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Synopsis

We started medical school by walking into a room with donated human bodies and a scalpel. And if you ask most doctors about it now, years later, there’s this thing that happens — the memory is still vivid, but the weight of it has somehow… shifted. This episode is about that shift.

Faith and Isaac talk through what cadaver lab was actually like — the smell, the pledge, the strange intimacy of returning to the same silent mentor week after week. But what starts in that room doesn’t stay there. From the first time you realise you’re treating someone’s worst day like a Tuesday, to the 4am calls where you have to find enough human warmth to deliver devastating news on barely any sleep — the emotional recalibration that comes with working in medicine is something nobody really prepares you for.

They get into patients rejecting life-saving dialysis, dark humour as a coping mechanism, what it means to “pace” with a dying patient’s family, and what the best and worst examples of clinical communication have taught them about who they want to become.

By the end of it, the question isn’t really whether doctors are desensitised. It’s whether some version of that numbness is necessary — and whether, if you’re honest with yourself, it’s started showing up in places it probably shouldn’t.

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Episode Transcript

Isaac
Hi, I’m Isaac.

Faith
And I’m Faith.

Isaac
And welcome to the We Didn’t Plan This podcast. So Faith, today we’re touching on something a little bit more medical and close to our hearts about the heavy conversations that we have and about how we cope and how we learn from the things that need to be learned from. So for full disclosure, the title of this episode, What Cadaver Lab Actually Does To You, It’s fully generated by Claude.ai, full credit given. But we thought it was a really nice opener because this is one of those things that we see as, at least in the literature, to be one of the first formative experiences of medical school. But I think once you go into practice, you kind of gloss over that. Because I guess all our emotional and mental attention is on the patients that we actually see day to day.

Faith
The live patients that we can actively help versus our silent mentors from the past.

Isaac
Yeah, exactly. And for a little bit of background to our non-medical viewers, this is often a rite of passage that you see in a lot of the TV shows as well abroad. It’s one of the ways that we are taught anatomy in school, where you get the chance to interact with what we call silent mentors. They are donated bodies of the deceased that we are allowed to use or to have a look at their organs, learn a little bit of anatomy, see what certain structures and all that are like, and I suppose apply it to our clinical learning. So this is one of the first things you go through in med school.

Faith
So very early, it’s year one for you as well. Yeah, first year for us, you also.

Isaac
Likewise, likewise. So do you remember the first time you went through that experience and what were your first thoughts?

Faith
Yeah, I actually do. I remember, that was like 10 years ago, I think. Yeah, so our first day, all of us wore our white coats, they told us dressed like semi-formally. I mean, those don’t dress in a sloppy manner. Because we’re going into, I think we had to recite a pledge or something on our first session. I remember that too. So we were all just standing around in groups of eight, each around a gurney with an asylum mentor on there. and then we set our pledge and then they, you know, unmasked, like, you know, they revealed the bodies and then they were like, okay, come now, this is anatomy class, let’s learn about maybe the arm today. Yeah, so each lesson will just, like, you know, study a different body part on someone who donated their body for medical education. Like, I mean, when you think about it from, like, a medical student perspective, it’s like, oh, wow, there’s so much to study, I need to, like, figure out all the names of these structures. you need to think about it in a very clinical, rational and detached way. Versus if you think about it from a human perspective, like, oh crap, this was someone’s mom or grandma, and someone who once had a life, but now is just there forever. How is it for you?

Isaac
I think the thought really hits you in and out, right? Because in this whole experience, for us the experience was, I would say, a step more intimate than that as well. because we got the chance to actually do the dissection of the silent mentals ourselves. So we had a bunch of surgical tools and then we would have an instructor who would walk us through, “Okay, if you want to explore this particular structure like a muscle or access a particular organ in a surgery, how they would do it is such and such. They would cut here and then that’s the approach that you would see.” And I suppose that was, if you think about it in a very rational way, that was really good for learning because it’s not the same as, oh, you know, like you just open a body for an autopsy and then everything is there. It teaches you, okay, like the surgical significance of certain structures and all that. And I thought it was a very good learning experience. But at the same time, I feel like when you go through that experience, sometimes the smell of the formaldehyde hits, sometimes…

Faith
Oh yes, the smell. I still remember it. Everyone was masked up. Some people were double masked because it was so strong. I mean, it’s what keeps the bodies from smelling too strongly.

