To be a doctor is to confront suffering, violence and death, and in order to handle such daily confrontations, we are all trained in medical school and beyond to suspend emotional involvement. This is a matter of survival in the medical profession. In the wake of violence, we have to separate ourselves a bit from the constant onslaught of trauma we encounter, or we would fall apart. We are taught to put emotions aside, to some extent. Emotions, according to medical training, get in the way of practical and logical thinking.

But doctors are also humans, and to be human is to feel emotions, both good ones and painful ones. While I understand the logic behind a certain level of emotional detachment to better handle the most urgent and upsetting of medical situations, I also believe that emotion, empathy and compassion can, and must, be a part of effective care. In the wake of violence, without emotion, without compassion and empathy, doctors—or any of us—become detached. Detachment makes suffering, violence and death easier to bear, but it also makes them seem more normal, even more acceptable. The result can be a shrug of the shoulders, a “that’s just life” approach, and that is not a point of view that will lead to the solutions our world needs right now.

I had a patient come into the office feeling anxious, with her heart pounding. She was a bit dehydrated and very thin. She looked exhausted. I examined her and at first glance, she seemed like someone with hyperthyroidism or possibly a GI bug that would be associated with vomiting and diarrhea. However, when I asked her some questions about her life, I realized her diagnosis was much simpler. She was a physician working the night shift in the Emergency Room in the middle of a large city, and although she was quite competent at her job, her nightly work life was filled with trauma, accidents, overdoses, rape and a lot of death. It quickly became apparent that her physical symptoms were the result of her emotional reactions. When she heard about the two mass shootings that recently happened within 24 hours and saw the photos and videos of the distraught friends and loved ones of the victims, it put her over the edge. It was too much—the proverbial straw that broke the camel’s back.

We talked, and she told me she needed to get away from death for a while. I thought this was an excellent prescription for her, but what impressed me the most was that she was not detached. As a doctor, in the wake of violence, she took on the emotional weight of her patients, and of all victims of trauma and tragedy. It might not be the approach taught in medical school, but it was a reaction that did not discount or trivialize suffering. I couldn’t help thinking, “This woman needs a break, but our world needs more of what she has.”

In the last few years, I have seen a dramatic upswing in patients coming to see me who are unable to sleep, who are experiencing heart palpitations, who have shortness of breath, and who say they feel an overwhelming sense of doom. But I’ve also seen something else happening in the world around me, and I believe it is a backlash to all this emotion. I have noticed that more and more people are putting emotion aside, toughing it out and beginning to express that the violence in our society is starting to feel more normal. The initial shock of violence has been supplanted by its regularity and frequency. It seems to me that the more lives are lost, the more our collective empathy has dulled, and our hearts have become hardened.

As a cardiologist, the irony doesn’t escape me. A hardened heart, literally, can be a death sentence. The arteries harden, stiffen, become less soft and flexible…and when those chunks of hardened plaque break loose, they can block the blood flow and cause a heart attack. And that may be the end. 

In the same way, I can’t help thinking that if we harden our hearts too much against human suffering, that will be the end of us. What are we without compassion? Who are we without empathy? I understand that we cannot live in fear. I understand that the places many of us have always considered parts of our lives, even sources of joy—shopping malls, concerts, restaurants, movie theaters, nightclubs or just plain old Wal-Mart—now seem menacing in the wake of all the bad news. It can feel like detachment is necessary for survival.

But just as I believe doctors need both compassion and clear heads to practice medicine and save as many people as they can, so do I believe that humans need both compassion and clear heads to step up and do something about a societal conundrum that has become untenable.

I think about it just like you probably do. When I drop my son off at school or I enter an airport, shopping mall or a movie theater, I often think, “This could be it.” But without empathy for every single victim and for every single person who loved every single victim percolating down through our hearts and souls, we will become hard, and we will become detached, and we will lose our humanity. It’s natural to fear for your life and for the lives of those you love, but it is also natural to look outward and feel for the losses of our fellow humans. In the wake of violence empathy is what makes us human and enables us to get through this together. We need thoughts and prayers, yes, but we also need emotion that spurs us to action.

As I have been traveling the country, assessing many of the health situations that have become part of our health-care crisis, with chronic disease, obesity, diabetes, heart disease, stroke, COPD and opioid abuse topping the charts, it is empathy, not medical training, that drives me to keep wanting to care for others and change the world. It is empathy that helps me to see that in the national conversation about psychiatric issues, it is not just those of the perpetrators and the victims that are relevant. It is the psychiatric issues afflicting families, caregivers, doctors, patients, leaders, followers, indeed all Americans. We are in crisis. We are psychiatrically unwell at a national, perhaps even an international, level. It’s easy to see why, but it’s also easy to see what a dire prospect this is for our collective future.

Politically, I think most of us feel that something has to change. We want action. Intellectually, I think most of us know that what is happening is unacceptable. We want a solution. But emotionally, where are we? The survival instinct may be telling us to move on and make everything okay in some way, to detach so we can participate in life without feeling traumatized. But there is a line somewhere—a line where compassion meets rationality. A line where empathy informs action. This is the line where I believe we need to stand, in our collective humanness. This is the line with the clearest view to a solution, whatever that may turn out to be.

I don’t pretend to know the answer, or even the exact cause, but I know that arguing about it won’t fix anything. What I do know is that in no other part of our lives do we all become the same more so than in the confrontation with death. If this is where we need to go to have a common vision, then let’s go there. Let’s walk that line together.