EP157: Rethinking Emotional Distance: Lessons from Dr. Laurie Lyckholm

The Power of Emotional Connection in Medicine: A Conversation with Dr. Laurie Lyckholm

In this episode of the Girl Doc Survival Guide, Dr. Laurie Lyckholm, a hematologist oncologist, discusses her three-decade journey challenging the notion that doctors should emotionally distance themselves from patients. Despite traditional training advocating emotional detachment as a professional strength, Dr. Lyckholm's experiences and mentors inspired her to value emotional connection in patient care. She shares personal anecdotes from her nursing and medical career that highlight the importance of empathy, active listening, and emotional presence. Dr. Lyckholm emphasizes that emotional engagement can energize healthcare professionals and improve patient outcomes, encouraging reflection and emotional expression as essential components of medical practice.

00:00 Introduction to Dr. Laurie Lyckholm

00:35 Challenging Emotional Distance in Medicine

01:06 The Power of Patient Connection

03:21 Transition from Nursing to Medicine

05:11 Emotional Boundaries and Personal Stories

07:54 The Role of Emotions in Patient Care

13:04 Techniques for Being Present with Patients

16:24 Final Thoughts and Reflection

Transcript

Christine Ko: [00:00:00] Welcome back to the Girl Doc Survival Guide. Today I have the pleasure of being with Dr. Laurie Lyckholm. Dr. Laurie Lyckholm is a hematologist oncologist who spent three decades challenging the notion that good doctors must emotionally distance themselves from their patients. She's received the Gold Humanism in Medicine Award and has mentored countless physicians, and she brings profound insights into maintaining authentic connections while navigating the emotional demands of medicine.

Welcome to Laurie. 

Laurie Lyckholm: Thank you so much.

Christine Ko: Definitely cancer is one of the most scary things to patients. In oncology, I learned as a student, you need some emotional distance. Often in medicine, we think emotional distance is a professional strength. What convinced you to sort of believe the opposite, that we need to use our emotions?

Laurie Lyckholm: Cancer, you're right, it's so scary, and [00:01:00] it's horrible. It can be for many people. And that word just strikes fear in people's hearts. I learned that as a nurse. I trained first as a nurse and worked as a nurse in the ICU, and then in oncology, in bone marrow transplant. I learned early on that the beauty of going to work every day is the leaning in and opening yourself up, and that patients need that connection for healing, and they need it in order to talk with you about their real, deep concerns. As a nurse, I would work 3 to 11 sometimes. I would go by rooms in the evening. There was this one oncologist. I would go by the rooms, and I would see him just sitting in a room just talking and laughing with his patients and their families. I just thought, you know, it's like nine o'clock at night. What's he doing here? He's got to have family at home, and he's got to want to go home and relax [00:02:00] and get some rest. But you could just tell that it energized him. I started thinking that this was this patient fix. That's what I called it. And I tried it as a resident, especially, and it did. You'd be dragging around on call and, you know, it'd been a long day and a long night, and you just admitted your fifth patient on internal medicine. And then you just kind of go in, without any agenda, just pick a patient that you made a connection with, maybe earlier. Go in and sit and talk with them and their families, not about necessarily their problems, but that was okay, too. But take a seat and you would just enjoy it so much and have like a personal conversation, maybe, about something that was going on at home or their grandparents or something, some memory they had that was very entertaining or sometimes it wouldn't [00:03:00] be. It would be some dark secret. All those things really gave you a sense of purpose and really helped you get to know those patients. And out of that, you do get so much energy.

Christine Ko: You saw this oncologist just chatting with patients and really enjoying it. But it also sounds like you enjoyed your job as a nurse. What made you decide to switch? 

Laurie Lyckholm: Oh I loved it! The reason I decided to switch is, at that time, late 70s, early 80s, nurses didn't get to do the things they do now. They didn't get to learn the things they learn now. They didn't get to read X rays and feel people's livers and look at EKGs and those kind of things. It was much more limited, and I met this medicine chief resident when I was working in the emergency department as basically an orderly. He worked nights on the weekends. Whenever he came in, I [00:04:00] was so excited because he treated me like a colleague. He treated me like a resident actually. And he would take me up to the. radiology department to look at X rays. He would show me how to palpate something that was unusual or not, or sometimes it would just be, this is how you do this. He loved to teach, obviously. And I thought he was just amazing. His name was Ed Schafer. He's a wonderful gastroenterologist at University of Nebraska. And I wanted to be like him. I wanted to know the things he knew, and I would start to watch the doctors, and I would listen to things they talked about. I love nursing. I love the closeness with the patients and all the time you could spend. I love my nursing colleagues. Still some of them, we're still on best friend basis, but I wanted to know more. And in nursing at that time, it was really hard.

