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Patients affect us in this way

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. Leaky 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?”

Comments

  1. #1 David Syzdek
    September 15, 2007

    Touching post. ALS is a very shitty disease.

  2. #2 Abel Pharmboy
    September 15, 2007

    Painful but beautiful – you docs are all extraordinary in my book.

  3. #3 baryogenesis
    September 16, 2007

    My son’s girlfriend is just completing her nurses’ training and is being posted and is young and new to the whole experience and talks to me about her emotional reactions and I know she will work her way through this, but…. cheers to all of you working in all of these related fields.

  4. #4 Lily
    September 16, 2007

    I’m a medical student, and the first (and so far only) doctor I saw cry was a neurologist discussing one of his patients who he had to diagnose with ALS. It happened in front of a small group of students (10 or so), and I remember everyone kind of sitting there shocked and unsure of what to do. I got up to grab a tissue for him, but it definitely took a second or two to respond – we’re not used to seeing our professors emotionally affected by their patients. You expect them to be hardened after all those years. I think the doctor was a little embarrassed by his emotional display, but personally I thought it was beautiful. I remember thinking, “that’s who I would want as my physician.”
    Nice post.

  5. #5 girlMD
    September 17, 2007

    this reminds me of a song from “Free to Be, You and Me” (i know, i’m dating myself):

    “It’s alright to cry. Crying gets the sad out of you. It’s alright to cry. It might make you feel better.”

    i’m in my last year of residency and i still cry for my patients. i hope i never stop. if i do, i think it will be time to retire. i don’t ever want to be that hard. i think there is a profound difference between being strong for your patient, because they need you to be when they can’t, and being emotionally detached. i think we as physicians, as healers, need to stay emotionally connected to our patients as much as we can stand. because when the medicines and therapies and surgeries don’t work, our patients look to us for strength and comfort. if that’s the last thing we can give them, then we owe them that.
    excellent post my friend :)
    girlMD

  6. #6 Zipperhead
    September 17, 2007

    Thank you for your kind and honest post. It is much appreciated.

    Sincerely,
    Keesha (Chiari and Ehlers-Danlos patient)

  7. #7 Kevin
    September 20, 2007

    Objectivity is fine, losing your humanity isn’t. Dr Leaky sounds like an excellent mentor.

  8. #8 film izle
    August 8, 2010

    I don’t think that makes me a bad person. Self-centered, maybe, but not bad. It does make Dr. Leaky 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.

  9. #9 islam
    October 16, 2010

    Signout reader named Benjamin Langer, who himself has a very nice critical piece on intelligent design in the current edition of SCQ.

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