All in good time
Presenting complaint: 70 yr old, male. Claims that he had a fall in the toilet, due to OA (osteoarthritis) causing his knees to buckle forward under his weight as he was getting up from the toilet bowl. He lay on bathroom floor for a day and a half before using a spoon to reach the phone to call himself an ambulance.
I get this far in my history taking, then everything else the patient tells me starts to become a blur, his lips are moving but I am not listening. I am overcome with grief. My thoughts become fixated on a few things.
1) He lay on the bathroom floor for a day and a half!
2) I am immensely upset!
3) Ask about social support, that’s all that matters, ask about social support!
4) He lay on the bathroom floor for a day and a half!
I compose myself enough to resume listening, and shoot my partner a few apologetic looks.
This is one of my few stumbling blocks in medicine. I get very emotionally attached to patients so much so that I often become paralyzed with overwhelming grief, sometimes to the point where it renders me ineffective. Last week my demon came in the form of a 50 year old male who had been in hospital for 2 months receiving chemotherapy for mantle cell lymphoma. The prognosis was not good. He was terminal and coming to terms with his own mortality, very evidently depressed yet still rallying strength to fight, what he thought was a long battle ahead. I thumbed through his case file after the requisite history taking and examinations and saw that his doctor had made a note for a possibility of a referral to palliative care. That broke my heart. I went home very depressed and remained in that state for a few days. I thought about my demon and debated if I would ever be able to separate my emotions from the job, if in the preliminary phase I am already struggling against becoming a sobbing mess.
I don’t think how I reacted was necessarily a bad thing. Should the day come when I become so hardened and impartial to suffering, I think that would be a sign for me to leave this profession altogether. But, I have to be more in control of my natural instinct to want to do everything I can to make this person feel better, manifesting as debilitating overt empathy.
Having said that, we are constantly being reminded that we should treat all patients as a person with a condition, not a condition with a person. Very evidently, some of my peers, no doubt very brilliant, have trouble injecting emotion into the profession.
I know I will be able to compartmentalize my emotions a lot better as I progress through this course and will eventually be able to maintain composure and a clear train of thought, so that in the future, I can ask pertinent questions like,
“Can you tell me what were you doing with a spoon in the toilet?” 
Shifaa replied:
Welcome to the world of social services hunny.
Words of advice:
Cry all you must. Bathe yourself in that emotion and feel it. When you feel it, you will understand. When you understand you empathise with others.
Empathy and compassion drives and motivates you to do what is humane and right for others. You will naturally feel attached to your clients i.e. patients. It shows you have good rapport and a strong bond with them.
This is a challenge faced by all practitioners in the social services field (even your classmates who seemed to have trouble showing their emotions). The next step to the challenge is to SNAP out of that emotional turmoil you encounter and return to your natural state.
Train yourself everyday to do this: Feel it, take it in, and move on. Always tell yourself, “My clients need me”. Remember, you are critical to them. They depend on you because you are the professional.
One day, you will be the one to make the decision for your clients and when that day comes, do not mistake being decisive as having no emotions. Trust me; you will feel something no matter what.
By the way, impartiality can be a good thing in critical moments. Being hardened means you have become adjusted and experienced, but does not mean you are emotionless. Think about it.
HUGS. You iz such a wonderful person Jo! The world needs more people like you.
xoxo.
February 25, 2010 at 9:10 am. Permalink.
Sideshowjo replied:
Thank you so much for that Shifaa, it helped put things into perspective. I esp like the part where you said “Being hardened means you have become adjusted and experienced, but does not mean you are emotionless”. I suppose that is a fine line between being decisive and being hardened devoid of emotion.
I think one of the most difficult parts about it is that, even in their suffering, they still take the time and patience to speak to med students, wanting to impart as much as they can before their time is up. Letting us poke and prod, question and question.
I really lift my hat off to you, you’ve been in social services for a long time now, but still manage to retain empathy. I can imagine that empathy would wane after seeing suffering or difficult situations day in and day out.
Thanks for the message, it makes a huge difference to hear it from someone who is in the know
March 1, 2010 at 7:27 am. Permalink.