When i was doing my geriatrics rotation last year, i was supposed to do my palliative medicine rotation along with it. Somehow i missed the entire week of palliative teaching/clinical sessions. I was away for one reason or another. I did not mind because i did not think i missed much. Then i did a general surgical elective. For some reason, i dealt with a lot of dying patients in that hospital or maybe it is because of the festive season?? I saw so many oncology patients that required palliative surgery or had failed curative surgery.

There was a patient with gastric cancer (i have never seen so many people with gastric cancers in my life); she was dying. But she fought on, and she held on for more than a week. Then there came a night when you know it will be inevitable. I was with the team on our evening ward rounds. Her family was there. Her youngest daughter was there. Her daughter was holding her hand. She was semi-conscious, and whenever she could speak, she could only talk about the pain she was having. We were already loading her with morphine and the oxygen therapy she was getting was not improving her saturation levels. The daughter saw us and asked us if we could do something about the pain. Her voice broke in the middle of the sentence and she started tearing.

“Please…please can you help my mother? I know she is dying, but it hurts me to see her in so much pain. Can you do something about the pain? Please?”

The grief was evident on her face. I felt sickened. I have seen patients cry; i have seen them receive diagnosis of terminal illnesses. But i can tell you now that witnessing the pain of the patients’ loved ones is a far worse experience. It isn’t about the tears; it is about the grief. It is so palpable that sometimes i wished i was covered by an impenetrable barrier that can protect me from these emotions. I felt like tearing on the spot. I was sad and angry with myself at the same time.

I am a medical professional. Death is part of life. I must be able to deal with it. I must be able to detach myself. I am a robot. I kept chanting to myself. In the end, i forced myself to look away and think medical stuff, think about the patient’s lab values, think about how we could make her more comfortable, think of the previous patient’s values, anything hard, cold and concrete, anything but this woman crying in front of me, and me not being able to help her at all but provide some useless pieces of tissues. I was fucking relieved when we exited her room. And then i had to plaster a nonchalant expression on my face because i feared that my colleagues would notice, and for some absurd reason, i felt that it would put me in a negative light in their eyes, that i was a weakling. It did not help that they were all males.

And then the same thing happened in my pediatrics rotation. A very sick child with an intellectual disability. The mother tried her best to distract the child; singing to him, talking to him, but we just could not find a vein. When we finally did, both the child and the mother were in tears, and the father looked very stony-faced as he stroked his wife’s back. Once again i felt sick. When i look at my other colleagues, they always seemed unfazed and unaffected. It makes me wonder whether i have a problem detaching or if they were all pretending like i am. If it is the latter, i really wonder why.


3 responses »

  1. Hey… I can identify with that situation. I work with the cancer patients in my hospital too. I think sometimes, it helps if we think of death as a form of release from the suffering. We often say that it is the living, not the departed who suffers. I feel that it’s definitely ok to tear, rather than to suppress those very human feelings. That makes one a good doctor 🙂

  2. wait why where they monitoring the cancer pt’s O2 sats? wasn’t she dieing? isn’t there hospice there? more morphine = more peace.

    definately it makes you a good doctor and it can help you connect with the patient and the family -they can tell when you have empathy for them. I am sure every medical professional deals with this … and it’s a good question, are they all pretending?
    probably not, some people are just not phased by other’s grief or pain.

    when dealing with family’s grief, I think if it catches you that way, it’s generous to share their grief and if you tear up a little, you give the family a gift (I wouldn’t want to tear up around a whole team of all male docs either!).
    Generally when dealing with death/grief, I think about a few things:
    -quality of life vs quantity
    -is the patient happier leaving earth and not lying in a hospital bed being poked and prodded all the time
    -has the family come together and reunited during this sad time? that’s a good happy thing.
    -is it the right time for them to say goodbye. (there really is such a thing!)
    -did we do what we can to share with the patient/family in their time of grief.

  3. The family brought her in thinking it was some minor issue but turned out that it was mets all over the place. We were trying our best; i guess it was more of “putting on a show” to help the patient’s family?

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