Isaac
And you also get to see a little bit of blood.

Faith
Oh, yours had blood. I guess for NUS medicine, it was different. Because as you mentioned, yours came not dissected yet. It probably passed through a few batches of students. So the silent mentors had been there for more years. So I guess it was a bit, you know, not so emotionally distressing. And we were able to be a bit more detached compared to yours, where you actually had to, you know, surgically open them up and prepare the body.

Isaac
Yeah. And I think it’s such a sensory experience as well, where you smell this, right? And then you look at a body that is otherwise untouched. And then I suppose now the onus is on you to do something to it. And yes, it’s for a learning purpose and all of that, but it’s also not a non-invasive thing, if that makes sense.

Faith
I know, it makes sense. I mean, it’s someone who is – literally us – if we were no longer alive. And it’s so visceral to just like cut it open and smell the blood and everything.

Isaac
Exactly. And the thing is that what also felt like you start developing somewhat of a relationship is that we would have the modules across quite a few weeks. So from the first day where we opened it up to learn about, let’s say a certain part of the body in the back, then the next week it will be another part of the body. And then you see this person every single week. And I think we both had some sort of a commemoration ceremony where you write a card. I’m not sure if families actually get the card from you, but then there was that whole ritual that you go through and then the gravity of it hits a little bit and then you realise that you really respect these people for what they’ve given to the science and our learning.

Faith
Yeah, for sure. So how did that impact you emotionally? What do you do after to decompress after dissecting someone?

Isaac
I felt that it wasn’t really a stressful experience per se. It was more a heavy one where it really hits you that for the first time, while this is not a person walking and talking in front of you, you’re in this very particular state or in this very particular profession where you get to do some things that are otherwise very invasive and very vulnerable. So then it sets you on this path of slowly reckoning with the fact that you do have a responsibility to be respectful, to give occasions the right gravitas that they warrant. I guess if we fast forward a few years down the road into it, you start seeing patients and all that. Did that feeling sort of evolve? Was there a moment for you where, you know, it felt like this is more real? Because, you know, even in your clinical education, you do get to see patients, you examine them. Often it’s, you know, to prepare for exams, right? But were there any interactions that slowly started to let that reality hit home for you a bit more?

Faith
Yeah, I mean, I guess the first time when you hit the wall, it’s so much like sensory overstimulation. And as a doctor, you’ve got nurses asking you for things, you’ve got seniors expecting you to do tasks, and then you’ve got so many patients who rely on you to be their care provider throughout their hospital stay. So emotionally, it does feel overwhelming. And then some patients are sicker than others. So you’ve also got to, you’re exposed to human suffering and human illness every day in the job. So you can’t really afford to let yourself feel everything. You can’t be like, oh no, I’m so sad. This auntie is sick, she needs dialysis. Oh no, this uncle is like cancer. you can’t be like crying for them all the time because then you will not be able to function at work and then everyone else at work will hit you or like just call you incompetent and fire you from your job so it’s like how do we balance like feelings versus you know just numbing ourselves for the sake of efficiency yeah how did you adapt to that when you started working in the world

Isaac
it felt like a delicate balance to strike because especially when you first start out you’re you’re you’re really struggling, right? And then you’re getting asked 10,000 things, you’re trying to not miss at least 999 of them. And then it feels like even when someone is asking for something, patient says, “I want to go to the toilet or water.” You can choose to answer them nicely, you can choose to walk away, or you can choose to say something that’s very, very good to them.

Faith
It’s like, “Okay, uncle, let me get you the water.” And then the second here is, “Okay, I’ll get the nurse to get you your water.” And the third here is like, you just ignore or something. You pretend they don’t exist. Pretend that he was talking to the nurse and be like…

Isaac
Yeah, and then all those things just kind of slip by. And I think you notice that a lot. And at a certain point, you feel like you start turning into a person that you don’t really like, or into a person that you wish you didn’t become. And then there’s that slow adaptation. I felt that as time wore along a little bit more, then you get to focus a little bit on the actual communication and the actual interpersonal relations, which felt very good. I think about not too long ago, a month or two ago, I was in a renal ward. So a lot of my patients want dialysis. Understandably, very understandably, a lot of them are not the happiest people around. It’s a very painful process to go through. It is a plot twist or rather spoiler alert, it’s not something that necessarily improves quality of life as the literature states. It generally only extends it. So actually there’s a lot of counselling you do about whether or not they should even be on it. And when you’re on it, I think it’s one of those difficult things where when you’re really living it, you start to feel a lot sicker. You start to feel tired.

