A Doctor’s Dilemma: How Much of Oneself Can A Doctor Really Show?
“When I have to tell a patient they have cancer and they cry, I say, ‘See? You’ve made me cry too,’” says Dr Sarin.
(On National Doctors Day, FIT is republishing this story to remind our viewers of the contribution doctors make to enrich our lives and to thank them for their service)
Prachi Jain, 28, can remember the first time she cried after seeing a patient. She didn’t cry during the session; she waited till after it was over, and then let herself have a good, long session of tears. The woman she had just seen reminded her of herself.
She had lost her dad. She was looking after her mother, and she was lonely. My patient was committed to helping her mother, but the duo had a rather strained relationship. There was little in her life that assuaged her own loneliness.Prachi Jain, psychologist
Prachi enjoyed talking to her, watching as sessions metamorphosed into conversations, making way for an unexpected friendship.
Sometimes, you relate to someone because you can see yourself in them. You feel like you’ve gone through the same thing. And one day – after you’ve heard their story over and over again – you break down.
For the Kolkata-based psychologist and counsellor, breakdowns aren’t recurring events – but she is constantly attempting to navigate the line between empathy and clinical detachment. “Why do we say therapists cannot counsel family members?” she asks me. “It’s because we cannot be objective. Of course, you shouldn’t be completely clinical, but a little emotional detachment is necessary.”
How Much of Oneself Can a Doctor Show?
This line between the expression and suppression of emotions in a doctor – particularly in one’s own doctor – has always fascinated me. How much of yourself can you show to the person you’re helping heal? How many of your vulnerabilities must be shoved under the rug lest it overwhelm the vulnerabilities of your patient – often a patient whose life (or quality of life) depends on you?
I was 14 when I thought of this, after a disconcerting phone call to my therapist. My therapist – who insisted I call her Smita Di – had given me her cell number to call her in case I had sudden panic attacks. I’d been fighting anxiety for a long time before I started meeting her, and Smita Di and I had long talks often, about things not particularly related to my anxiety.
I was never particularly comfortable about calling her at home, outside our sessions; nevertheless, I had one bad afternoon and I made the call. When Smita Di picked up, she was crying. “What’s wrong?” the 14-year-old me asked in dismay. Her dad had passed away that morning, she said.
My world stood still. I knew my therapist’s father had been battling cancer but I had never imagined him dying; I could also have ill imagined Smita Di – that stoic, ever-smiling person who betrayed little of herself to me – in such anguish. I told her I was sorry, and she immediately shushed me. I needn’t think of this, she said; I should tell her what was bothering me.
Of course I didn’t. I told her I was sorry over and over again and I hung up, devastated. I couldn’t forget the way she sounded – not when she was telling me about her father, but when she was hushing and shushing me, urging me to forget about her and talk about myself instead. In a decade and a half, I haven’t forgotten.
When you think of a person dealing with a traumatic sickness – physical or psychological – you think of their partners in that illness: the parents, the spouses, the boyfriends or girlfriends, the children, the best friends. But you rarely think of the silent comrade fighting alongside, the doctor, who is as intimately connected with the sickness as anyone could be. Several schools of thought have established that doctors must stay as emotionally detached as they can – to treat better. But how well do they manage to treat themselves?
Pain, when you relate too much, can be a hard thing to overcome.
Says RR Kasliwal, the chairman of clinical and preventive cardiology at Medanta Hospital, Gurugram:
I once used to treat this elderly man who would come to me all the way from Gorakhpur. I had treated him for years for a chronic heart condition. He had a young son who was a Major in the army. My patient had been coming to me for so many years that I had grown very attached to him and to his family; his son, in fact, was someone he and I were both equally proud of. Then, one day, his son died of a sudden heart attack. It was so ironical. I still remember his father sadly telling me – ‘You saved me for this.’
As I speak to Dr Kasliwal, he tells me he has been up the previous night – this is a Sunday – because a patient had begun to crash at 4 am, on a Saturday when he was home. Isn’t it hard, I wonder, to be able to leave these stories in the labyrinths of hospital corridors and not carry them home?