Christine Ko: Yeah. So it sounds like it's your own desire. [00:05:00] It sounds like you're very curious, intellectual, thoughtful person, but also you had some great mentors and teachers who you wanted to kind of be like. So that's cool. Is there a particular encounter or event that challenged your own emotional boundaries and taught you something?

Laurie Lyckholm: Oh my gosh, so many. When I was a brand new nursing student, the first night that I worked, I worked up on the orthopedic unit. And there was an very elderly lady, and she was just screaming in pain, screaming and screaming. And I just fell apart. I had never really been in a hospital. I'd never been around patients. And I just decided then and there I was going to quit. I was going to go talk to the nursing instructor that next day. And I did. And she was awesome. And she said, Laurie, you know, I get it. It must [00:06:00] have been really hard. But when you encounter issues with patients where they're in a lot of pain or they need something really badly, and you feel like you're going to pass out or cry or both. She said, don't think about meeting your own need. You have to think about meeting the patient's needs at that time. You can go home later and fall apart, and that's fine, and you need to go home and take care of yourself, but at that point, you need to take care of the patient, and if somebody is screaming in pain, you need to focus on that. And she said, don't quit, and it was really helpful. I've thought of that many times when I've had those kind of critical incidents. 

The other one was a young woman named Julie, who I'll never forget. She had acute leukemia, and I was an early oncologist at the time. I was a staff oncologist. And you know, you fall in love with your patients. I fell in love [00:07:00] with this patient. I've fallen in love with many patients. You just love them. She was a young woman who was just on the brink of graduating. She really fought, and she really did everything possible to get well from this leukemia and her family was very supportive. Eventually, she got sicker, and she got septic, and she had to have bilateral amputations because of gangrene. That was probably one of the hardest things, the morning she was going into surgery. Sometimes there's just no place to put that. There's no place to go and say, well, that happened. I'll just, I'll never forget. I think of her even now, 20 years later, I think of her a lot. 

Christine Ko: Thank you for sharing. Clearly, it has affected you. Even now, it affects you. It sounds like your emotions are useful to you. I cry very easily. If I'm crying, [00:08:00] people will say that I'm too emotional. I do think that the way that I was taught was to be detached and not let my emotions sort of get the best of a situation. You're not supposed to share your emotions. Even if I am sad for a patient, you know. I think all of that is to prevent someone from saying, oh, well, you're being too emotional. And so, do you have a response for that? 

Laurie Lyckholm: If you look at it from 5000 feet, what if you are emotional with a patient? It didn't distract from you taking care of the patient. It actually signaled them that you were really empathetic with them, that you really cared a lot about them. Knowing that somebody cares about them and thinks about them and feels about them, it just seems like it helps a patient. I think people kind of feel that if they let down their guard that somebody will [00:09:00] take advantage of them. Or they won't be able to think straight because they're too emotional. And that doesn't hold much water for me whatsoever.

Christine Ko: Yeah. It seems like there are mixed messages in medicine about emotions. At least in my training, the predominant one being that we shouldn't let our emotions get involved, and we should have a guard up. At the same time, I think that patients just want us to care. I think particularly oncology patients. I've been an oncology patient myself. I want my doctor to care about me. I don't want them to just be kind of clinical. 

There was a Stanford study, I think, that showed that when you suppress your emotions, you're less effective. Your thinking actually is worse than if you accept and recognize your emotions. Emotions are actually transient. So they only last for like up to 90 seconds. So, if you sit with it, you actually don't fall apart. If you suppress it, and you stop [00:10:00] realizing really what you're feeling, that's actually when it ultimately piles up and sort of takes over without you even really realizing. My training didn't teach me that.

Laurie Lyckholm: Yeah, there's that whole concept of equanimity, to remain detached. The famous Hopkins physician. 

Christine Ko: Dr. Osler?

Laurie Lyckholm: Yeah, Osler. He was the equanimity guy. It didn't mean that he didn't care. It just meant that he was detached. Which is a very interesting paradox. Trying to suppress things. First of all, I have two thoughts about this. One is, it's distracting, like what I heard you say. Trying to suppress emotions, or suppress the expression of emotion, is distracting. And the second part, I don't want to sound too suspicious. But, is it a man woman thing? Is it like this, don't be histrionic? 

