The Frustrations of Caring

Sometimes I wish I didn’t care.

I remember when I was an intern, the professor of surgery once said to me, ‘the trick of lasting in this gig, kiddo, is to stop caring so much.’

I thought at the time that he was referring to caring about what other people think.Then I realised he meant caring about patients. I was outraged; absoluately convinced that he was just a cynic.

Now, I think he is actually just a realist. A very experienced one at that.

Caring about patients need to have limits. I have learnt the hard way, that if not, the patient will start pushing boundaries with their expectations, my whole existence becomes one big worry-farm, and then my personal life deterioates.

When I meet my patients for the frst time in a consultation, I take the time and effort to explain everything to them. I care about how much they understood and whether they feel reassured. During surgery, I do my best to be efficient, methodical and meticulous, because I care about the success of their surgery. While my patients are recuperating, I make sure they have all the information and instructions to follow and a contact number to call if they are concerned, because I care about decreasing their distress and anxieties while they are recovering. And at their final followup, I care, in particular, whether they are happy with the result.

This translates to worry. I worry if they have had enough time to digest the information and ask me questons. I worry if I have done my best with their procedure. I worry if they are going to develop a complication after surgery. I worry if they are having problems at home after surgery. I worry if they are dissatisfied with their result and if there is anything further I could do for them.

I worry. And it’s tiresome. But after many years, this constant caring and worrying becomes part of normal living – a bit like the constant background hum one hears in an airconditioned room. Some days the humming is louder, like when I am working over 100 hours a week and I have lost count of the number of patients I have seen. Other days, it’s like a sledgehammer, when I am dealing with problematic patients and complex surgery. Rarely does it becomes silent, even when I am asleep (yes, I do dream of operations and patients), or when I am on holidays (I still receive emails of lab results, letters etc).

Sometimes I resent it. Like when I receive a text message from a patient at 1am with a selfie of their wound or surgical site. I feel like yelling in frustration. But I constantly have to remind myself that it’s not the patient’s fault my life is like this. They are only doing the right thing – contacting me when they feel something is not right. It’s my fault. My fault because I care. I care enough to ring them back and listen to why they can’t sleep, talk about their concerns, and address their anxieties. Then I lie awake worrying. By the time my caring has finished, it is time for me to get up to start my 12-hour day again.

Sometimes my husband resents it. ‘Why do you have to go in to work on Sunday?’ Because I worry that my inpatients may have deterioated overnight, or need an increase in their painkiller prescription. I worry that they are sitting in hospital on a Sunday, feeling abandoned by their doctor (who feels too guilty to have a day off). ‘Why can’t you switch your phone off for dinner?’ Because I worry that my patients may need me and I won’t be there for them. ‘You are thinking about work again and not listening to me.’ I was worrying about what I could have done better in surgery, instead of giving the one most important person in my life the attention he deserves. I worry because I care.

Believe me. I tried. I tried to stop worrying, and erect a wall against caring. I tried to emulate some of my colleagues who has Not-Caring down to an art. But my conscience kept me awake, and my attempt lasted for all of 10 seconds. I know I don’t have to care, I just have to provide a service to my patients. I have seen very capable and successful surgeons who don’t seem to care and still have excellent results. They shrug off complications, they don’t take their patient’s problems home, and they brush off complaints at the office door. They live by the ‘Shit-Happens’ Rule. They don’t ever look worried. Either it is because they aren’t, or they have lived with it for so long, it is unrecognisable.

The problems with caring, is it’s closely associated with feelings and emotions. More and more, I have had to find the strength to put it aside. I have seen that too much caring can cloud one’s judgement, especially if I worry too much about how they might feel. Sometimes, cold clinical judgement to do the right thing, which may not be what the patient want, is the only way to make sure they have the best outcome. The hardest part is stepping away from their expectations, so that the bigger picture can be see in perspective. Thus lies the basis for not
treating our own relatives.

