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When We Can’t Fix

Today, I was sitting with a group of first year medical students, and we were talking about loss.  Specifically, how to be with dying patients and their families.  We were discussing the situation of one man’s catastrophic grief:  the death of his entire family in a car accident.  What could we, as physicians, do in such moments, if anything?

One student raised his hand and said that he felt uncomfortable even thinking about it.  That to try and say or do anything would feel so insignificant in the face of such monumental loss, that it would somehow minimize or diminish the extent of grief in a way that didn’t feel right.  He almost felt a sense of intrusion on an otherwise intensely private moment.

Another student raised her hand, and questioned whether there was a way for us as physicians to “hold space” for a grieving patient or family, even in the absence of a “cure” or a “solution” to whatever problem was ailing the person in front of us.  A third student wondered if maybe offering tissues, blankets, or other comforts would help, or seem small in the face of unimaginable tragedy.

It was a challenging conversation.  Many of us became tearful remembering patients we have lost, or falling into memories of loved ones who have passed on.  It is inevitable to get triggered by such difficult experiences.

But part of our job as physicians and physicians in training is to learn to sit with such emotions.  After all, emotions are energy, and that energy ultimately must get directed somewhere.  Unprocessed, such emotions of sadness and grief can quietly morph into burnout, numbness, substance abuse.  Learning to be a physician is learning how to be with our feelings in a way that allows us to experience our direct contact with both suffering and loss on one end, moments of health and joy on the other end, and everything in between.

Slowly, we were able to deepen the conversation.  How often do we as physicians actually cure?  How often can we actually offer a solution that eradicates a problem?  Of course we do have a few examples.  Antibiotics, surgery, chemotherapy, vaccines.  However, when we look a little more closely, many of the health concerns that bring patients to doctors are not curable.  Hypertension, Diabetes, Depression…most illnesses are chronic, and we have treatments that help us manage the chronicity and severity of illness, rather than solve.

So if we often can’t fix the problem, what then is our role?  We realize that patients don’t just deal with loss at the end of life.  Almost every illness brings about a loss of some sort.  Perhaps a loss of mood, energy, vitality, time, hope, ability.  Even the loss of a favorite food or sport.   A significant part of what we can do for our patients is simply walk alongside them in their journeys of illness…which means maximizing their health as best we can.  And at the same time, supporting them through the losses that inevitably occur along the way.

If we believe our only role as physicians is to cure, then we are missing something very important.

Together, alongside our patients, we will feel something.  In fact, I hope and pray we feel something, because I am not sure why else we are here doing what we do.

I tell the medical students that it is okay to cry with patients.  It is okay to offer our tears as a way of being with our patients through the most tragic, meaningful, hopeful, and hopeless moments of their lives.  We can allow ourselves to be moved, deeply profoundly moved, by the act of caring for people.  We can allow ourselves to feel helpless at our inability to do more.

When we are in touch with the most deeply human parts of ourselves, we can offer our patients something so much greater than a cure.

We can offer them our presence.  We can offer them our love.  We can offer them a witness.

It is in these sacred offerings that something beyond cure or no cure unfolds.  And that is healing.

With gratitude, Monisha


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