Faith
Yeah, because they’ve got to go for that three times a week. And they have to go to an in an external centre and spend hours just sitting in a chair for the rest of their lives because if they don’t, their kidneys will not function and they will not survive.

Isaac
Yeah, and as a provider, I suppose, to have these conversations and to even navigate really tricky things like we need to increase it from two to three times a week. That’s one of the most controversial topics you can ever talk about to someone on dialysis. it really starts hitting home, I suppose, that we are in this position where I need to make sure my information is in the right place, right? I need to make sure that I’m giving it in a tactful way that respects whatever concerns that you’re giving as well. And I think ironically also that made me feel like, okay, now I’m doing part of the human part of the job that I asked for when I signed so many years of my life away. But it’s such a mixed bag. Do you ever feel like when you’ve had these heavier patient interactions, the feeling that you had is not always so clear cut. It’s not always like, oh, I feel so honored to be part of this. Neither is it, oh my God, I’m so sien and tired. It’s probably something in between, right?

Faith
Yeah, I feel like it’s a mixed bag. I mean, okay, so in medical school, did you have simulated patients also? Yeah, so for context, in medical school, we are trained to have communication exercises with simulated patients who are basically paid actors who act out scenarios like for example explaining why they need to increase their dialysis or breaking bad news telling them that maybe that they’re not going to get better so soon or they need to get this surgery and then I mean of course because they’re paid actors you just have to say the right collection of keywords and it magically respond in a positive way but it’s an exam right Yeah, it’s an exam and then you do well, you communicate well. But in real life, conversations are rarely that linear. I mean, you say A, but you expect the patient to say B, but suddenly they say Z and you’re like, how do I bridge that gap? And how do I manage my own emotions? Or how do you balance your emotions and the factuality of everything and still conveying everything that you need to convey in a suitably empathetic manner? I find it tough sometimes.

Isaac
I found a really funny thing that I noticed was, I don’t know how common it is for people to document their clinical interactions like this, but I noticed someone type “expressed empathy” as one.

Faith
Oh yes, I have seen that before. Yeah, definitely more than one person.

Isaac
It’s not uncommon, right?

Faith
Yeah, especially when you’re documenting for a family conference, which is normally in the most serious medical cases, you’re like, “Expressed empathy, address all concerns, family has no further questions.” Yeah, exactly. After you wrote all the factual science stuff, then you insert a few lines of human comms.

Isaac
Yes, yes. Answer all questions and all that. When I first saw that, I thought it was very, very amusing. And then I changed the way I phrased it to like, reassured regarding so and so and so. Then I just put the objective stuff that we actually said. Because I was just thinking like, was I really that empathetic?

Faith
Yeah, it’s just like a checkbox that we have to fulfill, right? Like, empathy express. Because if you’re a clinician who’s non-empathetic, people will be like, oh, they’re so cold, this doctor didn’t care about me. But if you’re too empathetic, then, I mean, if you cry in front of a patient, I mean, I remember in palliative care, the doctors always said you can’t really cry in front of your patient because then you’re also messing with their own processing of the grief or the guilt because they feel like they have to comfort the doctor, which is never a position a patient should be put in.

Isaac
Yeah, exactly. There’s so many angles to it where, you know, you’re in this weird dynamic where you have to be a source of strength, but neither can you over-promise the strength and neither should you ever under-promise the strength. And you have to sort of deploy vulnerability and show it in just the right amounts, right? Because at the end of the day, we are human too. I’m sure you’ve seen patients that reminded you of your own family or that really hit very hard, right? I think the closer for me, the closer in age the patient is to me, the more difficult it is. I remember overnight on call, I attended to a young guy in his 30s who I think had a stroke. And then I didn’t attend to the stroke, thankfully. But then it was just a very routine, you know, take bloods for a fever kind of thing. And it felt like as I was doing it, it was this at once terrifying, sobering, and very sympathy and empathy inducing experience I kind of hear this guy, it was quite a bad stroke as well. So he was like semi-talking to me, but also it wasn’t fluent. And the deficits were pretty serious. So I just heard of his body whacked out.

