I was recently given the unsolicited advice to keep my emotional distance in my job because it protects. I couldn’t disagree more; when you stop feeling, you stop caring and caring is the most important thing we do in medicine.
I have lost count of the many times I have looked into the eyes of family members, taken a deep breath, then delivered a savage blow. I don’t say I’ve lost count to be flippant, I say it because it is a devastating side effect of my job as a heart surgeon.
‘We did everything we could, but I’m so sorry, he didn’t make it.’
The reactions from that point on almost always involve tears. Sometimes there are cries of disbelief, hoping that what I said wasn’t real. Some fall to the floor, others are stoic and fight tears. One family even threw a desk at me on one occasion. Grief may look different, but at its core, it is pain.
One rainy Sunday, despite our gallant efforts, a very sick man finally succumbed to his sick heart. We kept him alive for five long days after a massive heart attack, with every machine known to medicine. Outside one of our private family rooms in the intensive care unit sat a trolley. A silver medical trolley was repurposed with bitter tea, cheap coffee and hospital biscuits marking the room where I was about to go and deliver the worst kind of news. The tea trolley in intensive care is synonymous with bad news.
I tell them straight away because generally, they too know the significance of the tea trolley and I’m sure the expression on my face. They cry and hug each other, simultaneously trying to be strong. I take them back to his room in intensive care, through a corridor of machines that alarm and ping, keeping many others on the cusp of life and death.
In his room, he lays peacefully and as cliched as it sounds, to the untrained eye, he looks peacefully asleep. The family sings and pray, promising to lead a life that he would be proud of them for. They thank him for his years as a husband and father and know that he is in a better place. The tears that were just pricking at my eyes then roll down my cheeks, silently because I feel like an impostor with my grief. Open tears would just intrude on their loss that I do not feel entitled to share in. I retreat to the mercifully empty theatre locker room and put my head in my hands and sob.
Heart surgery can be desperately serious, and death is an outcome that we are more familiar with than a lot of my colleagues in other specialties. Over the better part of twenty years, I have sat in rooms where hope has hung then swiftly been cut down by the bad news of death, imminent or realised. There are times when I think back at the names and faces of those whose lives have slipped away and I can’t do anything except cry for them.
My pain will never be that of a wife or a partner, a daughter or even a neighbour. However, my pain is still real and at times, I wonder what a lifetime of seeing so much loss will do to me. Doctors have some of the highest rates of mental illness and suicidal thoughtsin the community. Research has shown that losing a patient or experiencing a complication can have a devastating toll on a surgeonwith guilt, anxiety, depression and using substances like alcohol to numb the pain. While it may seem that we carry on, with black humour, stoic realism or the odd tear, the loss of a patient has a lasting impact on us, at times haunting us. Despite perceptions that doctors can be detached and uncaring it is really our ability to care that makes us better surgeons.
If you were to add up the toll of a career of being exposed to challenging moments such as this, you may understand why.
Doctors and other health care workers often talk about this need to be detached as a protective mechanism. We carry on our days as if nothing had happened, or resort to dark humour. What if we have been getting that wrong for so many years? A study of oncologists showed that burnout is increased when these doctors have a negative attitude to displaying emotion. Perhaps by removing that barrier to feeling, we show more compassion to our patients and ourselves. Sharing emotion after the death of a patient may help to battle burnout in doctors. The greatest purpose that it serves is to demonstrate our humanity to ourselves, to our colleagues and to each other.
A mentor once told me that the day you stop feeling that pain in the face of death, that is the day that you should find another job. Medicine and humanity are inextricably linked and if you lose that gut-wrenching pain that comes with sharing bad news, then you will have lost your humanity. You cannot possibly truly care about the people you need to help if you don’t truly feel agony for them.
The next day presents new hope. A new chance to do what we could not for this man and so many others who slip away from us. At the end of that day, in the waiting room this time I get to deliver much better news.
‘Everything went well, her heart is working well, and you’ll be able to see her soon.’
Despite the traumatic events of pas days, these good days alleviate some of the hurt.
Whatever happens in the hospital, whether it be amongst life-sustaining machines, under the lights of the operating theatre or in the emergency room, we are with you. We feel your pain and your joy in equal measure and both keep us toiling away. Healing on this occasion, helps not only you, but it helps me as well.