by Nancy Rappaport, MD
In order to be truly effective in our work, we physicians need to conduct our own personal exploration, take time for introspection, and replenish our personal reserves. Part of our job is to balance the demands of our work (be they finding a cure for cancer, caring for terminally ill patients, solving the problems of healthcare or delivering twins—whatever our calling may be) with caring for ourselves. This involves both introspection, and keeping a reserve, possessing enough mental, emotional, and physical energy to stay clinically competent and present.
Self-knowledge is essential if we are to be fully present to ourselves, and ultimately to our patients, no matter in what field of medicine we may practice. There is freedom that comes from understanding the way that our past shapes our responses to others; our task as doctors is to broaden our understanding of the ways we make meaning of our experiences. This insight can help to give us credibility with our patients, it is not always what we do but how we listen to each other that cultivates healing.
Possessing a keen awareness of our reactions and how our deeply held beliefs and behaviors affect them allows us to listen more acutely. From this self-reflection we draw a curiosity about our patients, and an openness that will help us to be more present and emotionally available to them, to more clearly hear their sorrow and joy in order to provide them with sustained comfort.
Rita Charon, an eloquent professor of narrative medicine, expands on this idea, saying that, “Reflecting on practice can grant to doctors time’s ultimate dividend-second sight.” and, “Like their patients, some doctors have learned that it helps to represent, in words, what they go through in practicing medicine. Such writing helps them to comprehend both their patients’ ordeals and their own lives with the sick. By rendering whole that which they observe and undergo, doctor-writers can reveal transcendent truths, exposed in the course of illness, about ordinary human life.”
Writing my memoir In Her Wake, I explore my mother’s death by suicide from the perspective of a daughter seeking answers, desperate to know something of her mother, and as a very present mother of three closely loved children, now teenagers, and finally, as a doctor working with teens confronted with deeply disturbing challenges. Having lived through this loss with its sense of betrayal, and ultimately healing, I have studied and worked with understanding how children make sense of a complicated world. As Jung explains in Memories, Dreams, Reflections, “Clinical diagnoses are important since they give the doctor a certain orientation; but they do not help the patient. The crucial thing is the story, for it alone shows the human background and the human suffering, and only at that point can the doctor’s therapy begin to operate.” Exploring my own story has added a depth and clarity to my work as a therapist.
Giving of ourselves is essential to a doctor’s work, but in many ways realizing our limitations and recognizing our exhaustion is most important if we are to effectively take care of our patients and sustain our passion. It is when we neglect ourselves that potentially fatal errors can occur; asking for help and realizing when we’re over our heads are crucial to our performance and maintaining our humanity.
And then there are the times when we may struggle to be compassionate. Maybe it’s the alcoholic man, bloated with cirrhosis of the liver, lying in bed and demanding we help him at three in the morning. Or maybe a parent who burned his child. We may feel disgusted or shocked; we are human after all. There will always be patients who are challenging. Ideally, we want to understand our responses and uncomfortable reactions in order to remain truly attentive and supportive to our patients.
I’ve learned to recognize when it is critical to take care of myself, and I encourage all doctors to develop a pattern of self-care. It’s necessary to prioritize time for family and for ourselves, allowing us to preserve our deep love for our healing craft, and the energy to keep doing it. Whether it’s getting a massage, taking a run, meditating, having a special dinner, blowing bubbles, or flying a kite, these activities sustain us. When we stop caring about our patients and begin to feel irritable and overburdened, this is a signal to replenish ourselves, to nurture our capacity to care deeply.
Nancy Rappaport is the author of In Her Wake: A Child Psychiatrist Explores the Mystery of Her Mother’s Suicide and is an Assistant Professor of Psychiatry at Harvard Medical School.
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