Balding, pale as a ghost, thin and frail, a protruding swollen abdomen. She walks in slowly and unsteady, with her family in tow, and is shown to her exam room. I am the medical student working that day with a surgical oncology attendant, a behemoth in his field. They have come here specifically, from states away, for the world-renowned cancer surgeries and treatments offered here … and for a third opinion. We had already reviewed her medical history, lab work, and scans. And this world-renowned doctor had to tell her that he agreed with the previous opinions she had received: She was not a candidate for surgery.
This is the first time I cried in medicine. I could tell just by looking at her that she had only days to live, surrounded by her loved ones, and I couldn’t hold back the tears. I, at least, tried to hide my tears until we left the room, where I went to a corner and bawled, my attending stoic and visibly unshaken.
The second, I had only known her for a day. I was still a student. She was a child in the PICU with a rare genetic condition. She passed away during the night shift. I had not even known her long enough to learn fully about her condition or to get to know her, but I cried. This time, I not only cried, I fasted from solid foods for the next 48 hours, as my own personal way of paying tribute to her life, short but not forgotten.
The third, I was a student on my obstetrics rotation. A mother had arrived in labor. She lived in a rural area and had almost no prenatal care. The little prenatal care she had received showed that the baby had a large mass growing on his face, covering at least his nose and possibly his mouth. Once delivered, the baby would likely not live for long, except on the small but unlikely hope that the tumor was not covering his mouth enough to place an endotracheal tube. The baby was delivered, and as feared, the tumor completely covered his mouth. It would be only moments before he passed away, so his mother was allowed as much time with him as she desired. Most eyes in the room were wet, mine included, as we continued our duties to them both.
I wish these were the only times a patient has died or been terminally ill and that I have cried in medicine. But, inevitably, they were not. I have seen several other patients pass away, several other patients terminal, several other patients healthy one day and severely compromised the next. And each time it affects me, almost as much as the first.
And for this, I am proud. The culture of medicine often teaches us to desensitize ourselves, block it out, compartmentalize, and move on. And, while we do have a duty to continue to treat the patient, consider their family, and then move on to provide the same level of care to the next patient, it is not mutually exclusive to our duty to be human.
As medical professionals, we are tasked with seeing people and their families at their most vulnerable, at their weakest points in life. And we are also tasked with providing what we can to help those individuals, often physically, but sometimes mentally and emotionally.
This doesn’t mean that we should cry in front of every patient or that every clinician has to process their grief in this way. But, it should mean that we should see it as important and healthy for ourselves and our patients, to process these emotions when we feel them instead of trying to block them. We should allow ourselves to be empathetic toward our patients, in all regards, but especially when medicine is not enough to save their lives or cure their illness.
Instead of focusing on keeping calm and carrying on, we should teach students, residents, and ourselves, to focus on the feeling, process the feeling, and use it to really provide the absolute best care and be the best advocates for our patients as we can. I strongly believe this, in turn, makes us better clinicians. To be able to see ourselves and our loved ones in the eyes of our patients makes us better people and better providers.
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