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It is midnight, and you are on a labor and delivery shift that will last until 7:00 am. During one labor the baby’s heart rate suddenly drops, and stays low. The mother is pushing as hard as she can, but the baby is still too high to reach with forceps or a vacuum. Anesthesia and neonatology teams are called, and the patient is moved to an operating room for an emergency cesarean section. The baby is delivered, but appears limp, and is soon taken by the neonatology team to another room while the obstetrics team manages the mother’s bleeding and closes the uterine incision. Just as the surgery is completed, the neonatology team returns to tell the other providers that the baby could not be resuscitated, and did not survive. After the mother wakes and has had some time to recover, the parents are informed of their baby’s death. After talking with both the obstetrics and neonatology teams, the heartbroken parents request an autopsy investigating why the baby could not be resuscitated.

It is now 1:00 in the morning, with six more hours left in the shift. The teams meet briefly to debrief on procedural issues, but there is little time to address the emotions team members are feeling about this unexpected loss. Three other patients are still in labor, and will need care in the hours ahead.

Medical care often presents a dilemma to providers and patients alike. On one hand, the potential for intense emotions to arise is high. In office visits, deeply personal issues can emerge around patients’ physical and psychological vulnerabilities, feelings of embarrassment and shame, reverberations of relationships and lifestyles, histories of traumatic experience, and dreams for the future. Such clinical encounters can quickly and unexpectedly reach a level of intimacy usually reserved for our close personal relationships. In hospital settings the likelihood of intense emotions can be even higher as people face matters of literal life and death, evoking emotions of fear and hope, the joy and relief of successful treatment, and the grief of profound loss. On the other hand, medical practice presents a need for clear thinking, rational decision-making, and expert performance, sometimes under tight time pressure. Given these demands, “irrational” emotions can seem like a distraction at best, or even a destructive influence to be suppressed as much as possible.

The aims of this chapter are twofold. First, we articulate the “deep rationality” of human emotions, reviewing theories that emphasize emotions’ evolutionary origins and explaining how emotions help us address challenges faced time and again by our ancestors.1–5 We highlight the widespread interconnections among emotional and cognitive processes, as documented by both neuroscience and behavioral research, showing that emotion, information processing, and decision-making are intertwined for a reason.6–8 Second, we offer evidence-based guidance in managing emotions in a healthy and constructive way within clinical settings, using them strategically to support decisions people can live ...

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