human behavior

When doctors cry

Posted in Health & Medicine, Religion & Ethics by humanb on November 5, 2010

To wrap up my medical education, I’m spending six weeks as a pre-intern working in the geriatrics ward of a Sydney hospital. I had already done a geriatrics rotation, but I love caring for the elderly, so I wanted to do another. Instead of choosing the brilliant male geriatrician under whom I had studied before, I chose a female geriatrician – a painfully soft-spoken woman with delicate features and a Buddhist-like self-possession. I had chosen her because I recalled hearing her struggle with the ethical implications of managing a patient once; so I thought she would be a great doctor from whom to learn about the ethical minefield of managing patients in the twilight of their lives.

Last week during our daily rounds, we paid a visit to a patient who had been in the hospital with us for two long months. She had just celebrated her 84th birthday the previous day. This woman had suffered through countless infections and despite multiple antibiotics, never seemed to improve very much. She was also unlucky enough to develop a severe allergic reaction to an antibiotic we had given her, and had to watch helplessly as her skin peeled off in thick layers from her face all the way down to her toes. Not surprisingly, she grew weary and exasperated with her stay in hospital. By the time we saw her on Thursday, her skin was looking close to normal and she seemed sadly resigned to her prolonged hospital admission. But she hadn’t been eating. And she spoke only when asked a question.

How are you doing today?

Alright.

The female geriatrician examined her, reviewed her blood tests, and then asked the patient’s daughter to come out into the hall with us. She told the daughter that she felt it was time to withdraw the multiple antibiotics and invasive intravenous line that was delivering them. She explained that the best care for her at this stage involved providing her mother with every comfort measure possible. The daughter understood.

After the daughter returned to her mother’s bedside, the doctor turned to us – her team of two junior doctors and one medical student. Her round, brown eyes started to water and redden. She began to sniffle. And her voice quivered when she spoke:

She’s been with me so long.

She didn’t try to hide her tears from us. Far from it, she even asked the male junior doctor to fetch her a tissue. When she first explained to the daughter her decision to withdraw treatment, I was shocked and ambivalent. But it wasn’t until the doctor showed me her watery eyes that I was overwhelmed with sadness.

Is it impractical for her to return home? I asked.

There was a quiver in my voice too. I quickly blinked away the beginning of tears and swallowed the growing lump in my throat.

No, it’s not practical, she said.

As we left the ward, I noticed that the female junior doctor was quiet. I looked to her and she said:

It’s so sad because the doctor is crying.

I thought that was interesting.

It was almost as if we junior doctors had already – and maybe too quickly – become immune to the sadness of a patient’s death. It was as if we needed a cue from the doctor to be sad. Or, maybe we were sad – not at seeing the end of a life – but at seeing human suffering in the form of a doctor brought to tears. We expect them to be stoic about the loss of their patients – especially the 84-year old ones.

Or perhaps we aren’t immune to the death of patients, but rather simply less invested. The senior doctor was the one responsible for this patient’s care. She made the clinical decisions. She was the person most responsible for returning this woman to health. She did her best, and it wasn’t enough.

I don’t know if her tearful reaction was a common one among doctors, but it struck me as unique. It comforted me too. Here was a geriatrician with decades of experience treating people over 65. She would have few patients who lived for more than two decades and many dying every year. But she could still cry.

This doctor impresses me in other ways, too. She always insists on closing the curtains around a patient’s bed when she examines him, while some younger doctors couldn’t be bothered in their single-minded focus to do the job. She’s always touching or holding the hands of her patients, especially the demented ones. She’s always speaking softly, visibly showing her concern, always making time – even to understand the ramblings of a patient who’s become delirious. And she always involves family in patient care – going so far as to invite them behind the curtain to oversee her examinations.

It struck me as interesting then, that she saved her tears until she was away from the patient’s daughter. I think the daughter would have been comforted by those tears. It’s a moving image when doctors cry.

The next day we approached the patient’s room on our rounds only to find the curtains pulled closed.

The patient had just died.

No tears came from the doctor that day. Only the sincerest condolences to a family visibly shaken. The family thanked her for her care and concern. And they meant it.

They knew the doctor was crying too, if only on the inside this time.

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3 Responses

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  1. Touch2Touch said, on November 5, 2010 at 11:14 pm

    A very moving post. A discussion much in the news in the US, where all kinds of long-neglected issues — touching patients in physical exams, the idea of terminal care (vs. heroics) and hospice — are at too long last being aired by mainstream doctors, who are also talented writers.
    If good change is to come about, that’s probably what will spark it, such doubly talented people. Think about it, since you are!
    Judith

  2. humanb said, on November 6, 2010 at 12:07 am

    Thank you for the lovely comment Judith. I’m glad you commented, as you mention a book on your lovely blog that was given to me by a surgeon here in Sydney (Final Exam). It has been sitting on my bedside table for months and I haven’t read it yet. I think I’ll start it this weekend.

    Cheers,

    humanb

  3. Touch2Touch said, on November 6, 2010 at 8:07 am

    From time to time I focus on medical matters in my blog, and I’ve compiled a short list of these amazing physician-writers: Pauline Chen, of course; and Jerome Groopman and Lisa Sanders and Atul Gawande, and the dean of them all, Oliver Sacks. I’m a writer myself, so that part I “get” — but the science (and discipline and drive and knowledge) of the physician is beyond me, so that I admire it enormously. Someone gifted in both areas is blessed.
    I’ll look forward to more of your posts. Judith


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