By: Eric Warm MD, Nicole Damari MD, Kate Jennings MD, Christine Zhou DO, Bi Awosika MD, Leslie Applegate MD, Danielle Clark MD MEd, Jackson Hearn MD, Matthew Kelleher MD MEd, Ben Kinnear MD Med, Salima Sewani MD, Stephanie Thomas MD, Danielle Weber MD MEd
Following the lead of John Koenig’s work, The Dictionary of Obscure Sorrows, our writing group recently presented a list of neologisms in the blog post entitled The Cincinnati Dictionary of Unspoken Moments in Health Professions Education, inventing terms to encapsulate medical experiences that lacked language.
Among the words formulated during our creative process were rishbar and jouraménager, two words that sparked vibrant debate about inclusion and resonance:
- Rishbar (reesh-BAR): The feeling when you break someone’s ribs during CPR for the first time, hearing the crackcrunchbreak, but knowing you must continue.
(Etymology: From Aramaic “raish,” meaning first or initial, and “shabar,” meaning to break.)
While editing our list back and forth via email, we found ourselves conflicted about including rishbar in our project—was it too graphic? Too painful for public consumption? While all of us recognized the experience at the heart of this term, some of us felt that we needed to be careful what terms we included, because of the potential to cause harm to our readers. Reflecting on this tension, we recognized a related phenomenon- represented in another neologism:
- Jouraménager (zhure-ah-MEH-nah-zhay): The carefully constructed retelling of one’s day to a loved one, crafted to bridge the gap between the intense reality of a medical professional and the gentler world of a non-medical listener. Sometimes we do this to protect others, but we also do this to protect ourselves from the loneliness of seeking out a connection that the other can’t provide due to lack of understanding.
(Etymology: From French “jour” (day), representing daily experience, and “aménager” (to arrange or adjust), symbolizing the tailoring of narratives.)
As these words were created, an email thread among our group offered a compelling snapshot of the tension inherent in capturing the unspeakable truths of our lives as medical professionals. As the email discussion unfolded, it became clear that our struggle wasn’t merely about the words themselves but the competing imperatives of our work.
Rishbar, with its visceral brutality, resonated deeply with some—acknowledging the unfiltered reality of medicine. Others felt its inclusion risked alienating readers or crossing a line of shared vulnerability. Conversely, jouraménager symbolized the artful concealment many of us practice daily—a way to sanitize our truths for the comfort of others, yet a reflection of emotional labor that’s no less significant.
It’s this tension—between rishbar and jouraménager—that feels emblematic of the unique dualities we navigate daily.
The Core Conflict
The core debate boiled down to questions like:
- What is our responsibility to our readers—especially those outside medicine?
- Are we obligated to soften the edges of our experiences for public consumption?
- Does omitting certain realities, like rishbar, contribute to the ongoing erasure of medicine’s emotional toll?
One sentiment emerged repeatedly: these choices are active. To exclude is a decision, as is the choice to present an idealized or sanitized view of medicine. For some, excluding rishbar felt like silencing a part of themselves—a suppression that mirrors the broader emotional costs of their work.
Living the Space Between
Perhaps most of us, whether consciously or not, exist in the space between rishbar and jouraménager. The former confronts us with the raw, unvarnished truth of what it means to be a healer in an unkind world. The latter allows us to tuck away parts of that world, constructing a version of reality that we can safely share without burdening others.
Questions
1. How do we choose what parts of our realities to share or hide?
This question sits at the heart of the balancing act that medical professionals perform daily. Whether in patient care, teaching, or personal relationships, there is always an implicit decision-making process about what to reveal and what to withhold. For many of us, this choice is guided by the audience: a colleague might appreciate the raw truth of a medical experience, while a non-medical loved one may only need a sanitized version.
The process of choosing is influenced by multiple factors:
- Empathy: We often hide the harsher aspects of our day to protect others from distress. For instance, recounting the visceral moment of a failed resuscitation might feel too heavy for a partner or friend who has never encountered death so directly.
- Professionalism: Sharing too much, particularly with patients or the general public, risks crossing ethical or professional boundaries.