Faith
He’s just around our age.

Isaac
Exactly.

Faith
It’s so scary. It could be us.

Isaac
Right.

Faith
I think that’s what makes it scarier. The empathy level just goes up when we relate to it even more.

Isaac
Exactly. And then it spikes again if it’s an elderly person who reminds you of your own grandparents. or they talk to you the same way and then you see those little, it kind of exposes a bit of ching in the arm from time to time. And I think it’s something all healthcare providers are exposed to in some degree. Are there any ways in which you process the heavier conversations? It can be the more angry ones or the sadder ones or whichever.

Faith
I feel like it’s easier to process angry conversations or like when patients are just very heated or emotionally charged or distressed because I mean anger is just like you know misplaced emotions or misdirected emotions they are probably also stressed but once you figure out what they’re stressed about or what they’re freaking out about then actually the conversation gets better or they’re just plain unreasonable sometimes it’s just like okay never mind water off her dog’s bag move on but like breaking bad news to patients or like watching seniors break bad news like oh this person has a stroke or you know the person didn’t make it or has a stage four terminal cancer diagnosis is I think it’s a lot harder to sit with and to process because you know how final it is. And no matter how much the clinician might explain the diagnosis to people, sometimes they still have hope. But you yourself know that this guy is not going to make it more than X months. And then you just have to silently carry that with you while you continue treating the patient, knowing that you never know when it’s going to be the last time you see them alive.

Isaac
Yeah, and there’s the whole concept that we call pacing with people. And you know it sounds like such a clinical, off the cuff kind of word. But in reality, especially if you’re in the same ward with the same patient all the time, and you’re on the phone with their family every single day, and you’re slowly together with them coming to terms with the reality that there is a number to the amount of time you have left. It just feels not easy sometimes. And I feel like the way that we process it collectively in a team, or as your friends, it’s enough but also not enough sometimes in the sense that you will tell your colleagues, most of the time it’s not like people will ever brush you off. to say that, oh my god, this is so sad, this and so and so happened. And then you just share the medical facts with your friend and share how sad the family members were. And then it’s kind of a moment, but it’s normally like a 10 second moment.

Faith
It’s just very brief because you can’t spend an hour talking about every single patient because there’s too many like that already. Maybe we’re a bit desensitised to some extent.

Isaac
I don’t know whether it’s a good or bad thing where it feels so far adequate also. I’m sure there will be times where we encounter much more severe and much more weighty scenarios that are quite junior in our careers as well. But then sometimes I wonder, am I a very different person going into this than I once was? I remember I wrote in my medical school personal statement, right? Wow, that’s amazing! There was this very tear-jerking, heart-stopping moment where I was doing some volunteering thing and then I gave some patient medication instructions and they were very moved by it. And it was some very simple act that…

Faith
Yeah, you managed to dramatise it a lot.

Isaac
Yeah, and it genuinely felt like at the time, it was such a big moment for this guy, you know? And then I was like, wow, I feel like so privileged and empowered to meet this position.

Faith
Yeah, it’s like you made such a great meeting in his life. And then versus us now, it’s in every way or current.

Isaac
It’s like you can talk to someone about metastatic cancer between your morning coffee and your lunch. And I’m not saying that we do our best to do it in the most tactful and in the best way possible. But at the same time, sometimes you are real with the fact and recognise the fact that actually inside, you’re not exactly in this place where you’re, wow, this is such a thing for you. you do your best, you do a good job out of it. And that’s perhaps the way to be sustainable, to deliver good care all the time as well. So that’s something that I think we’re all navigating right now, right?

Faith
Yeah, I mean, I guess it’s unavoidable. I mean, working in healthcare itself is not a normal thing. Most people are not surrounded by this amount of, you know, illness, emotional distress, suffering and death on a regular basis. So healthcare workers, we’re in our own little bubble where this is normal for us but to everyone else it’s like oh this is the worst day of their life but for us it’s just oh it’s just another day and it’s just another patient who’s sick yeah so i guess the perspectives are also very different depending on like whether you’re on the patient side or the healthcare side.

