Medicine is stressful, and you're human I was a second-year resident, doing a 24-hour shift on maternity care. I'd spent some arduous nights on call with my attending physician, Dr. Campbell. Now, we sat at the nursing station, joking about what this one might bring. "You must be a black cloud," she teased, accusing me of being one of those unfortunate residents who seem to attract medical emergencies. I laughingly protested, but in fact, these quiet nights worried me. I felt on edge, waiting for something, anything to happen. Finally, the emergency department called to say that a possibly laboring mom was on her way up. We got her name, which was Cecilia, and I feverishly dug out her chart. When Cecilia was wheeled into the labor room, she was smiling, and the man beside her -- her husband, Harvey -- also seemed at ease. I studied her face and demeanor, wondering whether she would deliver tonight or be signed out to the incoming resident tomorrow morning. As nurse Angela got her settled in, I reviewed her history. She was 36 weeks along. Kind of early, I thought. She already had three children -- all boys. According to the ultrasound report, this one was a girl. How nice. She was Group B strep negative and had suffered a miscarriage a few years back. With this pregnancy, for unclear reasons, she'd had only a few office visits. "No toxic habits," her chart said. What a relief. I headed into the room for the triage assessment and sat talking with the couple as Angela hooked Cecilia up to the monitor. Harvey sat on the edge of the bed holding Cecilia's hand while Angela traced circles across her abdomen with the fetal doppler device, and we all waited to hear that familiar galloping heartbeat. There was no sound. Looking puzzled, Angela tried again. Nothing. Our eyes connected. The fear in Angela's gaze mirrored my own. I looked back at Cecilia and Harvey and kept on talking in what I hoped was an even tone. Angela excused herself "to get some help with the monitor." She returned with Dr. Campbell, the ultrasound machine in tow. Gently, Dr. Campbell palpated Cecilia's abdomen. "Cold gel," she warned before squirting it across Cecilia's belly. Seconds later, the image appeared on the screen. It was a maternity provider's worse nightmare: a nonviable fetus, her little heart still. My own heart started racing. Dr. Campbell sighed, and tears started rolling down her cheeks. I felt surprised, but also intrigued. Although at this point in my career I'd shared more than a few sad moments with patients and their families, never had I openly cried, or seen another provider do so. Quietly, through her tears, she told the couple, "I'm sorry...." Cecilia's wailing filled the room. Harvey threw his arms around her in a brokenhearted embrace. We left them alone for a moment to decide on their next steps. Despite having seen Dr. Campbell's tears, I fought to hold mine back. "Do you want to be a part of the delivery?" she asked. "Yes," I said. "But I'll probably cry." "We're all going to cry," she said, kindly but matter-of-factly. Once Cecilia had received medicine to stimulate her contractions, the delivery didn't take long -- but it was more emotional than I could have imagined. The room was quiet, but my mind was so loud. It was calm, but the chaos in the parents' eyes was so palpable. Dr. Campbell and I delivered a very beautiful baby girl with the cutest little nose. She was tiny, but definitely a person. There was no resuscitation. There were no congratulations. There was no laughter, no joy ... just pain. There were tears and blood and sorrow. Dr. Campbell cried openly as Harvey cut the cord. In fact, she'd cried openly throughout the entire delivery. This gave me permission to cry as well -- and now I did. I cried as I helped Harvey put the baby's little hat on her head. I cried as I collected the instruments and removed the blood-soaked pads from the bed. I cried as I washed my hands. I cried as I left the room, helped to pin the purple feather on the door and said a short prayer for this beautiful family. Then I excused myself and rushed to the call room, trying to pull myself together -- because that's what you do in this field, you keep it together. I'd broken that rule; I felt I needed to redeem myself. I couldn't believe what had just happened. I felt impressed by Dr. Campbell's genuineness -- but also confused as to why, even this far into my medical training, I'd never till now seen a provider express such raw emotion. Dr. Campbell and I went to the break room and sat in silence for a few minutes. "How are you doing?" she asked kindly. I had no words. My tears broke free again, pouring down my cheeks. Dr. Campbell gently rubbed my back without saying a word. When her pager went off, she left me alone to ponder. "I'm sorry for your loss." "This must be very difficult." "I want you to know that we're here for you and your family." We use these phrases all the time to express our empathy. Words like these were spoken that night -- but I feel sure that it was the wordless, honest expression of emotion that most connected us all. What does this say about medicine and doctors? Are we all just cold-hearted people, "caring" but not really caring? I doubt that. As residents, we're taught not to be too open with our patients, for fear of harming the doctor-patient relationship. We learn to shed our tears in the call room or the bathroom; anywhere but at the bedside. "You should be supporting your patients, not the other way around." I've heard this sentiment often. In one sense it's true. But it also conveys an unspoken message: that I, as a caregiver, should treat myself as less human than my patients -- less entitled to fully experience my emotions or to fully express them. I've learned to maintain a façade of strength. When I'm having a bad day, and a patient asks me how I'm doing, I brush it off: "I'm fine. The more important thing is, how are you doing?" I feel guilty whenever I let the walls down and admit that I'm not doing so well. But why? I feel blessed to have trained with Dr. Campbell. She helped me to improve my clinical skills -- and she gave me so much more. She reminded me that staying open to your feelings when you're with a patient is OK, and that being real with your patients is a gift to them. I believe that sharing patients' pain, as she did with Cecilia and Harvey, can mean more to them than any medical intervention you can offer. I don't break down every time a patient suffers a devastating loss. But now I know that if I ever do, it's OK. Despite the unspoken message of my medical training, I know that I'm human, too.
