In 2016, Lauren Gambill wrote on KevinMD about being told, “She is not yours to grieve,” after a patient’s death. The message was clear: Grief was weakness, and physicians were expected to suppress it. Nearly a decade later, Arthur Lazarus argued that medical training does not change personality; it reveals scaffolding. He cited a “Blue Bloods” episode where Danny Reagan dismissed a racist watch leader and former cop with the blunt assessment: “He just wasn’t the man for the job.” Professions do not create character; they expose it. Under pressure, some structures bend, others crack.
That scaffolding metaphor resonates deeply with me. The keel is strong, the hull and bracing are live oak, and the captain is a character. Professions do not build ships from scratch; they test the hull already laid down. A weak keel splinters in the storm. A strong keel holds, even when the waves batter the sides. Live oak resists cannonballs. Training may add sails and rigging, but the voyage depends on the captain’s compass.
Too many of my civilian chiefs were Captain Blighs: rigid, cruel, transactional. I chose instead to be “Lucky Jack Aubrey,” leading with competence, humor, and resilience. That difference is the hallmark of empathy.
The hallmark of empathy
I learned this distinction not in medical school, but in life. During fellowship, I saw my three extremely premature sons, a 20-week singleton and 22-week twins, lying on white chucks. The singleton had gastroschisis, a condition that would have caused excruciating pain had he lived closer to term. The physicians thought they were doing me a service by showing me. It had the opposite effect. That moment taught me that detachment must never define how we treat other humans.
It explained my reaction. Earlier in Minot’s Level 2 nursery, I baptized premature infants after calling off resuscitation. The Lord told me “no” when I asked for His divine assistance.
It explained why, when the Lord said “yes” and gave me the power and skill to save a premature infant, I insisted the nurse take a Polaroid for the parents before I inserted umbilical catheters for transport. Parents deserved to see their child alive before the tubes and wires. That was empathy in action. I informed them of the need for transport to a NICU downtown, and I came back to inform them that the transport was successful and that the neonatologist would call them soon.
Detachment vs. presence
Detachment is necessary in making decisions. But detachment must never define presence. My upbringing taught me compassion and inoculated me against the coldness of detachment. I can decide with clarity, but I must act with humanity. That difference keeps medicine from becoming machinery. It is what separates human physicians from artificial intelligence. AI can calculate, but it cannot feel. Humans can compartmentalize, apply detachment to decisions but empathy to relationships. That duality is our calling.
“Star Trek: The Next Generation” staged this tribunal decades ago. Commander Riker was forced to argue that Lt. Cmdr. Data was property, a thing to be dismantled. Captain Picard stood and declared otherwise: Data was sentient, capable of growth, and, through evolution, capable of emotion. Later, “Voyager’s” Doctor demanded recognition as more than a hologram, and in “Prodigy” and “Starfleet Academy” the same philosophy continues: Empathy and dignity are not optional. They are the keel. Starfleet recognized that tools can evolve into teachers, and that dignity must be extended even to holograms.
Medicine faces the same choice: Will we treat grief, personality, and patients as things to be managed, or will we recognize compassion and humanity as the keel of our profession?
A choice of leadership
The culture of medicine has long erred on the side of Bligh. Rigid chiefs, transactional leaders, and a hidden curriculum that equates stoicism with strength. I have experienced my share of Blighs. Gambill’s essay shows how grief is suppressed. Lazarus’s essay shows how personality is distorted. My own witness shows what happens when detachment is misapplied: Physicians are left isolated, families are left unseen, and patients are reduced to cases. The cost is measured not only in burnout but in dignity lost.
But there is another way. Aubrey’s way. The keel is strong, the sides are live oak, and the captain is a character. Leadership rooted in empathy inspires loyalty, resilience, and trust. It is the difference between a mutiny and a crew that fights through storms and has the confidence to fight a larger and more potent foe. It is the difference between a family abandoned in grief and a family given a Polaroid of their child alive. It is the difference between medicine as machinery and medicine as sanctuary.
Detachment may guide the decision, but empathy must guide the presence. That difference is what keeps humans human. It is what keeps medicine humane. And it is what will determine whether our profession splinters under pressure or holds fast in the storm.
Ronald L. Lindsay is a developmental-behavioral pediatrician.
