I went to a patient's funeral this past weekend.  I generally don't do that for people whose relationship I've built in the exam room.  It's a complex set of emotions, but invariably some family member will start telling others what a nice doctor I am and how much the person had liked me as a doctor.  It's awkward getting a eulogy (literally: good words) spoken about me at someone else's funeral.  This patient I had known prior to them becoming my patient, and his wife had been very nice to us when we first moved here from up north. But that's not why I am writing this.  As I was sitting in the service, the thought occurred to me that a patient's funeral would be considered by many to be a failure for a doctor.  Certainly there are times when that is the case - when the doctor could have intervened and didn't, or intervened incorrectly, causing the person to die earlier than they could have.  Every doctor has some moments where regrets over missed or incorrect diagnosis take their toll.  We are imperfect humans, we have bad days, and we don't always give our patients our best.  We have limits.

Yet if patient death was the measure of a doctor's failure, then all doctors would be 100% failures in the big picture.  Doctors are not the only imperfect thing; the human body is frail, people make bad choices about their own health, and life itself is hard and unpredictable.  In reality, doctors are putting  a finger in a dike that is crumbling to pieces.  We are stalling, holding off the inevitable when we succeed, and standing and watching the inevitable when we fail.

This doesn't just apply to death, it also applies to suffering.  The huge number of comments on my last post bear witness to the vast numbers of people with chronic pain, illness, and suffering.  It some ways, for a doctor, the death of a patient is easier to deal with than the impotence felt when we are unable to help a suffering person.  There is always the question of whether we are missing something that could help.  There is the pressure from the expectant face that hopes we can fix what has been unfixable up to now, and the weight of the defeated faces of those who have lost that hope.  It's hard to stay above the emotion of those encounters when your stated job is to fight disease and minimize suffering.

Which brings me back to the funeral service.  After the service I greeted the man's wife with a hug, reminding her that I am available to her if she needs anything.  She thanked me for the care I gave to her husband and for the ways I've helped her through this time.  In a lot of ways, it was my presence that mattered most.

The word "sympathy" comes from the root words meaning "to feel with."  The word "compassion" comes from the root words meaning "to suffer with."  I remember once looking at a beautiful mountain vista by myself, thinking how much better it would be if there was someone to share it with.  The addition of that person wouldn't add to the beauty, but it would somehow validate it if someone else shared the awe and wonder I felt at that moment.  My role as doctor is not just to stand with people, but to help them.  Yet I cannot forget that I do see their pain without veil, I do experience the difficulty people live, they don't hide their tears from me; and that fact somehow made it better for them.

Perhaps that is what many of the docs who flee the chronically ill patient are missing: you don't always have to fix things to make them better.  You don't always have to relieve suffering to give care.  It's great when you do, but in the end the most important thing is to be there.  To feel with and suffer with people as they make their journey through this life.

19 Comments