Stepping out of the patient’s house and down the path I could feel tears welling up. By the time I reached the car I was sobbing.
During that visit I had provided technical care and the best advice I could, but I was also there as a witness to a family calmly and gracefully giving exceptional care to their dying older relative – tenderly moistening dry lips and adjusting the pillows. It is hard emotional labour to see patients I have often known for years suffer or die, especially when in most cases, I also care for – and about – their family.
I was glad I held on to my emotions until I left. I had no right to burden them with my tears or to invite their comfort. It was my job to provide comfort and support for them.
A considerable part of my time is spent caring for people for whom cure is no longer achievable.
Our population is ageing and for many, the burden of chronic ill health and frailty cannot be ignored, and talk must shift to a realistic appraisal of the future.
Symptoms often fail to fit the neat diagnostic labels in my undergraduate textbooks and easy answers are either hard to find or simply don’t exist.
But in this particular case, a long episode of aggressive treatment in hospital had been followed by a year or two of good health and calm before the disease recurred.
Despair was soon followed by acceptance and an invisible shift took place – to make each day the very best possible.
My role, as well as prescribing medication and advising on treatment, was also simply to be there.
To answer the difficult questions as best I could, to allow tricky discussions to take place and to anticipate crises. Acknowledging emotions and needs as they evolve can be tough at times like this. I have to draw on my emotional reserves and address the “what if” thoughts of my own which are inevitably sparked off.
The medical school training I went through in the 1980s aimed for me to be able to practise what has been termed “detached concern”, the emotional armour that allows me to handle illness and suffering on an hour-by-hour, day-by day-basis.
Fresh from school, I needed to be steeled for my chosen future. Within the first week I was introduced to a human cadaver that I spent the next ten months dissecting, exploring its intricate detail and understanding the mysteries of the breaths humans take and the movements they (we? I?) make.
It’s not just the structural malfunctioning of our bodies that is of concern when we are ill.
In fact in many situations, no underlying malfunction is ever discovered despite continuing serious and disabling symptoms.
Our lives and our wellbeing are also governed by our past experiences, by the way we think and by our human relationships. To be an effective doctor I have to be comfortable understanding the wider dynamics of being human, and often the most important things I can offer are empathy and concern.
I can provide time, and a place where patients feel safe to share emotions, and cry if they need to. The box of tissues on my desk is there for a purpose.
Difficult treatment decisions involve individual patient choices that depend on trust and understanding with their doctor. And when my patients are overwhelmed by the stress and emotions and the tears do flow, my response must reflect that at a deep level. I have no shame in “showing them a damp eye”, acknowledging and validating their profound situation.
There are other reasons why doctors cry. For instance, the doctor whose level of stress and vulnerability breaks them down at the end of the day. Or the doctor who is overcome with guilt from a perceived serious mistake.
This job is stressful as we are repeatedly exposed to the realities of being human. It requires us to work in a culture that acknowledges the emotional labour involved.
We may not always need to cry but we do need to be able to live comfortably with the emotional highs and lows.
Denying them is a recipe for burnout; we would become dehumanised, seeking the simple fix for our patients, failing to connect and so becoming less effective. High workload is then even less manageable and complaints more likely.
I hope the new generation of medical students and doctors in training will have a chance to learn this from a curriculum that values our humanity, because we are human, and need to look after ourselves and our colleagues and not be scared to ask for support.
Back in my car, after that visit, I take time to regain a sense of peace and balance.
I use the rear-view mirror to ensure I have also regained my outward composure because it’s time for my next visit, and I have three more after that before, my late afternoon surgery.
Dr Miles Mack is a GP in the Highlands and the former chair of the Royal College of General Practitioners Scotland
