Can I cry in front of my patients?

Can I cry in front of my patients?

Vijay Gopichandran

A small but strong army of bloggers is forming in our institution and these bloggers are inspiring me to write more. Yesterday, one of our student bloggers wrote an emotional and reflective piece on the various instances when she was moved to tears by the pain, distress, and anguish of her patients. Read the blog here. When I read her reflective piece, I started wondering what I did during the moments I was moved to tears. I was also reflecting on various discussions I have had with batches of students on this topic. In fact, another student of our college did a study on Emotional Intelligence and published it. I am going to write briefly on what I have done when I have been emotionally affected by a clinical situation and its influence on the way the patient related and responded to me.

I was pursuing my MD in Community Medicine at that time and had just lost my grandmother to a very severe form of pneumonia. I was very close to her and we shared a very special bond. The loss was painful, and I was grieving. At this time, I saw a patient in the hospital where I was working who looked very similar to my grandmother. Thin built, bent over with kyphosis of osteoporotic spinal compression fractures and a toothless calm smile on her face, she looked at me just like how my grandmother would do. It sent a huge flurry of emotions running in my mind and in a split second I became a young boy, running around her, holding the pallu of her saree and shouting and laughing in glee. The emotion was so overwhelming that without my knowledge, I had started crying right there in the outpatient department in front of everyone. The elderly lady put a comforting hand on my hand and asked me, “what happened doctor?”. I controlled myself and told her that she strongly reminded me of my grandmother and that I had recently lost her. The two of us instantly hit it off and our therapeutic relationship was excellent from then. Even after she went home from the hospital, she kept in touch by calling me on the phone and talking to me.

Once when I was seeing patients in the outpatient clinic of the NGO where I used to work in rural Kancheepuram, I saw a young woman, about 20-23 years of age, holding a very malnourished and sick child. She looked so frightened to even sit in front of me. Words wouldn’t come out of her mouth when I asked what the problem was. She was not crying but was obviously overwhelmed with fear and was paralyzed by it. This extreme vulnerability struck me hard and her apprehension affected me deeply. I wanted to help her somehow and just reached out for her child. With overwhelming fear and trembling hands, she warily handed over the child to me. That moment was one of the most emotional moments in my life. A young, scared mother, mortally afraid of the illness of her very sick child, with utmost trust, surrendering her invaluable possession to me. The moment was emotional because of two reasons – I realized the kind of immense responsibility that had just been transferred into my hands and there was a great deal of pressure to understand the situation and treat it immediately. The child was severely malnourished and dehydrated. Even as I held the child, who weighed as light as a piece of cloth, he passed loose watery stools. The overwhelming emotions and pressure to perform propelled me into action. Instantly, we established an intravenous line in the slender hands of the baby and started him on intravenous fluids. In addition, I also inserted a nasogastric tube to feed the oral rehydration solution. As soon as we started feeding the oral rehydration solution through the tube, the little one had a look of utmost satisfaction on his face and started making sucking movements of his lips. That moment was again extremely emotional and priceless. This was an occasion, where emotion had literally skyrocketed me into efficient action.

Emotions are not negotiable or optional. We all have them, some of us express them and some of us don’t. Emotional Intelligence is the ability to identify, understand and express our own and others’ emotions appropriately. Feeling emotionally bonded to a patient is very helpful in many ways. Emotional bonding ensures the dictum – “do unto others only what you would have done unto you”. When a physician is emotionally connected to a patient, it helps practice ethical medicine. This is because the emotional investment would not allow any conflicts of interest to arise. It helps the physician see the patient as their own kith and kin.

It is often said that a physician must be the rock of Gibraltar, the pillar of support and so on and so forth for her patient. While being the rock and pillar is important, the physician cannot literally be a rock or pillar, who does not feel or emote. While working on my Ph.D. research on trust in the physician-patient relationship, I could understand a very important difference that people perceived between competence and trustworthiness. Competence (nalla doctor) is an attribute of skill. This was associated with the educational qualification, the success rates of surgeries, etc. Whereas trustworthiness (kairasi kara doctor) is completely different. While competence comes from training and technical expertise, trustworthiness comes from humanness. For being human, a physician needs to be emotionally intelligent. Patients want their doctors to be human. They want them to feel their pain, empathize, understand, and emote. These are the attributes that increase a doctor’s trustworthiness quotient.

So, in response to my friend’s blog on whether a physician can cry in front of a patient, I strongly believe that a physician can. I believe that the more human the physician comes across as the more emotionally and socially supported the patient will feel. I feel that physicians should be the rock of Gibraltar, but a feeling, emoting and empathetic rock of Gibraltar!