I’m not immune to grief; instead my job makes me aware of the power I have to relieve others’ suffering ‘Being a doctor is emotionally punishing but connecting with our patients as fellow human beings is what renders it not a mere job, but an incomparable vocation.’ The grainy image of a doctor seeking a moment of solace outside a hospital after losing a young patient has travelled the globe, providing the public with a rare glimpse of the way doctors cope with and compartmentalise sorrow. It struck an immediate chord with me. Last week, in view of half a dozen doctors and nurses, and amid all the tangled, beeping paraphernalia of the intensive care unit, I pulled out – in other words, withdrew care – on a patient. I badly want to say that “we” pulled out on a patient, as this suggests a diffusion of responsibility, a team approach to the occupational reality of losing patients most weeks. But as everyone on the actual team knows, there is one person who has the task of calling it a day. Last week that was me. I had become unwittingly fond of him over these past few weeks, my patient with the pristine white hair, kindest of eyes and a gentle voice that belied all the anxiety that must have been bubbling inside him the entire time he was on our ward. He had an indolent malignancy. In practical terms, it meant that his doctors could afford to sit back and observe the cancer with academic savoir-faire while the patient felt like a yo-yo, attending any number of appointments to discover that he wasn’t in imminent danger of dying for at least another three months – until the next set of results were pronounced. This time, his mild, unrelated problem was improving and he was set to go home, back to his beloved garden. Nothing made him prouder than when I mentioned the magnificent roses that adorned his bedside; it became a running joke between us that he would perform his magic on my garden once I discharged him. Any day now, I promised. Then, inexplicably, one morning just before he was to go home, he crashed. It wasn’t just an oncologist’s misplaced optimism; even the intensive care physician felt that he warranted a period in ICU to see if there was a reversible reason for his deterioration. I held my distressed patient’s hand and outlined the plan. He wasn’t fully conscious although he did murmur that he wanted to be left alone. Amid the din in the room, I didn’t blame him. But his precarious vitals also didn’t give me the time to explore what he really meant. I found out the next day. The curtains were pulled back and all manner of sophisticated machinery beeped and trilled around his diminutive figure. Behind the high-flow oxygen mask he looked uncomfortable, the pillows unable to prop up his slumping body. His eyes were sunken, his smile gone. My heart sank. “We have been waiting for you,” his nurse whispered ominously. He clutched my hand as soon as I touched his and with his other hand tugged off his oxygen mask. The monitor screamed murder. The nurse groaned. “Doctor, I want you to let me go,” he gasped. “We both know that I will eventually die of the cancer but I can’t do this any more. My neighbour has my advance directive, check if you must. But please let me die, I am ready.” I am no stranger to such words, but what shook me was the transparent terror in his eyes. He wasn’t afraid of dying; he was terrified that his doctor wouldn’t listen. That I would coax him to give medicine a chance – to leave the mask on, to try the antibiotics, think of his roses, anything but let go. I felt drenched in shame that in the darkest hour of his life, my patient could not bring himself to trust me. The nurse replaced his mask. As I regarded his suffering, I thought of all the times he had talked about his failing quality of life and how much he dreaded being alive but incapacitated. His request to be palliated was informed and appropriate, and I supported it. But who should give the final irreversible order to turn off the support? Around me I saw shell-shocked nurses and junior doctors, stunned at the rapid turn of events. One moment we were discussing a mundane iron deficiency or cellulitis, the next moment we faced a man’s dying plea. It may have been my imagination but I felt trapped by the gaze of many eyes judging my next move. I stepped away to consult the ICU physician. “What do you think?” “I think he is dying, but it’s your call.” Returning to my patient, I held out my hand, looked him in the eye and found myself saying: “I hear you. We will remove every single tube right now and make you comfortable.” I couldn’t help but notice how closely the nurse checked my notes before she got to work. After all, it was my call. “I will drop by later to see you,” I said weakly. “Goodbye,” my patient replied knowingly. “And doctor, thank you.” The team staggered out, a medical student finally breaking the heavy silence. “What should we take away from this?” Can’t waste a teachable moment, I thought with irony. “Consider the immense power of doctors to influence the suffering of our patients, in good ways and bad.” But then I couldn’t continue because it all sounded so anodyne and what I really wanted to say was that I didn’t know there was a point because, actually, I felt wretched. Stirred up, conflicted, even a little aggrieved to have been the final arbiter of a life that I barely knew. What if he didn’t really mean what he said? What if his ex-wife had missed the opportunity to put their acrimony to rest? The thousand “what ifs” made me dizzy with doubt and I selfishly wished that someone else had faced them instead of me. And even when I banished the doubt, there amid the vital beating pulse of the hospital I felt heartsick and lonely, not because it was anyone’s fault but because this is what dealing with sadness felt like. But you were only doing what was right for the patient: the consolations of fulfilling a doctor’s obligations were familiar but so were the exquisite and fragile emotions that accompanied the loss of a patient. It was as if a bit of grief always lurked in the corridors, springing out to hijack the unsuspecting soul. Sometimes you swiped it away, other times it overpowered you. “Get some lunch, it’s been a long round,” I said to my team as I escaped outside. After all there was nowhere in the hospital where one could shed a tear without inviting scrutiny. “I lost a patient today” attracted a unique brand of awkwardness among doctors. And frankly, I just needed a bit of time to let my discomfort percolate into the fabric of my being. Locked in my car, I let out the breath that I had been holding forever. I wanted to cry but no tears came, as if my rational self was warning me to stay put in an unsentimental fortress because this situation would arise again, many more times. But I knew that there was a point to grief, as a catalyst for improvement. As I sat alone, I reminded myself that the hollow in my heart would again be filled by good tidings and the gratitude of strangers. Being a doctor is emotionally punishing but connecting with our patients as fellow human beings is what renders it not merely a job , but an incomparable vocation. Eventually I tracked my way back to the hospital to meet a young medical student. Brimming with enthusiasm, she asked what it was like to be a “real” doctor. Sometimes exhilarating, sometimes sobering, I truthfully answered. But the best thing about being a doctor was that you frequently went home with an insight that made you a better doctor tomorrow. Source
