Skip to content
  • About
  • Contact
  • Contribute
  • What Physicians Say
  • My Book
  • Careers
  • Podcast
  • Speaking
KevinMD.com — Social media's leading physician voice
  • All
  • Physician
  • Burnout
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • All
  • Physician
  • Burnout
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
    • All
    • Physician
    • Burnout
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • About
    • Contact
    • Contribute
    • What Physicians Say
    • My Book
    • Careers
    • Podcast
    • Speaking
KevinMD.com — Social media's leading physician voice
  • All
  • Physician
  • Burnout
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
    • All
    • Physician
    • Burnout
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • About
    • Contact
    • Contribute
    • What Physicians Say
    • My Book
    • Careers
    • Podcast
    • Speaking
  • About Kevin Pho, MD, Founder of KevinMD
  • Aging and dementia: what physicians say, in their own words
  • Artificial intelligence: what physicians say, in their own words
  • Be heard on social media’s leading physician voice
  • Cancer: what physicians say, in their own words
  • Children’s health: what pediatricians say, in their own words
  • Contact Kevin
  • COVID-19: what physicians wrote as it happened
  • Custom enhanced author page pricing
  • Diabetes and obesity: what physicians say, in their own words
  • Direct primary care: what physicians say, in their own words
  • DMCA Policy
  • End of life: what physicians say, in their own words
  • Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices
  • GLP-1 drugs: what physicians say about Ozempic and its successors, in their own words
  • Heart disease: what physicians say, in their own words
  • Immigration and medicine: what physicians say about immigrant doctors and immigrant patients, in their own words
  • KevinMD influencer opportunities
  • Medical errors: what physicians say, in their own words
  • Medical ethics: what physicians say, in their own words
  • Medical malpractice: what physicians say, in their own words
  • Medical school: what students and physicians say, in their own words
  • Mental health: what psychiatrists and physicians say, in their own words
  • Nursing: what nurses and physicians say, in their own words
  • Opinion and commentary by KevinMD
  • Opioids: what physicians and pain patients say, in their own words
  • Physician burnout speakers to keynote your conference
  • Physician burnout: what physicians say, in their own words
  • Physician Coaching by KevinMD
  • Physician keynote speaker: Kevin Pho, MD
  • Physician personal finance: what physicians say about their own money, in their own words
  • Physician Speaking by KevinMD: a boutique speakers bureau
  • Physician suicide: what physicians say, in their own words
  • Physicians and administrators: what physicians say about who runs medicine, in their own words
  • Primary care physician in Nashua, NH | Kevin Pho, MD
  • Primary care: what physicians say, in their own words
  • Prior authorization: what physicians say, in their own words
  • Privacy Policy
  • Private equity and corporate medicine: what physicians say, in their own words
  • Race and medicine: what physicians say, in their own words
  • Recommended services by KevinMD
  • Residency: what residents and attendings say, in their own words
  • Scope of practice: what physicians, nurse practitioners, and PAs say, in their own words
  • Subscribe to the KevinMD enhanced author page
  • Subscribe to the newsletter
  • Surgeons and surgery: what surgeons say, in their own words
  • Take-home messages: what physicians say when asked to leave one
  • Terms of Use Agreement
  • Thank you for subscribing to KevinMD
  • Thank you for upgrading to the KevinMD enhanced author page
  • The electronic health record: what physicians say, in their own words
  • Vaccines: what physicians say, in their own words
  • Violence against health care workers: what physicians and nurses say, in their own words
  • What physicians say: the KevinMD records
  • Women in medicine: what women physicians say, in their own words
  • Women’s health: what physicians say, in their own words

The functional and professional necessity of detachment

Ilana Yurkiewicz
Medical Education
July 5, 2012
Share
Tweet
Share

There’s an intersection in Boston outside one of my favorite places to eat. At the corner of two bustling streets is a white bike, chained in place, surrounded by flowers. In loving memory.

***

One evening earlier this month, I was riding the ‘T,’ Boston’s streetcar system, when our train suddenly stopped.

There were the usual sights and sounds of delayed passengers: people fiddled with cell phones, glanced at watches, tapped feet impatiently. Outside, the flashing of police cars lit the night. “Maybe we should catch a taxi,” my friend said, and I agreed. We asked the driver to please open the train doors.

“Can’t go anywhere yet,” he said. “See that dead body?”

“What?”

