Today I broke the rules. I held my patient’s hand and I cried with her.
That’s completely ‘unprofessional’ behaviour.
In fact it’s so taboo for doctors to show emotions in front of their patients that the image doesn’t even exist in the commercial photo banks. I couldn’t find a single stock image to illustrate this article. The photo I used is not of a doctor.
Why did I cry? I was called to anaesthetise a patient for a C-section when she had just found out her baby was dead.
The day before, she came to the pre-op clinic to plan her anaesthesia and surgery for an elective C-section. She’d reached full term in a healthy pregnancy. There was no hint of the impending catastrophe. At the anaesthesia clinic the patient said she was a little worried because her baby hadn’t been moving so much. As a precaution, the anaesthetist asked the midwife to do a quick scan while she was at the clinic. There was no heartbeat.
In 29 years of practice, I have never before given anaesthesia for C-section in a mother who is carrying a dead baby. Stillbirths usually occur earlier in pregnancy when the baby is smaller and a vaginal delivery is the safer option. I had to think really hard about how to give a safe anaesthetic and my goals for the patient.
Having a C-section under spinal anaesthesia is not a pleasant experience, even though the event may be joyful. There are many side effects and discomforts, even with the best anaesthesia. I didn’t think my patient would be able to tolerate the surgery awake when she was already profoundly distressed. At the same time, I didn’t think being sedated with doses of morphine post-op was a great way to be with her newly born baby while beginning her process of grieving. So I thought that doing a spinal anaesthetic as already planned, plus a general anaesthetic for the duration of the surgery, would allow her to be alert and pain free after the surgery but would save her from having to endure the procedure itself.
With my clinical thinking done, my more important task was to consider how I might best support this patient, her husband and the family, who were all shocked and grieving. In times past, I would have felt embarrassed and inadequate: doctors don’t deal well with death. I would probably have retreated to a place of clinical detachment. Now I know better. I allowed myself to have feelings. I allowed myself to feel deeply sad at the sudden and unexpected loss of this baby and the suffering of the parents. I was not overwhelmed by these feelings and they did not impair my judgment or my care; they were humanly fitting to the situation – except in the world of medicine where objectivity and professionalism are the unbroken rule.
I shared my feelings with the patient. After taking care with introductions, and making sure I brought a spirit of gentleness and compassion into the room, I asked the patient permission to sit on the bed with her. I held her hand and told her how sorry I was to hear her news, how devastating this must be for her, and how sad I felt. We shared tears.
I didn’t propose a plan for anaesthesia. I shared with her my thinking that the grieving process was very important: that the first few hours after her baby was born, when she got to hold her little girl and speak to her, were really important. I said that I thought it was important for her to be pain-free and alert during those hours but I also didn’t want her to endure any discomfort during the surgery itself. A possible solution, I said, was to combine a spinal and general anaesthetic. At that point she burst into tears and I wondered if I had said something wrong. It turned out they were tears of relief. She was dreading the prospect of being awake during the surgery and was intensely relieved to hear my suggestion that she could have a general anaesthetic during the procedure.
We quietly talked through all the details of care and how her husband could be involved. At the end of the consultation I asked her if would be OK to give her a hug. She held tightly onto me.
Everyone in the OR was kind, sensitive and compassionate and the procedure went well. Both the patient and her husband remained calm. A perfect baby girl was delivered, lifeless, and we all felt deeply saddened. The hospital Chaplain came to do a blessing and the OR staff were sent home early, before the end of their shift. I was relieved of my duties for the rest of the day.
The next day, I was busy in the OR and I didn’t have time to visit my patient. But I was really touched when no fewer than three staff members sought me out to convey messages from my patient that she was very grateful for my sensitivity and caring.
I saw her at the end of the day and we parted with a kiss; there didn’t seem any other way to express the intimacy of our encounter. Our lives had touched and I think we’ll both always remember that day.
I became a doctor because I wanted to be a healer; I wanted to be alongside people in their crises, to offer compassion and understanding, and help them to transcend their suffering. But modern medicine doesn’t acknowledge the amazing human capacity for healing. To call yourself a ‘healer’ is to invite professional censure and ridicule.
As we travel around the world we hear many stories of health professionals who have this same ache in their heart: a deep desire to treat people with compassion and healing but a healthcare system that dehumanises both patients and professionals.
At this point in my career I don’t care much for the rules any more. I’ve been campaigning for ten years to bring more compassion and humanity into healthcare and I choose my own way of being, even if it is ‘unprofessional’. I know in my heart that the emotional connection I have with patients is what sustains me and makes me a better doctor.
But if the culture of medicine and healthcare is to change we need more people who are willing to break the rules. Will you cry with your patient?