I was a novice intern on a night float rotation, called to pronounce a patient on the oncology floor. As a student, I had watched residents pronounce patients a few times and thought to myself, “I have this under control.” I took a look at the chart when I arrived on the floor: a 30 year-old woman who had recently been diagnosed with acute leukemia. She had begun induction chemotherapy and had developed severe pancytopenia. I grew a little uncomfortable. It didn’t seem like this death was anticipated. The nurse told me that the patient’s mother was with her. I approached the room, and stopped short at the doorway. There was the young woman, about my age, lying in the arms of her sobbing mother, holding her tight as if she could will her own life into her daughter’s limp body. I stepped back, a choking sensation in my throat and tears welling up in my eyes. After a few minutes, I thought I could control myself and entered the room. Standing there, I wasn’t sure what to do, and finally touched the mother’s shoulder and told her who I was. I struggled with what to say next and came out with a bleak, “I’m so sorry,” and began the ritual of checking for pulse, heart beat and respiration. I couldn’t think of what to say next, except another “I’m so sorry.” I stood there, tears welling up in my own eyes again and managed to say, “Is there anything I can do for you.” The mother shook her head, and I escaped from the room, tears streaming down my face.
As I began the necessary paperwork, I felt embarrassed and ashamed. In medical school, the attendings and residents I observed seemed eminently capable of being dispassionate. Detachment was supposed to be essential, all emotion sacrificed in the name of being objective and effective clinicians. I felt I had been weak and ineffective, and determined that I would be “tougher” next time.
Over the years since, I’ve seen grief many times. I now have a different answer to the question “Should doctors cry?” We are called “caregivers” for a reason. We must permit ourselves to care. I no longer believe that we risk our objectivity when we show our emotions. The foundation of our profession is humanity. Depersonalizing a death threatens our own well-being. Showing compassion and a connection with others in their time of grief deepens our own sense of well-being, and builds the same in those we work with.
One of my interns told me a story of how his senior in the CCU would go into the room of a patient who had passed away, placing a hand on the patient’s shoulder, thanking him quietly for allowing him to participate in his care. The death notes he wrote always ended in the phrase, “May he rest in peace.” A student told me her story of taking care of a young woman from Spain who had come to the US with her daughter to visit family. While in this country, she fell seriously ill and was found to have widely metastatic colon cancer. Because the student spoke Spanish, she became the principal communicator and advocate for the young woman as her illness rapidly progressed. When intractable pain developed, the student’s efforts enabled this uninsured woman to obtain an intrathecal pump. As the end neared, the woman said to the student, “You have been my angel. Now I will be your angel.” Connections like these are our rewards. They enrich us, and those we care for.