The few of us near enough to hear him went to the window. Motionless on the pavement was a human-size lump, covered with a white sheet. Next to it, a mangled bicycle. Wheels facing up. Tires and handlebars twisted. Around them, cops were talking. Or were they? It was hard to tell.

Mostly I noticed the way they were standing. In a circle, surrounding the sheet. This was not an unusual occurrence to them, and it showed on their expressionless faces. They were doing their job, and I’m sure they were doing it well.

I’m not sure why their lack of open emotion surprised me. But it did.

***

At the beginning of first year, we were asked to reflect on several aspects of becoming a physician. One of our prompts said this: “Doctors must simultaneously care deeply about their patients and yet maintain detachment. In what ways is detachment a positive, and in what ways can it be a negative, in the doctor-patient relationship?”

“I understand that as a physician, I will be immersed in people’s lives to the point that I will feel closely invested in their outcomes,” I wrote. “While I am concerned about confusing a patient for a host of disease, I also recognize the value of keeping some distance to allow for logical processing of medical issues…”

The person on the bicycle that night was not my patient. I know my feeling of connection is not rational; that it was provoked not by any meaningful relationship, but by the arbitrary circumstances of a T ride through Boston one evening. That people pass away all the time. Almost two per second, I read somewhere. I don’t have the capacity to mourn them all. That’s the right of parents and children, spouses and siblings, other relatives, friends, neighbors, coworkers, religious leaders, caregivers. The rest of us can feel horror, remorse, sympathy – but can a stranger truly mourn?

A bit of detachment is a functional and professional necessity. But it’s hard. For days, I Googled the name of the intersection and “bike crash,” waiting for the media to confer a face, a name, and an existence to what lay beneath the white sheet. I needed to know that a person, not just a body, was there. A person with a life, a personality, stories, friends, memories. In some way, it felt disrespectful not to know.

Maybe I felt that way because of how instantaneously a person becomes a body becomes a statistic. I thought of the graph they’ve shown us in medical school on the most common causes of mortality in the United States. A bar for heart disease. A bar for cancer. Followed by the third biggest cause of deaths in the US: accidents. The person on the bike couldn’t fade into that. Not yet.

Sometime while we were on that train, a bus was traveling in one direction, and a bicycle was traveling in another. Sometime while we were on that same train, everything was fine. Then: a blip in the universe, and something awful and irreversible.

ADVERTISEMENT

I can’t help but feel that there’s something deeply flawed with a world that can take a person’s life without even giving her time to process it.

“I do not want to let the heartache that comes from one unfortunate outcome become such an overwhelming emotional drain that it detracts from my ability to care for others.”

I know I can’t mourn everyone. I know, especially, that I don’t have the right to mourn the woman on the bicycle. To write about her. I never knew her, while others did. Others loved her.

I am so, so sorry for your loss.

***

The train eventually started moving again, and my friend and I sat in silence. Talking about the details of our days so soon after seeing what we did felt wrong. I alternated between looking out the window and at my feet. Partially I was looking away to hide my wet eyes.

“Do you think you’ll ever become desensitized?” he asked me after a while.

“I don’t know. I guess I have to, a little bit.” I said. “But I’m not sure I want to.”

Ilana Yurkiewicz is a medical student who blogs at Unofficial Prognosis.

Prev

Take the time to educate yourself before forming an opinion

July 5, 2012 Kevin 6
…
Next

What are bath salts and why are they dangerous?

July 5, 2012 Kevin 3
…

Tagged as: Medical School, Primary Care

< Previous Post
Take the time to educate yourself before forming an opinion
Next Post >
What are bath salts and why are they dangerous?

 

ADVERTISEMENT

More by Ilana Yurkiewicz

  • Doctor, what next? The thoughts of a graduating medical student.

    Ilana Yurkiewicz
  • a desk with keyboard and ipad with the kevinmd logo

    The transition from medical student to teacher

    Ilana Yurkiewicz
  • a desk with keyboard and ipad with the kevinmd logo

    Projection.  From an unlikely source.

