The physician’s encounter with patient suffering and death inevitability tugs at the existential nature of one’s own mortality. This can cause inner conflict which may originate from the intrinsic and inescapable experience of death and the human being’s existence in the world relating to meaning, purpose, and value. Aase, Nordenhaug & Malterud (2008) reported that most physicians could deal with patient death but “mostly keep it at a distance” especially since vulnerability was perceived as “a burden to be handled” (pg. 768). Physicians can have strong emotional reactions to patients’ death. Greif-related job stress can lead to burn-out, which on average affects more than 50% of physicians (Medscape Lifestyle Report, 2013). By confronting one’s own existential anxieties there may be more of a capacity to address patient anxieties and better process and cope with patient death.

You may still be asking yourself, why entertain this dark, scary, and unavoidable aspect of life when I don’t even have time to do laundry? The fear of having to investigate overwhelming negative feelings could dissuade you from internal investigation. The conscious exploration of this matter can often be ignored in developing and seasoned physicians alike due to time and space. This may result in a continuous undercurrent of “death” anxiety or perhaps, occasions of unruly eruptions of fear unconsciously manifesting itself in various forms.  Death anxiety refers the fear of and anxiety related to the anticipation, and awareness, of dying, death, and nonexistence (Gellman & Turner, 2013). This anxiety can also contribute to symptoms of worry, depression, and stress. Confronting your own mortality and existential anxieties can help to reduce stress and, suffering, and allow you to reenter life in a richer, more meaningful, and compassionate way. Furthermore, it can make you feel more connected to your patients and their family’s experiences of losing a loved one.

For the growing physician, adjustment to medical culture and evolving professional identity- moving from student to expert- is in development.  Combining this process with the increased exposure to patient suffering and death can potentially make it even more difficult to address existential anxieties and can result in prioritizing career enhancement over emotional and psychological well-being. Unhealthy coping strategies such as overworking, needing to control, and having a sense of personal omnipotence may arise in efforts to achieve symbolic immortality, defined as a quest to obtain a sense of continuity or imperishable legacy in efforts to stay connected to human life even after death (Lifton & Olson, 1974; Yalom, 1980). Physicians may also absorb the identity of being ‘godlike’ and ‘all-powerful’ when patients place them in that role in efforts to cope with their fears. The more ‘godlike’ one believes themselves to be, the more one views the self as immortal, reinforcing the denial of one’s own death. 

So where do we begin? 

1. Acknowledgment that it is frightening to take a hard look at our death and existential anxieties.  If we can acknowledge our anxieties with courage we have an opportunity to attend to our existential thoughts and behaviors, bringing it out of the shadow of our experience.
2. “Meaning is something to be found, not given. Man cannot invent it but must discover it” (Yalom, 1980). When facing our own mortality and finitude of our human experience we may ask ourselves, why am I here? What gives my life purpose? What do I want from life?  Where is the source of meaning for me in life? And in contemplation of these questions we can look at the current forecast of our experience and further ask ourselves, do I like the direction of my life? Am I pleased with who I am? Am I aligned with my values or is it time to let go of values that no longer serve me or are out of alignment with what makes me feel alive?     
3. One avenue to meaning is found through interpersonal relationships with family, friends, colleagues, romantic partners, community, and even our patients. We impact those around us and are interconnected to the world and the lives of others. This knowing can remedy our sense of isolation or loneliness. In contemplation of this we may realize this is an area in our life we want to enhance.  

Finally, psychotherapy and working collaboratively with a professional can provide a supportive environment to explore existential thoughts, feelings and experiences both personally and professionally.

Citations:

Aase, M., Nordrehaug, J. E., & Malterud, K. (2008). “If you cannot tolerate that risk, you should never become a physician”: a qualitative study about existential experiences among physicians. Journal of Medical Ethics, 34(11), 767-771.

Gellman, M. D., & Turner, J. R. (2013). Encyclopedia of behavioral medicine. New York, NY: Springer.

Lifton, R. & Olson, E. (1974). Living and Dying. New York: Praeger.

Medscape Lifestyle Report. (2013). Physician lifestyles – linking to burnout: A Medscape survey. Retrieved from http://www.medscape.com/features/ slideshow/lifestyle/2013/public#1

Yalom, I. D. (1980). Existential psychotherapy. New York, NY: Basic Books

Yalom, I. D. (2008). Staring at the sun. San Francisco, Ca: Jossey-Bass.