Patients affect us in this way
Category: End-of-Life Care • Internal Medicine
Posted on: September 15, 2007 10:03 AM, by Signout

I spent the afternoon today in the office of Dr. Leaky, a neurologist who takes care of people with movement disorders. One of the patients we saw was a man in his late fifties with amytrophic lateral sclerosis (ALS, otherwise known as Lou Gehrig's disease). ALS is a devastating illness that slowly drains muscle strength until a person is unable to feed themselves, bathe themselves, or even breathe for themselves. The course of the illness varies, but affected people usually die of respiratory failure within five years of the diagnosis.

This patient had been seeing Dr. Leaky for a year, ever since his diagnosis was first made, and this was a routine follow-up visit for him. The visit went at a leisurely pace, with an interview, a physical exam, a review of the man's medications, and some personal chat.

At the end of the visit, when the neurologist reached out to shake the patient's hand, the man instead wrapped his arms around Dr. Leaky in a hug. "I can't just shake your hand after these visits," he said.

After the patient left, Dr. Leaky closed the door to the room and looked at me, his eyes watery. As fat tears rolled down his cheeks, I sat next to the desk and watched him, stunned. "I'm sorry," he said, "but it's such a shitty disease."

When my patients cry--and they do, often--I sit down. I want them to understand that I'm not uncomfortable with their emotions, and sitting seems like the easiest way to make it clear I'm not leaving.

When Dr. Leaky cried, I stood up. I felt, briefly, confused and uncomfortable. He was not supposed to feel this much, I thought. We were not supposed to let patients affect us in this way. We work not to let patients affect us in this way.

It's not that I don't cry--I certainly do--but when I cry, it's because of my own suffering, not because of someone else's. I can't think of a single time in the last year and a half that I've cried for a patient.

I don't think that makes me a bad person. Self-centered, maybe, but not bad. It does make Dr. Comfort something like superhuman in my eyes. He has seen people die from the same disease for fifteen years, and he is still able to summon the emotion to mourn an individual person's suffering. That seems extraordinary to me.

At the time, of course, I wasn't thinking in so many abstractions. After my initial bolt from the chair, I came to my senses, found a box of tissues, and sat back down. Dr. Leaky dabbed at his eyes and stood quietly. After about a minute, he spoke: "Ready to see the next patient?"

http://scienceblogs.com/signout/2007/09/summon.php