Physician Shame Part 3


Dear friends, especially my colleagues,

My original post (or a least a version of it that did not include F words) was published several weeks ago now. Having written one ‘good enough’ post, I thought I would try my hand at a second story. Ever since, I have felt blocked, frozen, even constipated. Why? My best guess is because there is still stuff for me to process and heal about the particular story I have decided to share. Vulnerability is the best medicine for dealing with shame, no doubt. And, there is, particularly in the medical field where lives are at stake, consequences for opening our mouths, sharing, telling the truth about ourselves. So – we hide from our shame. We bury it. We pretend it is just another emotion that we have to stuff. We tell ourselves, “I’m fine. I don’t have shame”; “I am doing my best, even if I am not perfect – oh right, everyone expects me to be perfect”; “If they only knew”. Or, more likely, “fuck, fuck it” (my personal favorite). Finally, it feels like if we talk about it, let ourselves feel it, become a normal human again, we will be pulling the first thread of a large tapestry that undoes it all. The thread never ends until it is all unwound and POOF! “I’ll disappear!” Because, if I don’t “people will fire me!”; “I’ll be sued”; “the board will take my license”; “My family will never understand and will leave me”; “I’ll be alone”. Therefore, deny, don’t tell the truth, hide true feelings, turn off emotions, and SUCK IT UP. As the marines say, “embrace the suck”!

What will people say as I write more stories? What will the consequences be? To tell the truth, some of the stories would be/could be, in the past, a threat to my license, my career – given the current health system (more on that to come). What I do know and what I have learned is the great power of being vulnerable to a bigger and bigger audience. Why? Because I have heard how much of a difference it makes from a lot, a lot, of you. My intention is to share my stories because many cannot. Part of the reason I can be vulnerable and self-revealing is that I don’t have a license to worry about. I am retired. I gave up four state licenses because I was done. Just done; not like “omg, I can’t do this anymore” done, but simply complete with clinical practice; on my terms, and when I chose to move on. An astrologist friend (actually more than one) recently told me it was in the stars for me to have many deaths and rebirths. It is in the stars for me to take on the taboo. This is just one more. Physician coaching, providing deep and healing listening as a doctor is brave enough to open up, is a privilege. It is sacred – just like those early years of delivering babies. Likewise, vulnerability and connection, just like the birth of a baby, are miracles of life for those of us who deal with shame…perhaps just try it.


Dr. Robyn Alley-Hay

4 thoughts on “Physician Shame Part 3

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  1. Dr. Dralley-Hay, I am not a colleague, but I have some thoughts about your post about the mother of 5 who died. In our family, when I was 14, a cousin (21), did bleed out post delivery. She was in a room by herself and nobody checked on her on the 4th of July, a time when new rotations begin and hospitals are short staffed. She was saved with a hysterectomy and massive transfusions (fixed and dilated), but stroked, had paralysis, lost language – the whole thing. Though she is still alive, she was never the same. Next picture. We took in 3 nieces whose mother had died suddenly and unexpectedly (a cousin from the same family). She had an aortic dissection, and she had ALREADY had SIX children, including twins who we have had for the past 5 years. We always thought it was a mixture of drugs, bad health, etc. When 15, we learned that the weird symptoms our niece had was actually vEDS. Twin sister, also vEDS – very very rare. 2,000 in the US rare. We know now that that first episode in 1970 with the Aunt was likely due to vEDS. The vascular collagen is fragile and it’s like “sewing wet tissue paper”. One, a physician cannot always blame her or himself. Even though you can reason and rationalize making logical sense completely, trauma is an EMBODIED and emotional experience. I truly hope you read the book. Second, I am married to a clinical psychologist who practices EMDR, a highly effective process for deactivating trauma. If you read the book by Van der Kolk, MD, THE BODY KEEPS THE SCORE, you will learn even more about trauma. It can truly offer a miraculous recovery, even decades later. If you decide to give yourself that gift, as a physician, you will know and share something that can help people truly LIVE, relieve them of trauma, no matter how much later it is utilized.

  2. I could say so much more, but I am reminded of the “Dreams” episode of M*A*S*H in which all of the medical personnel, in a state of sleep deprivation following a major influx of casualties, have dreams that beautifully (and surreally) depict their worst fears. My favorite, perhaps most disturbing dream sequence (and I was probably in elementary school when I first saw this, in reruns) was Hawkeye’s: he’s in scrubs in a rowboat with a man who has no arms; prosthetic limbs are floating in the water, and Hawkeye cries in despair, “I’m so sorry! I fell asleep during the lecture on how to reattach limbs! I’m so sorry…” (or some such thing). As a physician I feel this all the time: somehow, magically, I should know how to heal someone’s pain, though there isn’t such a perfect treatment. As a psychiatrist, I am well aware of the many layers implicit in this fantasy, a defense against accepting the helplessness we all feel in the face of another’s suffering, as well as the intricate dance of transference, countertransferrence, and just plain humanness…
    Thank you for what you’ve written so far on the topic of shame. There’s an excellent (and growing!) psychoanalytic literature on the topic.

  3. Robyn: Please step back and give yourself some room to be human. As a retired physician, I have been there too. We cannot prevent everyone’s death, but we can do our best to make their life as comfortable as possible, while we are acting in their life. As an obstetrician, you have something in common with my career as an anesthesiologist. We shepherd many healthy people through temporary stressful periods. But, sometimes with predictability or unpredictability, the train goes off the track, occasionally with a speed and vengeance you have to experience to believe. Remember when you were a student in school, getting a mark of 85% was considered good or very good. Did anyone chide you by saying why didn’t you get 100%? As physicians we must strive to do our best to comfort, console and sometimes to cure. We must examine and learn from our mistakes but that does not mean we will be perfect.

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