A Reflection and Book Review of Dr. Jessi Gold’s How Do You Feel
For over twenty years, I’ve had a recurring nightmare: I’m back in medical training, and my patient is crashing. To save them, I must enter my medical orders into the Electronic Health Record (EHR). The only problem is, there are no open computers. I could give a verbal order in a real-life emergency, but those aren’t the rules in this nightmare world. I go from computer to computer, begging for someone to let me use theirs, but all I receive are cold shoulders—and colder stares.
I never shared the dream with anyone until I read Dr. Jessi Gold’s recently published book, How Do You Feel? One Doctor’s Search for Humanity in Medicine. Part memoir, part education in psychiatry, and part self-help for healthcare professionals, I found myself devouring page after page, feeling something I hadn’t in a long time, something I hadn’t realized how much I needed.
Feeling, well, seen.
Gold, who trained in different years and locations from me, had the same experience: “This may seem trivial, but as a medical student I often had to fight to be able to use the one available computer or had to alternate with the nurses at the nursing station.”
But there are much larger stories to be told in How Do You Feel.
The book is structured around four of Gold’s patients early in the COVID-19 pandemic, mainly during 2020. (These patients are composites to protect real patient identities). A pregnant oncology nurse “re-deployed” to the Covid unit who fears the risk of harm to her baby. A burned-out mid-career E.R. doctor who thinks she hasn’t felt an emotion, let alone cried, in decades. A medical resident experiencing increasingly frequent and intrusive obsessive thoughts and compulsive behaviors, who fears judgment from his peers and program if he takes time off for treatment. Lastly, an anxious pre-med student who experiences a severe panic attack during the MCAT (Medical College Admission Test), causing Gold to struggle internally over balancing her role as the student’s psychiatrist with wanting to warn her about what she may face ahead in medical school and beyond.
As Gold writes, “Our emotional suffering is medicine’s dirty little secret… People who ask for help are the subject of gossip and are judged.”
But if ever there was a book that could end this stigma, it’s How Do You Feel.
These stories matter not only because they are universal but because of the ubiquitous ways we’ve been told to stay quiet about them. In the book, Gold instead brings them under a brilliant spotlight—including her own story.
When the E.R. doc whispers the implicit message she internalized the first time she witnessed a patient’s death, “There’s no crying in medicine,” Gold thinks, “I honestly wish people would just at least acknowledge our jobs are weird, and that what we see, like codes and death, isn’t normal; it can be traumatic.”
Upon reading this, a memory of an especially traumatic death during my E.R. rotation as a med student came back to me. Afterward, we all just moved on to the next patient. A few days later, I hesitantly shared the story with a few of my med student peers. The response was a profoundly uncomfortable silence until, finally, one of them said, “Ew, gross,” and the others laughed in an offbeat mixture of relief and dismissal and then quickly, desperately, moved on.
That was the last time I sought empathy from my peers in med school. Now, all these years later, I can understand they were only protecting themselves—from feeling too much. Because how are we supposed to do our jobs if we walk around feeling everything? Ew, gross.
Gold writes about how medical trainees are reprimanded for showing too many of those pesky feelings.
“It was as if they were supposed to appear empathetic to a point, but if they cared too much, that was crossing a line, or bad doctoring.”
In the vignettes with her patients, Gold provides a compassionate window into the discipline of psychiatry. But she goes one step further by sharing her therapy sessions. Like peeling back layers of an onion, Gold shows us her awakening to her own burnout. In a highly relatable moment, she writes, “Mostly, I’m angry at myself: Why can’t I just suck it up and work through my fatigue?” [emphasis hers]
By modeling vulnerability in sharing her mental health journey, Gold gives the reader a meta experience in which we vicariously benefit from her sessions with her therapist and then receive further insights from Gold’s treatments of her patients. I dare say even those who’ve never considered therapy will find their minds changed after reading this book.
At one point, I found myself experiencing such strong feelings, I had to pause reading.
Then, I imagined Dr. Gold asking me, how do you feel?
I tried to put words to the feelings. In my notes app, I wrote:
“Sad—a very big sadness—like it’s hard to let myself feel it because it’s so big.”
Then, in a lightbulb moment:
“Grief! I think this is the word for the big sadness.”
Gold tackles that grief–
—the big sadness of working in healthcare, in a system that we pour so much of ourselves into because those called to the profession are altruistic and empathetic, at least when we start. Before the system makes us each feel we’re only “a machine who works, not a person who works.”
Many of us carried this grief well before the pandemic, and then, as Gold writes, “the pandemic just made everything worse.”
Four years later, this book remains urgent and necessary. As a fellow author, I understand that most books take years between the first blank page and publication, but far from having lost relevance, reading these stories provides even deeper insights. To recall that 2020 feeling when “for the first time ever, it felt as if change was happening. Or, maybe it was just that everyone in medicine had reached their breaking point and simply couldn’t hold it in anymore.”
I think this perhaps is the most valuable lesson from Gold’s book: “Maybe there is a time and place for feelings. Even if we are told otherwise, it certainly can’t be nowhere and never.”
Maybe it can finally be here and now.
Originally published at KevinMD November 17, 2024 as The emotional toll doctors face: a book review
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