Taking photographs has evolved from the ancient tedium of bulky cameras and glass sheets to flicks of our wrists and clicks of our fingers (to say nothing of the eyes in our skies: the drones and CCTVs that are now a part of every urban landscape).
The ubiquitous nature of photographs has been a steady if silent invasion in modern lives. For most of human history, the visuals we consumed extended only to our immediate surroundings, limited by the light our eyes captured. First paintings, and then early photographs, enabled us to preserve these surroundings. The process was time consuming, and the costs involved were great enough to warrant careful construction. And, as with Instagram influencers today, when we carefully construct our photographs, we tend to showcase what is good about our lives.
With lighter tools and greater connectivity, however, modern photography has also given us a tool for social change: photojournalism.
The image of an emaciated Sudanese child, wasting away, dying from hunger, whilst a vulture lurking, remains a gut-wrenching emblem of hunger, starvation and disenfranchisement. Kevin Carter, the photographer, died by suicide four months after winning the Pulitzer, having written about the pain he felt after witnessing such suffering up close, and not having the power to prevent or mitigate such atrocities in his suicide note. The image of three-year-old Alan Kurdi’s lifeless form, sprawled on a Turkish beach, sent shockwaves through the world in 2015, and brought home the unbearable truth of the hardship refugees had been enduring for a few years at that point.
Power of Visuals and Loss
His aunt’s comment, “God put light on that picture to wake up the world” sums up the power of images that portray loss. They wake us up. Something human within us suffers, whether the wound is personal or not. George Floyd’s recorded murder by a uniformed officer ignited protests against racial injustice and police brutality in the United States. It is a movement that we hope will correct the course of history, but we must acknowledge the painful visuals that fuel it. We cannot unsee that knee on George Floyd’s neck. We cannot see Breonna Taylor’s photograph without being reminded of what happened the night she was shot.
In our social media hivemind, infested with visual reminders, suffering is as universal as outrage. This constant experience of the trauma of others is unique to our times. People who work in medicine witness others’ pains as a part of their job. Whether it is the actual fact of our bodies or minds turning against us, or the tears of someone who lost a loved one to an illness, or even dealing hands on with the gruesome visuals that often accompany life in a hospital, a good clinician carries emotional tools that may do us all good in processing pain that isn’t entirely ours to feel. It may, therefore, be worthwhile to explore what medicine can teach us about dealing with the suffering that surrounds us and seeps into our lives.
It must be noted that burnout and compassion fatigue in medicine are terrible consequences of dealing with the constant barrage of human sufferings. These three general ideas could help us deal with the emotional burden that is often ours to bear.
Bearing Witness
The complexities of human life, and indeed suffering from illness, extend beyond the scientific know-how of disease processes and treatment protocols. A good clinician knows that the simple act of listening, of being present when the person in the room is experiencing or expressing their pain, can sometimes go a long distance in alleviating pain. We cannot heal the world of the pain we see through our screens, but we can witness it. We can acknowledge the suffering and hear out those who suffer. And in doing so, we stand in solidarity with the suffering, oppressed or disenfranchisement of the people. Medecins Sans Frontieres, which was born in protest against the silent spectatorship of human misery, has institutionalized this principle in the adage of “témoignage”, a reminder that bearing witness is not the same as tacit agreement.
Looking Beyond the Pain
A tolerance for the seemingly grotesque is developed early in medical training. Dissecting a cadaver is part of the curriculum in the first year of medical education- a medical neophyte is exposed very early to intimately observe a dead body, to pick it apart respectfully, and to learn from it. Clinicians look closely at wounds, to recognise signs of healing, to identify and get rid of material that may delay the healing process. When someone walks differently, clinicians observe their gait, to tease out where the unsteadiness stems from. They constantly seek what lies underneath the apparent abnormality. They understand that physical pain signals an alarm for something deeper that is damaged and needs to be fixed.
They also understand that very often, pain is part of the healing process, such as a body recovering from surgery, or a mind recovering through therapy.
Equanimity
William Osler, in a valedictory address delivered in 1889, famously uttered that the most important quality in a physician or surgeon was equanimity - or imperturbability. To him, imperturbability was the “coolness of mind… in moments of grave peril…” But in the decades since, there has been a tectonic shift in the idea of equanimity; it has gone from being immobile in the face of suffering to being equally open to experiencing both pleasure and pain- inevitabilities in life as well as in medicine. Building from Osler’s speech, we need to allow photographs that make their way to us carry a suffering that then becomes ours, but in no way diminishes the joy we are capable of feeling. It is a reminder that life carries on irrespective of the emotions we feel. Equanimity today is more than stoic impassivity - it is a sense of emotional awareness which allows us to feel, become empathetic clinicians and engaged citizens, without getting lost in the turmoil that touches our lives everyday.
The lives of doctors are front page news because of the ongoing global pandemic, and yes, doctors along with other essential workers are front line warriors in this battle between life and death; however, these heroes are not superhuman.
We, doctors, must give ourselves space to absorb, recover, heal, and reflect.
As social media democratizes access to images erstwhile limited to hospitals walls, these listed general ideas hold value for the general public as well. Now, more than ever, it is important to respect the toll that images of pain take on those not physically feeling the pain and also those that are actively attempting to alleviate the pain.
(Dr Sucheta Tiwari is an Oxford graduate and psychiatrist in London; Dr Bhavna Seth is a pulmonary critical care fellow at Johns Hopkins University; Dr Ruha Shadab is a Harvard graduate, currently based in Boston.)
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