Isaac
Do you think anything in the course of school or training really prepared you for this or at least do you think what training was given was enough?

Faith
I don’t think they really train you specifically for this though. They train you to handle all the intellectual side of things and the practical side of things. You’re trained how to restart a heart, how to defibrillate someone, how to intubate them, but not necessarily how to deal with your own emotions, your own emotional regulation, stress regulation, and just coping with the fact that your patient might just conk on you in the middle of a call. Do you feel like your medical education touched on that?

Isaac
it feels like it did and didn’t at the same time. In the sense that there was so much emphasis placed on communication, there was so much emphasis placed on understanding patient journeys. I think there was one time where they brought in a patient to share her own journey recovering from a stroke, things like that. I thought those were really good experiences. And then I think the marking rubric in our schools is a bit different also in the sense that they did mention, I think some of our tutors are common across schools, I think they were saying that at least for our curriculum, they try to do away with some of the marking rubrics for the communication so we don’t have to, or rather we’re not obliged to say certain things when it’s not the most accurate or appropriate. And then it’s a little bit more, they spend a little bit more time coaching us on like, actually in this context, in a very real sense, you know, your tone was a little a little bit of like smile a bit too much, smile a bit too little. I thought those were really good.

Faith
Those are really good tips though.

Isaac
Yeah, yeah. I mean one of the things I got was that I smile a bit too much, which I think is very fair. I’m a very smiley person outside the hospital. For many other reasons in the hospital, I don’t smile as much. That’s not because I’m deliberately trying to be serious. Relatable. But I think what it doesn’t prepare you for is the circumstances in which you to tap on those communication skills where it is the 10th time in that day you have to do it or it’s 4am and you barely feel like you want to do anything let alone be a part of a heavy conversation but the patients don’t take what time they deteriorate and you just go into it right and it’s more of like I don’t know I’m thinking you know we should suggest to the faculty one or two of these classes should be they make you like stay up overnight Yeah, stay at overnight. Then you do the session to end your overnight stay at 5am.

Faith
Yeah, you do both practical tasks and emotional tasks.

Isaac
Exactly. And see how you feel at the end of it. Exactly. You go and take blood from the mannequin and then after that, you’re cleaning up the mess, you go and call someone.

Faith
Yeah, and then you have to call someone and say, oh, your father’s not doing too well, his oxygen saturation is bad, you should come and see him at like 3am or something.

Isaac
I think that’s really the crux of it. So, I mean, I guess if we move away from the medical, the purely medical circumstances. It’s a really heavy thing and it’s something that we’re continuously working on, no matter what setting we’re dealing with patients. Moving on to the more interpersonal and interprofessional level, I think that’s a more interesting one where, I mean your co-workers are figuratively but not literally dying. But I would say that the way that we interact with each other, I think the desensitisation in general also trickles into it. Do you have any thoughts when I say desensitisation and interacting with your colleagues? Off the top of your head?

Faith
I feel like everyone sort of developed some form of dark humour to cope with things. They’re just like, oh, this guy is dying and then the other patient is also like a rock or something. Yeah. I mean in context, should we explain this context or not? I don’t know if we should. Yeah, but basically, we are happy when a patient is more like a rock because it means that they are stable and they’re well, which means there’s nothing new to do for them, which is better than a patient being really sick and us having to take bloods for them every day because we’ll be really worried about those. So we’re happy to have rocks. I mean, these are all just coping mechanisms that we develop. It’s not that doctors are being insensitive, it’s just a lingo that we’ve adapted to an outsider that might sound cold or rude or confusing, but to us it’s just like, okay, this is our daily life. It is what it is.

Isaac
Yeah, and I think the other way that it sometimes comes across might be, it feels like you have a lot less emotional bandwidth if you draw a parallel to other professions. People complain about, sometimes their co-workers are like, “Fig nice to them.” you know, like you mask or your superiors, they mask things with corporate speak and then they deliver your, you decline your leave on a velvet glove. But I feel like for better or for worse, what I’ll say is that there’s no fake niceness because there’s not that much niceness period.

