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Our blogger discusses the emotional component of caring for patients with a chronic disease.
In some specialties, the physician-patient relationship is brief. An orthopedist, for example, might meet a patient for the first time after a fracture, and once the fracture is healed, no further follow up is required. If someone has kidney stones, perhaps he or she will see a urologist for a while, but if the stones are not recurrent, the patient may not need to return to that office.
Endocrinologists, however, like several other specialists, see patients for the long haul. Most of our patients have diseases that are managed, not cured. We may see the same patient for years, maybe even our entire career. It is, therefore, not uncommon, I'd say it is actually necessary, to really get to know our patients – how they live, who their family is, what their interests are.
It is also, sadly, common for us to become attached to our patients. Perhaps it is also usual to lose objectivity.
A few weeks ago, my associate came to me and said, “I did a terrible thing.” When I asked her what happened, she said that she cried in front of the family of a patient who had just been put on hospice for metastatic cancer. I reassured her that it was not a terrible thing, but she still felt bad. “They should not be comforting me,” she said. I told her that I was sure the family was touched that she cared enough about him to cry over his impending death.
And yet, a few days later, when I found myself crying at the bedside of my patient who was put on hospice for end stage congestive heart failure, I was relieved that his family wasn’t there to witness me break down. The man was over 80 years old, had heart and kidney failure, aspiration pneumonia, and had been in and out of the hospital numerous times in the last 4 months. His death was not exactly unexpected or premature.
But I had been seeing him for the last 5-6 years. He always came with his wife and daughter and would joke about how they boss him around. I would pretend to scold him over his night-time cookie habit. I heard about the anniversary parties, the grandchildren, and the vacations, so it felt like losing a family member.
I’ve cried or commiserated with patients over miscarriages, divorce, abusive relationships, infertility, and addicted children. I’ve known some of my patients for over 10 years. I’ve watched one go from single young man, to boyfriend, to fiancÃ©, to husband, to father. I saw the wedding pictures and the ultrasound. I almost feel like a grandmother (almost – I still say I'm too young for that, although my husband likes to remind me that his mom was a grandmother at my age. Thanks, Honey).
I went into medicine to take care of people, and the busy days take a physical toll; but there are days that the emotional toll takes more out of me.