Sick of Myself

“In the end, we all become stories,” says Margaret Atwood, the great Canadian novelist and poet; and in the end, most of us will become patients too. In becoming a patient at the age of forty, while practicing as a physician and educator, I can now reflect and admit that everything I thought I knew about a patient’s journey and my own empathy was somewhat naive. My perspective has forever been changed; and, I have now become a story, a medical fairytale of a “wounded healer” to be passed into the future as a clinical case report.¹

The notion of a “wounded healer” is not new and dates to ancient Greece and Chiron, the wounded healer centaur and teacher of Asclepius, the God of medicine. More recently, Carl Jung used the term “wounded physician” to describe how self-understanding and a personal experience of pain results in the capacity to accept others’ suffering more fully.²

The fever of my acute Kawasaki disease started while examining medical students in their final examinations at Royal College of Surgeons in Ireland (RCSI) amid the SARS-CoV-2 pandemic in 2021, and my immediate suspicion was obvious; however, after numerous negative antigen tests and being “wounded” by pyrexial delirium, the boundaries between what was real and imagined, lucidity and hallucination, what was true and false all started to become blurred: “in the midway of this our mortal life, I found me in a gloomy wood, astray.”³ My sense of self was unraveling before my untrustworthy eyes as I fought to maintain control of my life and my world while at my most vulnerable. In those moments, what was truly important crystallized to clarity—it did not matter how intelligent I thought I was, how many degrees I had earned, what my diagnostic investigations had revealed, what treatment I was receiving, or what I understood to be happening inside of my own body… all that was important, all that I wanted, was to hold my partner’s hand and to live.

In those moments, as I lay fearful and alone in my hospital bed on inotropic support and without visitors, that unraveling of self felt like a very real and tangible experience. In psychoanalytic theory, the id, ego, and superego are 3 distinct, interacting agents in the psychic apparatus akin to Plato’s theory of the tripartite soul. For Freud, the id is the impulsive part of a personality that is driven by pleasure and repulsed by pain, the superego is its judgmental and morally correct part, and the ego is conscious, mediating between the id and the superego and making decisions. For me, as I lay wrapped in delirium, watching the three versions of my self take separate, human forms to interact and argue before my eyes, they became affectionately known as me, myself, and I—with myself the ego. Over time, I witnessed myself lose voice, grow exhausted from all the conflict amid the confusion, and surrender all decisions to those that cared for my mortal body in the rational world. And so, as I lay there unraveled, with myself—my doctor ego—silenced, I finally felt at peace; and, akin to a childlike state of blissful apathy, I trusted that those around me – the adults, the other health care professionals – would safely guide us through that “gloomy wood,” back to a life worth living.

“All drama is conflict,” says Syd Field, the American screenwriting guru; that conflict can be either internal or external for any character. In dramatic terms, conflict is synonymous with obstacle, but as I watched the individual elements of my tripartite soul separate to repeatedly tussle and argue for supremacy in front of my eyes, I saw them each as an obstacle and, taken together, an internal conflict in my own personal procedural drama.

For Jung, conflict is necessary for growth. To become more conscious, one must be able to bear conflict and, if the tension between opposites can be borne, then something new and creative can grow. In Jung’s view, this something is a symbol that contributes to a new direction that does justice to all sides of any conflict and is a product of the unconscious rather than of rational thought. And so it was, as the intravenous immunoglobulin led me out of the darkness of my delirium, away from the drama of my subconscious, that I felt something new materialize in my rational reality: a new balance, a new harmony, a new perspective, a new direction…with my ego now in check.

Previous studies of doctors’ illnesses have revealed how doctors gained awareness of patients’ perspectives after experiencing illness and how those who returned to work felt greater emotional and cognitive empathy toward their patients, showed improved communication skills, and became more proactive about patient care^2,4; that being said, traditional medical training implicitly suggests that physicians should somehow be impervious to illness. When health issues occur, medicine promotes a separation of patient and physician roles.⁵ As such, it is often considered both a sign of weakness to acknowledge personal illness and unprofessional to discuss personal experiences with patients⁵; however, “by determining how best to integrate physicians’ work and personal experiences, medicine can advance to more consistently embrace its core humanistic values for both patients and physicians” writes West⁵…and, we whole-heartedly concur.

In the end, doctors are human too.

Funding Support and Author Disclosures

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.