Physicians: Heal Yourself First

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I was trained in delivering bad news. I knew what to expect. I knew the questions that would come. I have learned the stages of grief. More importantly, I had done this before many times in the past 15 years.

This is my job and my responsibility, I told myself.

I got to work earlier than usual, diffused some comforting essential oils, and did my routine 10-minute morning meditation. Then I slowly sipped my tea and read through the reports once more. I thought about all the possible questions and combed through to see if I had missed anything and had a plan formulated.

With a deep breath in and a gentle smile plastered on my face, I knocked and walked into the room with the first patient of the day — the one who had stolen my sleep since the scans had come in the day before.

He was in a room where one of my own abstract paintings hung on the wall. It was a waterfall in vibrant blues and white with hints of gold. It calmed the energy of the room and was a conversation starter — usually. But not today. Today, it just took up space on the wall.

Three pairs of eyes looked at me expectantly. He sat on the examination table, comfortable, even a bit nonchalant. His daughter and wife sat on the chairs — both of them leaning forward a bit. The morning light streamed through the large window behind them. The masks made all their expressions inscrutable, kept me guessing how much they suspected. The air in the room felt thick and palpable. I apologized for being the bearer of bad tidings and delivered the worst news of his life on that beautiful morning. I stated the facts and explained the findings.

And I braced myself: for the denial, the anger, the disbelief, the questions.

The truth of the matter was, I had been preparing for this from the minute I had set my eyes on him just a few weeks ago. My keen clinical instinct had intuitively warned me to look and keep looking for answers … answers that confirmed my suspicion.

My hope, though, had been to find something simple, something mundane, something treatable, curable. It is hard to be proud of instinct when it means pain for the patient. So now, I spoke and waited.

I was wrong. He was gently accepting and stoic. There were shimmering eyes and quiet tears from his wife and daughter.

They had suspected. My quick summons had worried them. They had also braced. My breath eased, and I started explaining and answering questions.

The daughter stood up, got up behind her father on the examination table, set her chin on his left shoulder gently and hugged him. He reached back to pat her lovingly.

At that moment, my invisible armor just fell off, and I was left staring at the tender father-daughter exchange. I don’t have words to describe the swirl of emotions, the violence with which it slammed into me, the flashback where I was the daughter with the ailing father, the grief that came so fresh all over again … I was unprepared.

We can never completely understand what another human being is going through until it has happened to us. A colleague told me once that there was a “club” for people who had lost their fathers. And that outsiders would never understand how it felt to belong to that club. He is right. And the same is applicable to every adverse experience in our lives, whatever it may be.

Medicine had prepared me for many, many things, but not this. I now had to learn to confront my reality of losing a parent over and over again. As a medical student or in training, I had never thought personal experiences would make a difference in my work. I was taught the science and the objectivity and impartiality that were necessary to do a good job. Empathy and compassion were easy for me. But now, I had to learn to choose that for myself also.

It is easier to wall off and go through the motions. It is much harder to remain open and receiving and vulnerable. Being vulnerable may create an open wound, but it eventually heals. Walling off prevents healing, and the wound festers.

All our lived experiences and pain — love, loss, grief, pregnancy, childbirth, marriage, divorce, bullying, harassment, racism, discrimination, financial loss, illness, caregiving, mental health disruption, death — have a purpose. It makes us take notice, learn, teaches us something valuable.

And that knowledge is solely for us to understand ourselves better and to let us do better as humans and as physicians.

One does not need to experience pain and adversity to be compassionate, but it is true that there is a certain understanding that cannot be gained any other way but by going through it.

And that is exactly why we have to heal ourselves first. We have to take care of ourselves and also watch out for our peers and colleagues. We have to be OK with speaking about our vulnerability and seeking help.

Physicians are more stressed than ever now. Burnout, job dissatisfaction, depression, and anxiety have been more prevalent over the past 10 years, and physician suicide is on the rise.

As much as I wish to never talk to another daughter about her father’s terminal illness, I know it will happen and that I will be present with compassion and space. I will remember to hold the same compassion, love, and space for myself.

And so should every physician.

Maheswari Raja, MD, is a family physician.

This post appeared on KevinMD.

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