(WOMENSENEWS)– The current debate over the right-to-die movement in California around the End of Life Option Act, or Senate Bill 128, has called into question the role of physicians when a cure is no longer an option. The ethics and politics of physician-assisted suicide may be in the spotlight, but the emotions a physician experiences remain veiled when the limits of medicine have been reached.
How do doctors grieve?
A recent photo of a physician doubled over in anguish after a patient’s death captured by a coworker outside a California hospital earned more than 4,000 comments on Reddit and 3,600 Facebook likes, drawing attention to the neglected emotional toll the practice of medicine can have on doctors.
I know this moment.
The first time I dealt with my own grief as a physician was during my obstetrics and gynecology residency. I placed an ultrasound probe on the abdomen of a young expectant mother, and discovered her baby did not have a heartbeat.
In the kindest but most definitive way I could piece together, I told Michelle (not her real name) that her baby was dead.
She sobbed, "Please, you have to do something, make him better."
But I couldn’t. As neither could a priest, rabbi, nor minister, I had no salvation or blessing to offer. I was not a psychologist or social worker. I did not know how to address her shock and despair.
"There is nothing I can do. I am sorry."
Years of medical school and residency training to make people well, to fix the ill and to find a cure were useless in that moment.
Each year over 2.5 million people die in the United States and over 700,000 of those deaths will occur in the hospital. Death is inevitable, universal and for those in the medical field, routinely unavoidable.
From the limited data available, we have learned that most physicians cope with this reality by trying to emotionally distance themselves from difficult or sad cases in an attempt to avoid burnout, a pervasive problem in medicine.
A 2012 study of oncologists found that compartmentalization, dissociation and denial were common themes used to describe reactions to a patient’s death. Those same physicians reported that it was difficult to find boundaries between growing close enough to care for patients, yet remaining distant enough to avoid pain.
While the medical community perceives these boundaries as necessary, I believe they are artificial, unnecessary and potentially stand in the way of a physician’s ability to pursue self-healing and achieve longevity in the field.
Sixteen years at the bedside of patients has taught me that separating myself from my patients’ stories removes a sense of the sacred from medicine, when a cure is no longer an option. I think the heart of physician burnout lies in distance, not continued connection.
Physicians–male and female–may choose to separate themselves from cases where a cure is not an option because they no longer perceive meaning in their role. A different perspective is offered by Dr. Rachel Naomi Remen, the founder and director of The Institute for the Study of Health and Illness, who writes, "Meaning strengthens us not by changing our lives but by transforming our experience of our lives."
For physicians, finding meaning outside a cure involves embracing the limitations of medicine, finding fulfillment in helping patients and families face death well and redirecting goals away from solely preserving life. These constructs are not traditionally taught in medical schools. Indeed, it is documented that physicians are inadequately prepared to face the challenges associated with suffering and dying.
Curriculum Provides Foundation
Several schools around the country have adopted The Healer’s Art, a curriculum developed by Remen, which has five main areas of focus: the loss of meaning in medicine, loss and grief, death as mystery, experiencing awe in medicine and service as a way of life. This curriculum provides a foundation from which students can build a sense of humanity in medicine and a source of meaning as they navigate the long road ahead.
Courses such as The Healer’s Art should be as ubiquitous in medical schools as gross anatomy. Just as a physician never quits learning the science of medicine, doctors must continue to work on understanding the humanity of their profession at all stages. Programs should be developed and implemented in residencies and opportunities for continued medical education should be available for practicing physicians.
We must give physicians permission to get close to their patients, to feel grief when they face loss and to understand their sadness. Doctors should know that self-reflection and sharing can provide opportunities to recognize when their pain may be too great to address on their own. It is important that they know how to seek help — and where — in these instances. Ultimately, I believe these practices will help more physicians avoid burnout.
For me, death doesn’t get easier. If the sting softens, if the death of a baby becomes routine, then it is time for me to leave my chosen profession.
What has changed is that I have learned to deal with grief by finding reverence in my patients’ stories, even when the outcome wasn’t expected. I have embraced that death does not equate to medical failure, and in the midst of pain, finding meaning in my role despite the inability to offer a cure has given me a sense of peace. The times when families allow me to stand with them during their most vulnerable moments have been my most rewarding experiences.
Physicians don’t wear armor on their hearts. For that, we should all be grateful.
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