Faith
Yeah, yeah. If people are nice to you, it’s pretty genuine. No one’s going to be like, I’m going to coddle this person because I want to act, I want to have a good reputation. People are just like exhausted. So what you see is what you get. If they’re nice, they are uniformly nice. If they are mean, they are also probably uniformly mean or sleep deprived. Which is fair.

Isaac
And I think when you get refused things, there’s no velvet glove. It’s just, you cannot take leave. Sorry. I don’t think there’s a sorry actually.

Faith
Yeah, there’s no sorry. They’re just like, oh you cannot take leave. Just take another week. You can’t book your trip. You can’t do this, you can’t do that.

Isaac
And do you feel with this tone or this tempo of interaction, sometimes you must quote switch when you go outside, whether it’s in your personal or even your professional interactions outside. I feel that I have to sometimes.

Faith
Yeah, I mean we definitely have to code switch even among the hierarchies. Like to a fellow health officer or medical officer, you can probably shoot the shit even a registrar. But around your consultant, you can’t go around being so informal or casual or making dark humor jokes. Because they probably think less of you. And I mean in front of patients, obviously not. You can’t even… I mean, oh yeah. So some… I think there was once where someone made some dark humor joke, but the patient’s family was nearby. They didn’t hear it but we were like, “Oh my gosh, it pulls them away.” So you have to be careful because everything is within the shot of someone who could hear it and take it the wrong way.

Isaac
For sure. And I think you also then have to tune the frequency or the courteousness a little bit. I have a really vivid memory for one of my postings in a specific department, in a specific hospital, where I was quite new, weeks into the job then. I think at that point, basically what I was doing is that there was a patient and they had to go for kidney dialysis in the inpatient dialysis centre. I didn’t forget anything. It’s just that the superior or the senior wanted to make sure that they went for a morning slot so that they can do something in the afternoon. I forgot what it was exactly. And then I mentioned, okay, I called them to book an appointment or make sure the name is in. And then they didn’t reply. I’ll call later. And this senior got very, very frustrated, like visibly frustrated. And then she said this, like she said that you are not here to learn. You are not here to make decisions. you are just here to get things done. And then she marched me to the dialysis centre.

Faith
Oh, to book the slot.

Isaac
To physical… And how she did it was that she went to the counter. She snatched the book away from the patient service associate or the nurse who was like… Kind of like… I think she was like there. It wasn’t like in her hands, but it was there. And then she just pulled it over without saying, “Sorry, can I take a look at this?” She opened it and say… And then she just shouted at… She didn’t shout but she was like, “Is this patient in the morning slot?” And then the nurse was like, “Yeah, yeah, yeah, yeah, God, don’t worry, don’t worry, calm down.” Yeah, and then it was, it kind of, that was probably I think a more extreme situation. It’s not very common.

Faith
Yeah, it’s not common.

Isaac
But I think it really emphasised to me that, okay, yes, like part of me is sympathetic that this senior of mine probably has not slept very much and whatever. but it also emphasises to me, you know, like when I go out, I should probably not treat people like this. And when I’m juniors next time in the medical system, or when I’m juniors right now outside, I try not to do that. You know, sometimes you see examples like this that really hit home as well.

Faith
Yeah, I mean, sometimes you see like truly shocking ways that like doctors or other people treat the nurses. And I mean, that doctor probably thought that she would, I mean, that doctor was doing good for the patient in terms of achieving the objective of getting the patient at a slot. How the doctor went about that was a bit concerning, but I guess emotional regulation is difficult sometimes when you’re running on a high-stress job, poor sleep, and I don’t know. A lot of things. There’s always so many things going on in a senior doctor’s mind because they’ve always got research papers, surgeries, procedures, people to answer to, families to speak to.

Isaac
And for the mid-level people, there’s always someone on their bank.

Faith
Yeah, there’s someone above you and then people below you asking for things. Yeah. It’s a stressful job all around. Yeah, I feel like we have to numb ourselves a bit to some extent. Do you feel like you’ve had to numb yourself since you started work? Like, if you had to give a percentage, or how numb?

Isaac
I think numb about 80%. I think 80% is my ballpark.

Faith
Yeah, because if we feel everything is, we’ll just be so stressed and so sad for all our patients every day.

