Coping Mechanisms

One of the most traumatising experiences in my life was visiting the Morgue. From the moment I heard we had to do this, I wanted out. Not interested. Yes, I acknowledge that I need to know what it is and the processes involved, but can I not read it in a book? No.


It was surreal - two rows of about 10 trolleys suspending the 'shells' of life. Some of the bodies were surprising as they looked very healthy and fit; some were also young. Then there were the others - massive impact trauma, negligence and more. Watching the technicians work on the remains was horror in its own right... saws, blades and retractors - unlike surgical equipment with smooth borders and sterile. This was the real deal - autopsy.


I wondered how these people, Pathology Registrars and Mortuary Technicians actually went home at night or had a few drinks with friends. How do you participate in 'normal' activities day after day of butchering?


The concept of 'Coping Mechanisms' was brought to my attention by the tutor. I watched with disgust as the Technicians laughed at jokes, discussed sport on the weekend and socialising. They weren't joking or laughing about the deceased, but it sure felt like it. I was horrified with what they were doing, how they were doing it and how they distracted themselves. On top of that, all my sensory inputs were shutting down and that vomiting reflex was creeping up on me. 20 minutes after we entered the rooms, I left in a rush. I slept the rest of the day.

Although it was inappropriate for these Technicians and Registrars to laugh and socialise while doing what they were, I realised that this was only my perspective. I am now confident, thanks to a colleague, that they would've felt the same when they first started. Eventually, we all come to realise that someone needs to do it and may they be blessed for doing what I cannot do. I could never do any of that and these people are eternally stronger than me for being able to suppress everything and get on with it.

Coping Mechanisms are substantially variable. Unlike the examples above, it's obvious that in the clinical setting, people's reactions to disease, pain and suffering will be different. And as healthcare professionals and medical practitioners, how do we cope with these day to day encounters?

In The House of God, I read about people distracting themselves through isolation. In one book, the Intern could not take what he saw every day and had trouble coping with the patients' question. He became obsessed with exercise, neglecting his family, friends and 'external life' for exercise and then hospital time. It wasn't until his friends realised what happened and they dragged him back to who he was before, just with a higher pain threshold.

In another book, the author describes his method of Coping through continually working. This provides a distraction and being constantly busy means one can only focus on what they're currently doing, not on what they have been doing for the past... 70 hours straight. He's obviously a Surgeon and he makes a perfectly good point about decompensation - you work and work, cope with it all and then, sleep prematurely absolutely everywhere and watch the friendships and relationships shatter around you as you wake up to a new day in the theatre... oh wait, it's still the same day.. Shit I'm on call again.


Talking to colleagues about Coping Mechanisms I've heard a variety of them:

• Exercise / Gym / Outdoors / Training
• Travel (domestic and international)
• Reading Books
• Photography
• Music
• Sex
• Spending time with family
• Binge-eating / Binge-drinking
• Medications (SSRIs, Benzodiazepines)
• Self-medicating (alcohol, opiates, marijuana, ecstacy, etc)
• Yoga / Meditation
• Religion

Those are the common ones I have heard. I think it is obvious that we all need a few of them and besides from exercise, I think this Blog is definitely one of the other mechanisms for me. I do self-medicate with alcohol at times, but that hasn't happened for a few months. 

Then I came across one exception. My tutor in first year - Dr. MG. I was offering the first year co-ordinator to take on some tutorials or perhaps organise some sessions with students and she mentioned that Dr. MG was taking several weeks leave as his 2-year-old son was admitted to Intensive Care. We didn't know why. I became quite concerned for Dr. MG because of his character. He is a very closed person and one can never know what he is thinking or feeling, except when he is laughing. I can't tell if he's stressed, or he's had enough. A man made of bricks, full of knowledge and endless experience, but no outlet... at least not to me. 

So one day during the Surgical rotation, he came up to help with an Endoscopic assessment of a patient and we left the theatre at the same time afterwards. I decided to ask him what happened. 

Well, he is a 2 year old boy whom had neurological deficit based on my impression and was admitted to the Emergency Department when he started vomiting. He was diagnosed with a cerebral arteriovenous malformation. He is recovering well after radiotherapy to the region of interest and will be discharged home on a few medications. I'll monitor him closely and eventually he'll require neurosurgery for correction. Thanks for asking.

I wished his son well. We parted ways - he was off to the endoscopy unit to correct some gastrointestinal bleeding and I was on my way home. How he responded to my question of concern was alarming. He presented it like his own patient, objectively and put me in the perspective of his colleague. Thinking about it for a while, I concluded that the way he communicated his son's medical situation was frankly disturbing... and I have no idea how he copes with it.

Some people are so strong. They can stand tall with their back straight and regardless of what happens, their posture never slumps. I cannot fathom how they can possibly prevail everyday in a sound mental state with no sense of release. Thinking about it now, I wonder how his son is doing and why I care is not only because I care about his son, but I care about him. He's a good person, a good man. And I just feel that he keeps everything to himself and as inappropriate as it sounds, I just want to be there for one of my role models... one of the Consultants I admire and respect. Just once.