The volume of patients wasn’t the worst that I’d experienced. Not by a long shot. But the tragedy and rollercoaster of emotions was perhaps one of the most draining and heart breaking.
Some days are 'straight-forward-ish'. Then there are those 'other' days when by sheer coincidence or for me 'the guy upstairs' you get several people coming in with related pathology. And then there is the heavy stuff... 'one of those days'. So let me tell you about 'one of those days'.
'Shortly after 6.30pm, on what was an ordinary working day, I was seeing off my last patient of the day. On the way out, I caught my reflection. What struck me the most was the bloodshot eyes and puffy face. If I'm honest with myself, I looked haggard'.
In one day, I’d seen one of the most severe presentations of a skin condition of a person, to hearing the distress on the voice of newlywed man who’d just lost his partner in a completely senseless way, to a mature couple who'd never wanted children seeking a termination, to a single woman who after various rounds of IVF and a successful delivery - only to be diagnosed with end-stage cancer, who wanted a safe space to cry (away from the family), to a child who’s distressed cry still keeps me awake at night.
Sure there were some beautiful moments in the day. Yet as I sit here today, the thing that won’t leave me is the sadness, the grief, those dark moments in the lives of my patients.
The art of dissociation
In medical school, we are 'taught' the art of dissociation. We don't really talk about it. Or at least, it was not discussed when I was in medical school. Yet, I can recall almost too vividly the moment I understood dissociation was 'a thing'. It happened sometime between the 1st anatomy session in the lab and my first clinical encounter with a patient. Dissociation, is an unspoken skill that is chiselled into the fabric of doctors. To use Jada Pinkett's Smith's word on this - whatever happens don't get into an emotional or psychological 'entanglement' with the emotions in the consultation room. You HAVE to leave it behind.
This time round I could not dissociate. Not even a tiny little bit. The empath and fully human part of me was present in every encounter. So each experience hit me like a wave. I found myself immersed in the lives of my patients. My heart breaking for each of them as they shared chapters of their lives. Even today, sat here scribbling away...I can picture their faces.
On being a generalist (in the middle of the world)
Over the span of ... well however many years I've been at this... I still stand by the following:
The greatest privilege one can bestow on another human being is Trust. In particular - Trusting a person to accompany you during the dark moments we encounter as part of our lived human experience.
As a doctor, when I go to see my doctor whom I've entrusted with my health (my most precious commodity), I feel vulnerable. Despite all the medical knowledge and experiences, I... feel... vulnerable. Even if I'm attending for the most benign of reasons or a follow up, I feel vulnerable. When one is on the patient's seat, one is expected to share deeply personal and sometimes embarrassing symptoms. Let's face it, not many people fancy talking about their bowel habits... or how often they pass wind... or that since they had their breast cancer removed they're terrified of intimate or sexual relations with their wives/husbands/partners. That's before getting to the examination (part of the consultation). It can feel painfully awkward.
With this in mind, I can't begin to comprehend how much more vulnerable our patients feel during some of these encounters. I don't take for granted the amount of trust that is bestowed on me (us) by the patient. This is even more poignant, when I have to break some bad news...when it is my job to share a piece of news that they didn't see coming, which will completely turn their world on its head....like the C-word ... suspected dementia ... or the nth miscarriage...or that the time has come to put affairs in order (they are dying...soon).
Yeah, it is hard, and on 'one fo those days' it feels like carrying the world on the shoulders. But....but....my goodness!!! what an honor to serve in this way.
The Privilege of privileges
When I find myself with red eyes and a puffy face, feeling drained at the end of 'one of those days'...I remind myself of the trust bestowed upon me and the privilege it confers. On a very human note, I'm absolutely exhausted. Actually, at the end of those days, I look like haggard.
Yet, on a spiritual note, I am filled with gratitude. Gratitude for the privilege of being allowed to walk beside my patients from cradle to the grave. For example, when they receive the bit of good news they've been waiting for... or they're brought in by their parents with their first ever cold as newborns, ....or later in life when for one reason or another they can't advocate for themelves, ....or when they're approaching the end of their lives. It is the Privilege of privileges to be a line, in the last paragraph, of the last chapter of their lives. It’s something special no? Yeah, that’s why I have red eyes and a puffy face at the end of ‘one of those days’.
At the end of the day
The question I pose to myself is....did I do enough? did I show enough compassion? Did I make a difference? Did I help? Did I help not just in the way that I could but in the way they needed me to? Did I show up for my patients with both the physician and human? Does it make a difference?