As a doctor, I often see my patients cry but its rarely in response to bad news
The Guardian
Few patients cry at the obvious stuff a cancer diagnosis or an unexpected recurrence. Instead, tears flow from frustration and simple acts of kindness.
She follows me into the room smiling but as soon as the door is shut and we are seated, her smile disappears. She fans her face, lunges for the tissues, then relents, tears streaming down her red face.
Seeing you again makes me tearful, she stammers. You have no idea how emotional I feel.
Its been years since her cancer diagnosis. I have met her episodically in clinic where she cycles between several doctors.
My whole family has been mentioning you in their prayers, she says fervently, Im sorry I am crying like an idiot.
I am completely puzzled but stay silent.
You have saved my life, she says, gratitude writ large on her now composed face.
This, I can truthfully refute: Your cancer was gone well before I even met you!
I know that but you brought my appointment forward, remember? You got me seen by the gynaecologist!
Suddenly it comes back. The last time I saw her she reported heavy menstruation leading to anaemia. Someone had made a referral to gynaecology but her appointment was not for another nine months. She was obviously embarrassed and exhausted, unable to plan ahead. Moreover, I noticed that she felt completely disempowered. Feeling sympathetic, I got on the phone. I wasnt sure I could help but I managed to find her an understanding and efficient gynaecologist.
I am thoroughly embarrassed by my patients disproportionate gratitude and tell her that I was only doing my job. She replies, Last month, standing in the supermarket aisle, I felt this gush of blood, ran out to the car and thought this was going to be my life. But you changed that and I will always be grateful.
Once she leaves I return to the more typical offerings of the day, almost relieved when my crankiest patient takes me to task yet again for keeping her waiting and for then just skimming every page of her symptom diary. I read fast, I protest, but her complaints against the system duly trash all the high praise of her predecessor.
Later, I speak to a friend who muses, I guess your work is full of tears, prompting me to think back.
One imagines that an oncologists office must be a repository for tears. Well, it can be but for different reasons than one might think. Over the course of my career, I cant help noticing that very few people cry at the obvious stuff a new diagnosis, an unexpected recurrence, exhausted treatment options.
Naturally, this news upturns lives but we must have an inbuilt mechanism for rising to the occasion in the thick of the moment. Typical observations include: Yes, I could see that coming; That doesnt sound good; Tell me what happens next. I actually cant remember the last time a patient, young or old, cried inconsolably at the news of having cancer, although I suspect that most do in their private moments. I find this deeply courageous.
So what makes patients tearful?
Two main things, the first being frustration. The average patient sees far too many doctors and receives fragmented care. If, like most people, you have multiple health problems, it is all too common to shuttle between specialists and tests before embarking on the quest to find out what on earth is wrong with you.
I have just one task for you, a man snapped. I want you to list all my conditions and who is responsible for managing each one. He calmed down enough so that we could actually discuss his various ailments but it was evident that our opaque and labyrinthine system of healthcare had driven him to distraction. I meet many patients like him who are fed up of being treated like a collection of diseased organs for whom holistic care is a clich.
I know its only an infected toenail but it hurts when I walk. What will it take for someone to examine it? This from an irate patient who was told that people died from heart attacks not infected toenails. Many patients cry because they actually want to help themselves but are up against a system that makes it hard. All too frequently the doctors priorities diverge from the patients, especially in large and impersonal health systems.
Gratitude is another reason patients cry and its rarely because we have saved their life. Unfortunately, in spite of the march of science, many cancers remain incurable tears from patients are mostly for making life bearable. They appreciate professionals who treat them with genuine understanding and care. When someone writes down the unpronounceable name of their cancer or bends down to inspect their infected toenail. When someone sits by the bedside, gives them a hand to walk, cancels an unnecessary appointment or conversely, detects distress and pushes for an earlier one. Long-term, or very ill patients, often resign themselves to multiple visits, constant waits and brusque staff. It must be easier to have low expectations, which is why people cry when these expectations are exceeded.
For all the disillusionment of modern doctors, it is an undeniable privilege to be able to make a real difference to someones quality of life. It is practically impossible for a lone doctor to scale the systemic barriers to better care we cant expedite someones liver surgery, hip replacement or emergency waiting time. And we cant combat the dreaded funding crisis that rears its head every single day in every public hospital.
But I cant help observing that good patient care often comes from sweating the small stuff. Like calling in a favour, relaying results on the Friday before a long weekend, pulling out an unnecessary catheter, sparing someone a midnight blood draw, and calling a distressed relative.
The media often celebrates acts of heroism but paradoxically, the smallest gestures tend to receive the greatest praise. Or maybe there is nothing paradoxical about the fact that people everywhere respond to kindness. In dreaming big, we ought to recall Hippocrates who observed that wherever the art of medicine is loved, there is also a love of humanity.
Source: The Guardian
