Last week was particularly stressful; marked by staff shortages, anguished relatives, conflict over complex discharge processes, and pressure to create beds. The amount of time I spent with each patient on my ward rounds was less that what I, or they, would have wanted but despite coming in early and leaving late there are only so many hours in a day. In weeks like these I often feel guilty as I leave work that I am unable to give more time to those patients and relatives facing the end of life.
More than many other people I know, I am acutely aware of the fragility of life.
Modern medicine is amazing and can achieve results and outcomes that continue to astound me. The satisfaction of discharging a patient with a smile on their face after an admission for respiratory failure that looked like it might be their last; or being able to tell a patient that their cancer is curable, is difficult to describe. But even more difficult to articulate is the sense that the days in which I have the greatest impact, the days that are most rewarding are those in which I’ve had to break really terrible news, and have done it well. Such conversations require patience, time, compassion and, I used to think, empathy. I have seen grief, and its many varying manifestations. But being close to grief is not the same as understanding it and I am often aware of the vast distance between myself and a patient’s relative as we sit side by side in a quiet room after I have delivered bad news. What do I really offer in this situation? I try to communicate the medical facts clearly and sensitively, and give patients and families a sense of what will happen next. I feel sympathy, but am unsure whether I can truly say that I empathise. I have limited life experience and, thankfully, very little personal experience of death, and I find it difficult to imagine what grief feels like.
I recently read a powerful blog from a woman who had seen friends, and acquaintances experience grief, helped them through it and thought she understood. Until her father died. “That night I fought off a panicked dream of the earth falling away under my feet. I realized then, that until that moment, I had never had the right to speak.” This acknowledgement that there is a gulf of emotion between seeing and experiencing grief is something others have identified, including physicians.
I hope that I can continue to find the time, compassion and words to help patients and their families through the most difficult times in their lives. But, selfishly, I hope that for as long as possible I maintain a degree of distance and lack of understanding and that I continue to sympathise but not empathise.
“No one ever told me that grief felt so like fear.” C. S. Lewis (1898 – 1963)
drlj 
I experienced this while attending the funeral of a patient of mine. I went to support the husband but found myself feeling out of place. I knew the patient only in the context of her illness; I wasn’t prepared to see her through the eyes of her family and friends. It was quite difficult for me. Ultimately, I’m glad I went but it was a hard thing to get over.
Thankyou for your response. “I knew the patient only in the context of her illness” – this really resonated. When dealing with difficult issues and incurable conditions I think sometimes it’s easier to not look beyond the illness to the whole person. It makes it easier to function as a professional, but perhaps we don’t realise what both patient and doctor are losing.
In the past 3 years I have lost 3 grandparents. There was dementia, heart disease and liver failure. All incredibly hard as they were slow and painful.
My sister is a doctor and is able to distinguish between personal and professional deaths but, like many others, there’s the odd case that gets to her. She deals with it by ensuring she did all she could to get patient through.
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