The emotional toll of empathy in emergency medicine

Emergency medicine is a career defined by its urgency, unpredictability, and intense human connection. But for those of us who work in the emergency department, it’s also a career shaped by the weight of the people we’ve cared for—the ones we’ve saved, the ones we’ve lost, and the ones whose stories stay with us long after our shifts end.

When I talk with colleagues about stepping back from clinical responsibilities, one sentiment often emerges: Our patients never truly leave us. Every time I sit down to document a new patient interaction, it feels as though I’m opening a box filled with memories of previous patients. Patients from medical school, from residency, and even from last week are all there. I remember their voices, their tears, their families, and even their final breaths. These memories have shaped me, but only because I let them.

In emergency medicine, no one is immune to the emotional impact of the job. Every physician has pronounced a child, a mom, a friend. These moments become part of who we are. We tuck them away to function, much like an old school we no longer visit but that remains a part of us. Each hand we’ve held, whether we saved them or let them go, contributes to our identities—not just as doctors, but as humans.

Yet, in suppressing these emotions to keep functioning, we risk doing ourselves harm. Ignoring the humanity of what we do—seeing medicine as “just a job”—shrinks us. It diminishes the emotional depth that makes us compassionate caregivers. Keeping those feelings inside takes a toll, mentally, emotionally, and physically.

As my colleagues over the years know, I cry. I have mascara that can withstand two cries per shift. My mission was always to take a moment afterward and help everyone involved in tough situations to decompress—to feel, to grieve, and to process. We need people on the front lines, physicians and staff who haven’t succumbed to compassion fatigue, because someone is always having the worst day of their life and needs us to stand by their side.

One patient visits my heart frequently. During my residency, I cared for a young woman with lupus on dialysis. For months, I poured my time and newfound skills into keeping her alive. I performed countless procedures and had many heartfelt conversations with her. Toward the end of my ICU rotation, I walked in one day to find her reading to her five-year-old son. She was leaving the ICU, heading to a medical floor, and soon to be discharged.

Months later, I was working a shift in the emergency department when a young female came in coding. I ran the code, trying everything I could to save her. But it became clear she wouldn’t survive. A paramedic handed me the patient’s medication list, topped by her name, and the horrific connection was made. She was unrecognizable, bloated and worn, and I couldn’t save her this time.

Every time I “open the box” to care for a new patient, she’s there. I’m grateful for the extra time I was able to give her with her son, but her, and his, loss—like so many others—stays with me.

This is the paradox of compassion fatigue. It doesn’t mean we don’t care; it means we care so deeply that we need to protect ourselves. We build walls to survive. We create boxes to keep from drowning in a pool of ghosts. We move on—not because we didn’t care, but because we have to. We need to be present for the next patient. We need to have something left to give when we go home to our families and ourselves.

Compassion fatigue doesn’t mean we’re broken, and empathy is far from a sign of weakness. Choosing to redirect that compassion toward ourselves and our loved ones is an act of strength, even if it goes against the norms of our training. As physicians, we are molded as “residents,” with our minds and hearts rooted in the hospital. Shifting that focus is a deeply personal decision, one that exists on a continuum—and only we can determine when and how to make it.

Maureen Gibbons has transitioned from a fulfilling career in emergency medicine to one where her skills, training, and passion for teaching yield unparalleled returns—physically, emotionally, and financially.

With over 25 years of mentoring experience across her roles as an athletic trainer, triathlon coach, sports nutritionist, and physician, Maureen founded Active Medical Solutions, a lifestyle medical practice. She also developed a simple yet powerful EMR designed for asynchronous care.

Dr. Moe’s own journey—marked by both successes and setbacks—has created a space for her to guide physicians and other high-level professionals toward improved health and transformative career paths.