Warning: This article mentions sensitive subjects including suicide.
“Hello, my name is Ria, I’m a…”
We use this introduction every single day, for every single patient. Why do we do this? For me, it’s to demonstrate taking responsibility, to humanise myself to the patient and to be present. I am putting my own name on the fact I will do my job. For the patient, it’s to put a name to a face. It’s creating a mutual understanding that we both have the same goal; to ensure their wellbeing and to be there throughout their journey. It is to attest we will do our best to ensure our patient gets better, but what happens when this doesn’t happen?
The strange thing (I find) about the medical profession is the fact we get an automatic invitation into the most personal details and moments of an individual’s life. We’re blasé about the asking details of people’s sex lives, we perform intimate examinations and unfortunately break life-changing news (depending on your speciality) on a semi-regular basis. We’re trained to do this to the point where it becomes second nature, however, I personally had a total lack of preparedness for the reality of spending a lifetime witnessing pain, suffering and the reality of mortality. I rocked up with a stethoscope on placement, notebook in hand and found myself incredibly overwhelmed at the situations my eyes were witnessing (I specify my eyes because often I found myself having to wait for my mind to process what I was actually seeing). Frequently, I would find myself getting home and just sitting, absorbing the events I could not comprehend (the death of a small child, a widows suffering).
I vividly recall the first time I attended a cardiac arrest. Following multiple unsuccessful attempts at resuscitation, the patient’s relatives were called and I was present when the news was broken. I went home thinking about how their lives had been drastically changed with a few words spoken by a Registrar they’d briefly met. I got fixated on how they’d have an empty space at the dinner table indefinitely and how the next time they received a phone call, it would undoubtedly take them back to the moment they received the call from the hospital. I started to wonder whether my reaction was appropriate- what is appropriate for us? How does this become a “part of the job”? We are not the bereaved relatives, we are not the suffering party- but we were present, we were involved, surely that provokes a response? If it is sadness, does this make us weak?
If it doesn’t make us sad, does this make us cold, does this make us abnormal?
Does normalising death make us wrong?
I broached this subject with a medical consultant over a coffee. His response was
“The minute I no longer feel sadness after a death of my patient, I will leave my profession”
From this, I deduced what he was eluding to was that is it this sense of connection, of caring for our patients, that underpins our career.
This isn’t to say everybody in the medical world encountering death should feel sad, it is to say it is okay to not be okay.
With the recent increase in the rate of suicide amongst medical staff (namely Junior Doctors), I feel there’s no better time to address this culture. If you have read this article and have finally felt some acknowledgement of the isolation, the battles with your own thoughts and the gnawing anxiety, it is likely your peers or colleagues have, or are experiencing this too.
We spend our lives supporting others with their difficulties- why can we not do this for ourselves?
Next time you sit down for 2 minutes (unlikely, I know) look around the room. Is there a student silently sat in the corner, a junior doctor tearing their hair out over what to do with a patient? Break the silence and broach the subject – “Are you okay?”
We need not only to safeguard our patients, we need to safeguard each other, after all, what doctor has time to see a doctor?
There are multiple resources available for support including “The Doctors support network” (for both doctors and medical students).
Alternatively, there is also the Balint groups (a recent revelation for myself). Balint groups offer a safe space for doctors to discuss cases and be provided with support and advice from peers. There are several based across the country and the website also details on how to start your own (be the change you want to be and all).
The Samaritans also offer free confidential support 24/7, 365 days a year on 116 123 (UK).
On a more sincere note, when you get home late at night and you feel like you’re carrying the emotional burden of the entire population, be kind to yourself. Take a long bath, eat; you aren’t a machine.
You’re just human and that comes with some strings, and that, is okay.