- Emotional safety: Sometimes, we hide truths not for the listener’s sake but for our own. Naming a painful experience makes it real, forcing us to confront emotions we might not be ready to process.
Yet, these choices can also be fraught. What is left unsaid might create distance or misunderstanding, particularly in relationships where connection relies on openness. Striking the balance between transparency and protection requires constant navigation—and sometimes, introspection about why we feel compelled to hide certain truths.
2. What happens when the choice is taken away—or when the weight of sanitization becomes too heavy to bear?
In many ways, the ability to choose what to share is a privilege. When that choice is taken away—perhaps through a moment of unintentional disclosure or when someone demands more openness than we’re ready to give—it can feel exposing and deeply uncomfortable. Imagine a patient’s family member pressing for details about a grim outcome, or a loved one intuitively sensing when a vague “it was a tough day” carries a heavier truth. Being forced into vulnerability can leave us feeling raw and unprepared, amplifying the emotional toll of an already demanding profession.
On the other hand, the deliberate act of sanitizing our realities, while protective, can also become burdensome over time. The more we curate our narratives, the more effort it takes to maintain the facade. For many, this weight is compounded by the need to sustain the appearance of resilience—both for ourselves and for others who rely on us. Over time, this suppression can manifest as burnout, emotional exhaustion, or a sense of isolation.
We also choose things to share or not share based on assumptions. We assume we need to protect whoever is receiving the story (the reader, our families, the patient) or we need to keep it from them for some reason. We also assume it is protective at all. But just as us choosing to share is a choice, so is the receiver’s decision to listen/engage. Jouramenager is not just choosing for yourself, it is also taking away the choice to engage from the receiver.
When the weight becomes too heavy to bear, the consequences are profound. Relationships may suffer as loved ones sense the disconnection. Within ourselves, the lack of an outlet for processing raw experiences can lead to a backlog of unresolved emotions, making it harder to perform the very work we are trying to shield others from. In the worst cases, the pressure of maintaining these boundaries might contribute to moral injury or even mental health crises.
The Takeaway for Educators: Guiding Learners Through the Currents of Sharing and Hiding
As educators, our role isn’t just to impart knowledge but to create a safe harbor where learners can navigate the complex emotional waters of their profession. Teaching medical trainees to balance what they share and what they withhold requires understanding, empathy, and intentional guidance.
First, we must recognize that learners are often grappling with their own versions of rishbar and jouraménager. They may be processing their first encounters with life-altering moments—breaking ribs during CPR, delivering bad news, or witnessing profound suffering—while also grappling with decisions on how to share their experiences with others. These moments are formative, and how we as educators respond can shape their ability to process and grow.
To support learners:
- Normalize the Tension: Help them understand that living between these two extremes—raw honesty and emotional curation—is part of the professional journey. Share your own experiences, both when you’ve chosen to reveal the raw truth and when you’ve opted to protect others (and yourself) by holding back.
- Create a Safe Space: Provide environments where trainees can safely express the unsanitized realities of their experiences. Debrief difficult cases with empathy, allowing them to explore their emotions without fear of judgment. Remind them that there’s no shame in needing support for the weight they carry.
- Teach Narrative Flexibility: Guide them in tailoring their narratives to different audiences. Model how to ask at what level their listener wants to engage with the narrative and/or how to share enough truth to connect, without overburdening others—or themselves. This skill not only preserves relationships but also fosters resilience in their professional lives.
- Address the Risk of Suppression: Help learners recognize when the act of hiding their truths begins to weigh too heavily. Encourage them to seek appropriate outlets—whether through mentorship, peer support, or personal reflection—to process their experiences before the burden becomes unmanageable.
Finally, frame this journey as a part of their growth—not a weakness to overcome but a skill to cultivate. By equipping learners to navigate the space between rishbar and jouraménager, we prepare them not only to thrive as medical professionals but also to build meaningful, authentic connections in an often unkind world. As teachers, our role is not to dictate how much they should share or hide, but to empower them to make these choices with clarity, care, and compassion for themselves and others.
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