    Ilana Yurkiewicz

More in Medical Education

  • What clinical support staff notice that charts never show

    Maria Alemu
  • Learning empathy in medical school took my father’s cancer

    Sneha Dabadi
  • Monetize clinical expertise without becoming an influencer

    Justin Allan Montgomery, MSN-FNP
  • Medical infographics now look right without being right

    Shaan R. Mody
  • Clinical uncertainty is missing from medical training

    Lohithasree Bode
  • Why nearly every pre-med now takes a gap year

    Claudia Rodriguez
  • Most Popular

  • Past Week

    • Retirement isn’t the end of medicine, it’s a second act [PODCAST]

      The Podcast by KevinMD | Podcast
    • The conflict of interest that discloses as nothing

      Martha Rosenberg | Medications
    • 4 fibromyalgia myths the current evidence doesn’t support

      Kayvan Haddadan, MD | Conditions and Diseases
    • Why exhaustion can make you see things that aren’t there [PODCAST]

      The Podcast by KevinMD | Podcast
    • AI governance in health care has to reach the exam room

      Amanda Heidemann, MD | Health Technology
    • The Pennsylvania measles outbreak and the cost of forgetting

      Christine King, CRNA | Conditions and Diseases
  • Past 6 Months

    • Why CDC opioid guidelines get the overdose data wrong

      Richard A. Lawhern, PhD | Conditions and Diseases
    • Retirement isn’t the end of medicine, it’s a second act [PODCAST]

      The Podcast by KevinMD | Podcast
    • Sensory processing in autism and the brain’s volume control

      Josette Pelatan, PhD | Conditions and Diseases
    • What maternity care deserts cost a town

      Manisha Kaliaperumal | Health Policy
    • Why medicine needs a national physician license now

      Vaishali Popat, MD, MPH | Physician
    • A cold cost $945. The cost of primary care is broken.

      Susan Newman, MD | Physician
  • Recent Posts

    • Why exhaustion can make you see things that aren’t there [PODCAST]

      The Podcast by KevinMD | Podcast
    • 3 reforms to counter wellness influencers in practice

      Farid Sabet-Sharghi, MD | Physician
    • Shift work and circadian rhythms shape the 24/7 workplace

      Deepak Gupta, MD | Conditions and Diseases
    • Paid for twice

      Physicians paid for G2211 twice. Most never bill it.

      Michael Duben, MD | Physician Finance
    • The next child

      Medicaid managed care and the case for mutual stewardship

      Steven Merahn, MD | Health Policy
    • Choosing a limb lengthening surgeon requires accountability

      Hrayr Basmajian, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 7 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Retirement isn’t the end of medicine, it’s a second act [PODCAST]

      The Podcast by KevinMD | Podcast
    • The conflict of interest that discloses as nothing

      Martha Rosenberg | Medications
    • 4 fibromyalgia myths the current evidence doesn’t support

      Kayvan Haddadan, MD | Conditions and Diseases
    • Why exhaustion can make you see things that aren’t there [PODCAST]

      The Podcast by KevinMD | Podcast
    • AI governance in health care has to reach the exam room

      Amanda Heidemann, MD | Health Technology
    • The Pennsylvania measles outbreak and the cost of forgetting

      Christine King, CRNA | Conditions and Diseases
  • Past 6 Months

    • Why CDC opioid guidelines get the overdose data wrong

      Richard A. Lawhern, PhD | Conditions and Diseases
    • Retirement isn’t the end of medicine, it’s a second act [PODCAST]

      The Podcast by KevinMD | Podcast
    • Sensory processing in autism and the brain’s volume control

      Josette Pelatan, PhD | Conditions and Diseases
    • What maternity care deserts cost a town

      Manisha Kaliaperumal | Health Policy
    • Why medicine needs a national physician license now

      Vaishali Popat, MD, MPH | Physician
    • A cold cost $945. The cost of primary care is broken.

      Susan Newman, MD | Physician
  • Recent Posts

    • Why exhaustion can make you see things that aren’t there [PODCAST]

      The Podcast by KevinMD | Podcast
    • 3 reforms to counter wellness influencers in practice

      Farid Sabet-Sharghi, MD | Physician
    • Shift work and circadian rhythms shape the 24/7 workplace

      Deepak Gupta, MD | Conditions and Diseases
    • Paid for twice

      Physicians paid for G2211 twice. Most never bill it.

      Michael Duben, MD | Physician Finance
    • The next child

      Medicaid managed care and the case for mutual stewardship

      Steven Merahn, MD | Health Policy
    • Choosing a limb lengthening surgeon requires accountability

      Hrayr Basmajian, MD | Physician

Copyright © 2026 KevinMD.com | Powered by Astra WordPress Theme

  • Terms of Use Agreement
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The functional and professional necessity of detachment
7 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...