Isaac
Yeah, and I feel like being invested in it, in a very genuine sense, or rather over invested in it, takes away your bandwidth to do the same for the next guy, and the next one after that, and the next one after that.

Faith
Because you only have like maybe a hundred units of emotional…

Isaac
Yeah, yeah. This is like a bit of a dark, a bit dark humor already, but I was like thinking, you know, sometimes you have mornings where, especially in certain departments, you have to talk to maybe three to four families whose family members have a really bad cancer every morning. It’s like you barely can remember who has what cancer, you know what I mean? Yeah, yeah, it’s true, it’s true.

Faith
You have to refer to the paper.

Isaac
Exactly, exactly. And then if you’re too sad about it, it’s like, I would have to take a break from it and then go to the next one. And then that means by the time it gets to the third one, right, then you don’t even, you might not be able to deliver whatever you need to deliver.

Faith
Yeah, you’d be emotionally spent and mentally spent and your time was also just gone. And I guess patients also sort of expect doctors to be the rational and calm ones in times of crisis. If we are too emotional, we’ll also get criticised. So it’s like you can’t really win.

Isaac
I think the best seniors I know, or at least the ones I try to emulate, are the ones who are able to, for lack of a better word, manufacture a little bit of the emotion in healthy doses.

Faith
Microdosing it.

Isaac
Exactly. Sometimes you see really glaringly bad examples of cold communication and you don’t want to go there. But neither do you want to be. I’ve seen some colleagues or fellow juniors who are really very invested to the point where it’s unsustainable.

Faith
Yeah, when they get stressed and they stay back late on purpose just to check the patient’s results and check on the patient, and they can’t leave work because of that.

Isaac
Yeah, exactly. Then you wonder, if you go to a tougher posting, then what now?

Faith
Yeah, speaking of leaving work and leaving your work behind, Do you feel like you sometimes carry some of that emotional numbness and desensitisation home to your personal life? Or interactions with friends, family, or whatever?

Isaac
I think I’ve definitely found myself guilty of that. Especially in a more professional context, like when I talk to my partners, my colleagues, or whatever, my clients outside, less so clients, but probably to the people who work alongside me. I do notice that I take a lot of the way we talk to each other in a healthcare setting outside where I say, “Okay, let’s get this done, one, two, three, four.” And then I just kind of leave it at that. It’s less of a, “Oh, if you have the time, do this, could we do that?” And then you sometimes catch yourself. I suppose at the end of the day, to me, it feels like, well, actually there’s a mix back to this, right? the way we communicate in healthcare, I feel it’s very effective.

Faith
It’s very efficient, you get straight to the point, you outline what has to be done. You don’t need to quote them and be like, “Oh, you were great today. If you have time, can you do this? I really appreciate this.”

Isaac
I think SBAR should be something that is taught at uni to every course and every day.

Faith
The way you hand over cases, it’s very clear cut. You just explain the background and the assessment and what you’re doing for the patient.

Isaac
Exactly, for people who do this, for people who don’t know this, quickly, in this situation, background assessment recommendation, right? So it’s like, oh, I need to get this proposal, I need to get this proposal done for someone by this day. It’s already been, you know, it’s three pages in, but then I just need you to tidy up the final bullet points, run it through the AI once more. I would probably recommend that you use this AI and check with this other person if you’re not sure.

Faith
So it sounds like it’s such a great framework to think about. It’s such a nice, concise plan. But I guess people would call us too clinical or too cold in the outside world.

Isaac
So the hope is that you can package some of the good bits of what we learn and try to mitigate or maybe cushion it with some of the other not so nice tendencies that might be excusable, that might be not excusable in a situation with less medical urgency. And I guess you find your communication style outside of that. How much of that do you leave at the door?

Faith
Oh my, I don’t know. I feel like I end up… Because I mean in the GP clinic, every day I’m just telling people, “Okay, it sounds like you’ve got a flu. Let me just give you these medicines.” My brain, even when I leave work, sometimes I’m just subconsciously just telling people what’s best for them or what needs to be done or feeding them the name to their problem or their feeling before they even had time to process it themselves. So I do wonder if it makes us more like paternalistic in a way. Like you’re just like, okay, you have this, therefore you need to do this because it’s medically indicated. And then in the personal life, it might sound like, okay, you’re like eating too much or something, I don’t know, or you’re not taking good enough care of your health, you need to do this, this, that. And then to the people that you’re talking to in your personal life, they’ll be like, “No, why are you telling me to do this? I don’t want to do this.” But it’s just an occupational hazard, I guess, sometimes.

