Fight or Flight, or Something In Between

Jennifer L. Lycette, MD


December 14, 2021

On my way to work, I drive by an abundance of water — a bay that changes with the seasons' moods. Some mornings, the wind whips up tall waves, and I grip my steering wheel against the gusts that shake my car. Other mornings, the wind is absent, and the water placid and smooth. On these days, the herons are usually out, balanced near the shallow shores on their thin legs, as still as the water. These are my favorite days.

Something about the herons reminds me of a particular patient. I think about this person, departed from this earth for some time now, on my drive, not sure yet what it is about the graceful birds that brought up their memory.

Later, it comes to me. It is the stillness itself of the creatures. The posture that implies they could take off at any moment but are choosing not to. They are simply there. Present.

Being present in the moment is something I constantly struggle with. Too often in my work, I sense my patients wanting more from me. More time. More options. More results. More answers. More and more and more of the things that they increasingly realize I cannot give them. Not because I don't want to. But because they are not mine to give.

It is hard not to pull away but to simply be with them in those moments. Still like the heron.

But this particular patient didn't want any of those things from me. Instead, I wanted more from them. I wanted them to try the treatments I could offer, but they chose a different path.

"Here," I kept saying. "Here are more and more and more of the things I can offer. This is a cancer we know how to treat."

But they shook their head, and along with it, shook off my words like water.

I think about our human tendencies, the extremes of fight or flight. Is there an alternative, an in-between? If so, what is it?

So often, we assume our patients want to fight." But sometimes, they instead choose to take flight. And all we can do is hope for a strong breeze to carry them on a journey that is out of our hands.

But on my drive, I find myself wondering, Did I miss a way to help my patient find the in-between?

How would we even go about this for our patients?

Perhaps first, we must discover what helps us find the in-between. Yoga, exercise, meditation, writing, art. These are only tools to find the in-between space. They, in and of themselves, are not the space.

Corporations and hospitals have hijacked these things as quick fixes for burnout, but they don't work like that. The tools are not the space; the space is inside of us. That is what they do not understand.

We must protect that space at all costs.

Our patients remind us of this.

My patient didn't need me to help them find that space. They already knew about it. That is what I discovered in writing this piece. It's us, the doctors, that need help finding it.

In my recovery from burnout, I am constantly seeking the in-between space. To relearn another way to exist.

I see the herons on my drive to work, and they remind me.

There is a space between fight or flight.

Follow Medscape on Facebook, Twitter, Instagram, and YouTube

About Dr Jennifer Lycette
Jennifer L. Lycette, MD, is a rural community hematologist-oncologist, mom of three, and recovering perfectionist who's writing her way back from physician burnout, one word at a time. Her essays have been published in The Intima, The New England Journal of Medicine, JAMA, JAMA Oncology, Journal of Clinical Oncology, The ASCO Post, and more. Connect with her on Twitter @JL_Lycette or her website.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.