings. He peered at it so intently that I remember wondering if he were doing that because he’d discovered a fascinating article–or if he were just using the opportunity to get a hold of himself. I focused on small parts of the autopsy, just what I could tolerate. I didn’t actually physically look away, but a part of me was shut off.

During both of these experiences, I was very anxious. Calling it a stressful experience is the ultimate understatement.

Maybe I should just admit I nearly fainted. It took a monumental effort but I think I achieved (or maybe “suffered” is a better word) a major refinement (“loss”? “coarsening”?)–a way to compartmentalize my emotions during those episodes.

That continued during the remainder of medical school. Something like that probably had to happen and it still happens. Some of us simply take it better than others. Maybe the experience is supposed to render us imperturbable, something which Osler taught and wrote about. I don’t think I’ve ever met an imperturbable doctor.

Sir William Osler

Sir William Osler

“Cultivate, then, gentlemen, such a judicious measure of obtuseness as will enable you to meet the exigencies of practice with firmness and courage, without, at the same time, hardening “the human heart by which we live.”–Sir William Osler, Aequanimitas.

I admit to being liable to obtuseness. I’m not imperturbable.

But just as Osler says, we can cultivate courage without hardening our hearts. And just as George points out, it’s our responsibility to cultivate a health care system which nurtures the healers as well as the sick. We don’t have enough leaders to champion this kind of vision. And that’s a shame.



  1. You always give me something to think about. I am very involved in the stuff of Emotional Intelligence as it also grapples with balancing heart and head. Something all must deal with. As a patient, I definitely want a doctor with both. As a parent and grandparent, I want my children to have both. Thank you.

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