Isaac
Yeah, I think there’s a lot that you one digest and one processes and we all find our balance at the end of it, right? With all this in mind, is there a particular moment or a particular feeling or perhaps era in this whole journey that really stuck with you, even if it’s not individual patient interaction?

Faith
Like an interaction that made me think that I need to compartmentalise?

Isaac
Or no, something that just maybe really set the tone for what kind of a clinician you want to be. Or that just stuck in general.

Faith
I think it would have to be like when I was in my internal medicine posting. I mean, back to dialysis patients. There was this guy who came in with kidney failure. I think it was in his 50s. He wasn’t very old. So actually he could have had some road to live on if he had chosen dialysis. But the thing is, we sat him down for a family conference, explained everything in great detail to him and his family multiple times and he was still like, “I don’t want dialysis. I just want to pass away naturally. I don’t want to lead a life where I’m being forced to do this just to survive because there’s no quality of life.” So I think it’s in those kind of things, these kind of situations where one part of me is like, “But medically it doesn’t make sense. you should do what’s good for you but at the same time you have to respect the patient’s autonomy even though you’re like why are you doing this this is a waste of your life like we can save you but you’re not letting us save you so that you can’t afford to get too emotionally invested in such cases i suppose because you know it just feels like like or why why can’t you know see what’s best for them yeah so you just have to leave your feelings at the door in such a case i guess

Isaac
Yeah, I think we all have that, one or two interactions.

Faith
We’ve all had this.

Isaac
I have this actually similar situation, dialysis related also.

Faith
Yeah, that situation really causes a lot of emotions.

Isaac
Right. I had this also internal med, but there was this lady who had to go on temporary dialysis for a certain very urgent buildup of toxins in the body, that kind of thing. And the hope was that she would get to go off it. But it didn’t look very good. Background was that this auntie was, as they say, in the UK they like to use this term which I’ve seen on TikTok sometimes, called “Pleasantly Confused”. She was very pleasantly confused. So it’s those really cute aunties who have no idea where they are, but they are very smiley and very lovely. And then, miraculously, she actually took a turn for the better after about two weeks. We already had a conversation to pre-empt them that the dialysis will have to stop and it will be terminal. But somehow she did a U-turn and she went from just like being in the bed looking very very weak to standing up and like she gave us the Korean hearts one day.

Faith
I mean wouldn’t we love to see that? It was so adorable.

Isaac
And then we were like okay she’s like two days away from walking out of the hospital on her walking stick right and then there was a complication so it was a surgical complication also she started there was like a bit of a bleed and then after that we didn’t know why went for scope there was a further procedure she had to go for and then it was one big new turn so it was we saw her go from smiling and giving us big hardships to being very very sick again and then i think that really stuck with me because I knew the family throughout this process. The patient went up to a different ward also. But then I think it was just, it was probably one of the few times where, you know, because each patient encounter most of the time is very fleeting. It’s like one or two day thing. And normally either it’s fully downwards or fully upwards, right?

Faith
Yeah, it’s not up and down. It’s just like playing with our emotions also. Exactly. You just really want to root for your patient. You’re like, yes, please get better. Like get out of hospital, they want you to recover and then suddenly, just when you guys talk things about you, it’s right in the feels. Right in the feels. So, I mean, we all have that person that we

Isaac
remember. I think everyone who’s in healthcare listening to this has a person or two or a family that really stuck with them. And I mean, with all of this, today we talked about the living and the previously living and how we’ve carried that through throughout this career many more years where we will get to slowly and fully, maybe not fully, not even close to fully, uncover the full spectrum of human experiences which I suppose we’re all looking forward to with cautious optimism at the end of it.

Faith
Yeah, I guess it’s all just about learning how to strike a balance between being a sufficiently empathetic doctor but also not letting all those emotions overrule your clinical judgment and ability to be professional. So yeah, I guess that’s it for this episode.

Isaac
Yeah, here’s to better communication, better feelings and learning and growing. See you next time.

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