There are things medicine teaches us explicitly.

How to recognize a deteriorating patient. How to interpret an ECG. How to deliver difficult news. How to respond when a room suddenly fills with alarms and people begin moving faster.

And then there are the things we learn without anyone teaching us.

How to leave one room where someone is dying and walk into another with a steady voice.

How to listen to a family receive devastating news and then sit down at a computer to finish the note.

How to eat lunch after witnessing something that would have once made us lose our appetite.

How to say, “I’m sorry,” close the door, and move on to the next patient.

We call this professionalism.

Sometimes it is.

Sometimes it is survival.

But somewhere along the way, many of us become very good at not feeling things until later.

And later does not always come.

The usefulness of the compartment

Compartmentalization is not inherently unhealthy.

In medicine, it is often necessary.

There are moments when our own emotions cannot occupy the centre of the room. A frightened patient needs us to remain calm. A family needs us to explain what happens next. A medical emergency requires decisions, not reflection.

We learn to put something away temporarily so that we can continue functioning.

The problem is not that we have compartments.

The problem begins when we forget how to open them.

I have seen this in colleagues. I have seen it in myself.

A difficult encounter happens, and we move on.

A patient dies, and we move on.

Someone says something cruel to us, and we move on.

We make a decision that follows us home, and still, the next morning, we move on.

Medicine rewards this ability. The waiting room does not empty because we are shaken. The pager does not know that the previous conversation was difficult. The next patient still deserves our attention.

So we become extraordinarily skilled at continuing.

When functioning looks like coping

One of the difficult things about being a physician is that functioning can disguise distress remarkably well.

We show up.

We answer messages.

We finish our documentation.

We teach. We make decisions.

We care for other people.

From the outside, everything appears intact.

And because we are functioning, we may assume that we are processing what happens to us.

Those are not the same thing.

There is a particular kind of emotional efficiency that medicine can cultivate.

Something painful happens, and almost immediately the clinical mind takes over.

What happened? What could have been done differently?

Was the decision appropriate?

What does the evidence say? What needs to be documented?

These are important questions. They are also safer questions.

The harder ones often come later.

Was I frightened?

Did that patient remind me of someone I love?

Did what happened change me?

Am I angry? Am I grieving?

Why am I still thinking about this?

There is no checkbox for these questions in the medical record.

The emotions that follow us home

The boundary between physician and person is not as impermeable as we sometimes pretend.

We carry things.

A sentence a patient said.

The expression on someone's face when we gave them bad news.

A family member crying quietly at the bedside.

A patient whose story resembles our own.

A decision we replay while driving home.

Sometimes what follows us is not dramatic enough to have a name. It is simply an accumulation.

We become quieter.

More irritable.

Less patient.

We stop wanting to talk when we get home.

We find ourselves thinking about work while walking the dog, making dinner, exercising, or trying to sleep.

None of this necessarily means that we are unwell.

It may simply mean that we are human beings doing work that regularly places us beside fear, suffering, uncertainty, and death.

Yet medicine has historically been more comfortable teaching us how to manage other people's emotions than how to recognize our own.

The danger of feeling nothing

Emotional distance can protect us.

It can also become habitual.

If we repeatedly teach ourselves that the appropriate response to distress is to suppress it and continue working, eventually that response may stop being something we do at work.

It can become something we do everywhere.

We may become less available to the people we love.

We may mistake numbness for resilience.

We may begin to believe that being unaffected is evidence that we are good at our jobs.

But I do not think the goal of medicine should be to make us unaffected.

The work should affect us.

Not so completely that we cannot function. Not so deeply that every patient's suffering becomes our own.

But enough that we remain capable of being moved.

There is a difference between carrying every patient home and pretending none of them ever follow us there.

Learning to open the compartments

Perhaps what we need to teach more deliberately is not how to avoid compartmentalization, but how to reverse it.

How to recognize when something needs to be revisited.

How to say to a colleague, “That was harder than I expected.”

How to sit in the car for five minutes before driving home and acknowledge what just happened.

How to notice when irritability is actually exhaustion, when detachment is grief, or when the patient we cannot stop thinking about has touched something in our own lives.

Sometimes processing happens in conversation.

Sometimes it happens while walking, writing, sitting quietly, exercising, creating, or spending time outside.

Sometimes it requires professional support.

And sometimes it begins with nothing more complicated than allowing ourselves to admit: That affected me.

There is no failure in that sentence.

We were never meant to become untouched

Medicine requires steadiness.

It requires judgment, boundaries, and the ability to continue working in circumstances that are sometimes profoundly difficult.

But steadiness is not the absence of feeling.

Perhaps resilience is not learning how to become untouched by what we witness.

Perhaps it is learning how to let ourselves be touched by it without allowing it to consume us.

We can close the compartment when the patient in front of us needs our full attention.

But eventually, we have to remember that it is there.

Because the things we learn not to feel do not necessarily disappear.

Sometimes they simply wait for us to come back.

Devina Maya Wadhwa, MD, FRCPC is a psychiatrist practicing in Northern Ontario, Canada, and an Assistant Professor at NOSM University.