And now I understand that the advice was given to me to prevent ‘Burn-out’. I have learnt that sometimes I am unable to solve all my patient’s problems, and that I am not responsible for all their woes. I have also realised that just because I can’t help them, it doesn’t mean I don’t care. It is often enough for people to know that someone cares.

I have discovered that I need to reserve some ‘caring’- for myself and people who love me. I need to care about my health, that I shouldn’t live on chocolates and coffee. I need to care about my husband, what problems he’s having at work and why he’s wearing a shirt with missing buttons. I need to care about my mother, who still refuses to have her home security installed. I need to care about my 90-year-old neighbour, who still push my bin out every week for the rubbish truck but can barely manage to climb up the stairs of his porch. I need to care about my ever-loyal staff, who stays behind in the office and keeps their family waiting in the evening because I have two extra patients to see.

But how does one measure ‘caring’? And how do you dish it out in equal portions? What is enough and what is too much?

Caring is frustrating. It brings with it tiresome worries, sleepless nights and at times, total helplessness.

If I could talk to Prof now, I would ask him, ‘But, how do you NOT care?’

Two minutes

Mrs Warren* came into my practice yesterday.

Mrs Warren is the mother of Hannah*. Hannah was a 35 year old beautiful young mother of three children, who passed away from metastatic breast cancer two weeks ago. Hannah was my patient three months before she succumbed to her illness.

I heard Mrs Warren’s voice at the front desk reception.

I stayed in my office, consumed by guilt. When Hannah was dying in hospital two weeks ago, one of the nursing staff informed me about her readmission into hospital. ‘Things are not good, I don’t think it will be long.’ 

‘Maybe I should pop by and visit.’ I thought, mentally swiping at the tears that threatened to clog up behind my eyes.

‘I think they will really like that. Hannah loved you. She thought the world of you.’

I started, then realised I had thought out aloud, the nurse was just responding to my comment.

Days, then weeks passed. I couldn’t bring myself to visit her. Several times I walked towards her room – steeling myself to walk in to face her emaciated semi-conscious form on the bed, surrounded by her grieving family – then finding myself turning, striding rapidly away.

Hannah was my age. She was a lawyer, a lawyer who studied hard, worked long hours, made sacrifices and achieved. She once told me that she was the youngest associate ever to be offered partner. She told me how there was no female lawyers in her department at which we both smiled simultaneously in mutual understanding. She said she sees a reflection of herself when she looks at me. As I do, when I see her.  

I never went to see her, I never said goodbye. I never attended the funeral. AFter all, I told myself, she wasn’t a friend. She was a patient. The only thing I did, was to write a card to her family.

Now her mother is standing in my office. And I am kicking myself. I should have made more of an effort. It would have just been ten minutes of my life; After all, my ten minutes would have been nothing compared to ten minutes in her last days. My cowardice overwhelmed me,  I found myself hiding in my office, afraid to move. Or breathe.

‘Hello Mrs Warren, we are so sorry to hear about Hannah.’

‘Thank you.’ I imagined her waving her hand elegantly. Mrs Warren always reminded me of a grand matriach, she moved and spoke with such pride and grace. ‘I just wanted to come in and thank the doctor for her card.’ A sniffle. ‘It was so lovely that I had to read it to Hannah yesterday.’ A brief silence was followed by a sharp snap of a handbag. Must have been a tissue. I could almost see her in my mind, using the task as an oportunity to gather her composure.

‘You know, we had so many people at the funeral last week, the church had to leave the doors open.’ There was less wobble in her voice. ‘We got so many flowers and cards.’

‘She had so many specialists, but doctor was the only one who sent a card. Please thank her for me, we were so pleasantly suprised……’

I shut the door.

Tears were running down my face. I was humbled.

It seems the two minutes it took for me to write a card was enough for them.

 

 *All names have been changed to ensure confidentiality and protect privacy.