The pain I feel in primary care is real

Today I lost one of my patients. He saw me in the office for the first time about three and a half years ago. It went downhill after a simple infection, with repeated hospital visits back and forth, and ultimately today, he passed away. He gave a good fight, he had a strong will to live, and he fought hard. When I heard the news, I was at home, and without any warning, I cried. It was only for a few minutes, but I felt pain, the loss of someone I cared about. I remember visiting him in the Icu as many days as I could on my lunch break every day when he was admitted to my hospital, trying to be a familiar face to him in a time of doctors and nurses wearing masks and gowns; unrecognizable. Where you are alone, with family only on a tablet if you are awake enough to participate.

When he finally woke up one day, I encouraged him to try to eat, build his strength, and he joked that he would love a steak dinner when he gets through this. That was the conversation we always talked about, let’s get you better so you can go have that steak dinner.

The pain we feel as primary care is real. It has not gotten easier. Arguably it has become harder as I build more relationships with patients and get to know more about them. Residency and training cannot prepare you for this recurrent loss. It is something we have to work through on our own.

I feel pain when I diagnose a patient with a terminal illness, when a patient becomes homeless, or they undergo other major traumatic life events that we, as primary care doctors, cannot solve. We are there as the continued crutch of support and a familiar face, even as everything else changes. I felt pain when a patient of mine asked to sleep on an exam bench just for 30 minutes because he hadn’t slept for days, afraid of being robbed if he fell asleep outside. It was cold out, and he had nowhere to go. I will never forget that feeling I had.

As a doctor, I remind you: I am human. Sometimes these feelings become overwhelming; it is difficult to “not think about it” when I am at home. An on/off switch does not exist. I often wish I could help in ways more than treatment of conditions and discussing lifestyle changes to lead a healthier happier life. At times I feel helpless. I have heard others mention it’s not our job to worry about these things, which is technically true but difficult to put in practice. It is difficult not to feel concern for our patients’ well-being, and we are often resource poor. Patients are left trying to contact social services and other avenues that are often difficult to connect with. I wish I had more time and resources to help them through these struggles. The struggle of trying to afford medications, and items like a blood pressure cuff and sometimes even food.

I know that my patients who lost their battles and have these struggles will not be forgotten. We go into primary care wanting to help others and make a difference. To help patients live healthier, happier, longer lives. As a primary care physician who truly cares, I hope that I can make a difference in my patients’ lives. It makes the pain that I feel worth it.

Jasmine Toor is an internal medicine physician.

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