But I've seen plenty of men cry, men doctors, and men nurses, [00:11:00] and men APPs, and every other kind of male provider.

Christine Ko: Yes. I do think that women, as a stereotype, are seen as more emotional than men, sort of in a negative way, right? That women are seen as, Oh, you're being too emotional. We're just like not thinking properly. I think that there is a gender nuance sometimes to when I do want to express emotion.

Because I am female, and so it's sort of like, Oh, well, you're a woman, and that's why you're being too emotional, in the negative sense, rather than like, Oh, well, yes, you're a woman, and maybe that's why you're emotional, and actually, maybe that's really a strength that we should all learn from to be able to name and use our emotions as data to make us more effective.

Laurie Lyckholm: I agree completely. Being [00:12:00] empathetic. That's a big part of being a good health care professional. It makes the world of medicine so much richer. Being able to talk to your colleagues about how you feel, being able to talk to other people about it and it not being taboo to talk about your emotions at work. I think that's really important. Seeing people in like true dire straits and true pain and true suffering, on the oncology unit and elsewhere in the hospital. Not just physical suffering, but existential. Being able to talk about it with other people helps so much. And if somebody puts a barrier on that, I don't know that that helps anybody.

Christine Ko: Yes, because I think you're touching on the fact that when we suppress our emotions, we can't really sit with someone else who's expressing emotion. Especially oncology patients, cancer patients, there can be a lot of fear, other emotions. Do you have methods or [00:13:00] techniques for being present during difficult patient conversations?

Laurie Lyckholm: Learning to listen, actively being present,. just noticing the patient and using everything. Using silence as something that's really important for patients. Eye contact, touch. When you're talking with somebody, listening at least five to one, you know, five parts, listen, one part, talk.

Christine Ko: I like how you said it. Try to listen more, really think about body language, try to use silence, really be aware of the patient. Earlier in my career, I think a lot of times without being aware of it, without realizing, I was in my own head, a lot of the time. We have to check off all these boxes, the computer might be down, or maybe I'm running late. Maybe I'm hungry. Maybe I'm tired, as well. Maybe the patient before was unhappy with me for whatever reason. There's that tension again, where Dr. Osler was the [00:14:00] one, you leave your emotions outside the door, and I think he was right in the sense that I shouldn't bring all that baggage of being tired and stressed and hungry and sort of worn down by a difficult patient encounter, you know, right before. I should go in as fresh as I can and really be present for the next patient in the room.

Laurie Lyckholm: Oh, I love that. 

Christine Ko: It goes along with what you said. You have to really have the awareness. 

Laurie Lyckholm: Oh my gosh. I was just thinking, as you were talking about that, being in your head. Sometimes you go in and you are listening to a patient's lungs and their heart, and you're in your own head instead. You have to go back. I have had to go back and say, could I listen to your lungs again? I, I was thinking about this instead of really listening to your lungs. And they always just laugh. They're like, sure, listen away. I'm sure there are ways of being much more focused. Maybe [00:15:00] that's a good reason to learn meditation and those sort of things where you train your head or in your brain to be much more focused on the minute. 

Christine Ko: Yeah. Being with a patient in a clinical encounter is actually not really any different than any other relationship, you know, any other serious conversation that we're having. Those same skills that we use in daily life where, am I really listening to this person? The skill we've learned throughout our life of being able to connect with someone or not. I will say that before I really started thinking about all of this stuff and eventually starting this podcast, I would not say that I was very skilled at connecting with people.

Laurie Lyckholm: I think you're really skilled. I'd like to know your secret.

Christine Ko: Thank you. One of the reasons I'm continuing to talk to people on this podcast is because it Is meaningful to me to hear a little [00:16:00] bit of your story and to emphasize that you care about this stuff. There's someone else that cares about and believes in using emotions to benefit us in medicine. It's a learning experience and journey for me still. Your insights are really important.

Laurie Lyckholm: Thank you. 

Christine Ko: It really has been a pleasure to talk to you. Do you have any final thoughts, anything you would like to say? 

Laurie Lyckholm: I have loved talking with you. This was wonderful. I know I'm going to be reflecting on this. Reflection is really important, whether it's just thinking about things or whether it's written reflection, or whether you reflect in your painting or dancing or music or whatever. 

Christine Ko: That is a really great final thought. We really do need to be reflecting. Sometimes the most profound things sound so simple but because of the pace of medicine and all of these [00:17:00] things on my to do list, a lot of times I'm like, I don't have time to think. Thank you. 

Laurie Lyckholm: Thank you.