Not so much anymore, but it used to be. I would go home to my wife and tell her stories of what I’d seen. I would tell her, ‘Today I met a 25-year-old guy with heart problems… today I met a young woman who had brought in her father…’ I would keep telling her. But over the past 30 years, I have learnt to get used to it. The immediate people around you – your family – also deserve good quality time with you. You can’t forget that.
“How Can I Do Better?”
For several doctors, going beyond the prescribed norm is a quick, sharp, on-the-spur-of-the-moment call. Dr Arun Mehra – a senior cardiac surgeon in Mumbai’s Breach Candy and Lilavati Hospital – has had to make several such calls in the cases of terminally ill patients.
This elderly gentleman had once been admitted to the hospital, clearly dying of a heart attack. He had gone into early organ failure and needed a bypass surgery. Even with that surgery, his chances of survival were less than 5 percent. We needed his son’s consent to perform the surgery – but he had just landed a job, after great difficulty, in Dubai and coming back to sign the consent form would mean losing it.Arun Mehra, cardiac surgeon
“His wife, the patient’s daughter-in-law, wanted to do it for him, but her signature wouldn’t do. I had to decide quickly; this man was close to death anyway – and if we didn’t operate, his chances of survival were 0. Against guidelines, therefore, I took a telephonic consent from the son and operated on his father. He fell within the 5 percent success rate and survived!” he recounts.
Dr Mehra recalls feeling elated, even as he reveals that his biggest anxiety after so many years is whether he’ll be able to surpass those percentages.
Even today, I keep worrying about how I’m putting in a lot of effort for only a marginal improvement in the patient outcome. How can I do better?
The many, many doctors I spoke with – cardiac surgeons, oncologists, therapists – all of whom have dealt with seriously unwell men and women, continue to wonder at the attachment patients develop to them, an attachment that they return, often mingled with inevitable anguish.
They look at you as a person who will heal them. Yeh doctor mujhe kuch nahi hone dega, they think. Their lives depend on us. When I have to tell a patient they have cancer and they cry, I tell them, ‘See? You’ve made me cry too.’ You treat them the best you can. But sometimes, the cancer comes back and you know you can do nothing more for them. You’re as upset as they are, because by this point, they’re like a friend or a sister who you’ve known for years.Dr Ramesh Sarin, senior consultant, surgical oncology at the Apollo Cancer Institute, New Delhi
The ability to be a partner to your patient is a joy that patients themselves carry, through the often long, laborious, agonising sessions of medical treatment. Who else would tell you that you still look beautiful when you feel like you’ve had your gut wrenched out, asks Neelam Kumar, a two-time breast cancer survivor who has also written books on her medical journey.
I remember when I went to get the lump on my breast checked out, and my doctor – Dr Badwe – told me, ‘The results might not be what you’re looking for, but we’re in this together.’Neelam Kumar, two-time breast cancer survivor
It was a partnership she forged with doctors who treated her over the years.
Dr Muzammil Sheikh who treated me all through my second round of cancer, would tell me I was a beautiful lady, even when I felt far from it. My beauty was my vanity and I could feel it slipping away every day, but not once did he treat me like a piece of machinery that needed to be fixed. He would tell me what kind of chances I had, but also give me reassurance at the end of it.
Having successfully fought the disease twice, Neelam today believes she healed because she had a partner who fought alongside with her.
Doctors struggle every infinitesimal moment of treating you with the line between heartbreak and carefully-controlled emotion. Prachi still remembers a patient who had inflicted self-harmed after she had stopped coming to her sessions.
She said she wanted to come back, and I wish she would. But I also understand that the onus is not on me. Therapy should be her choice.Prachi Jain, psychologist
A billion self-help blogs will tell you that the best way to protect yourself from heartbreak is to keep emotions at bay. Imagine having to make that choice, over and over again, every single day.
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