Uninvited Gift

cc Flickr shared by by atlebra

It’s been five years since she was told she was “cancer free”. Today she was told it was back, and the future was quite grim.

My job was to make sure she understood how to properly take the medication that would reduce the swelling around the tumour so radiation could start as soon as possible.

That was my job. Clinically speaking it wasn’t the most challenging or difficult issue of the day as I scanned her file. Then I went to speak with her.

It took mere minutes to make sure she understood how the new medication worked, how to fit it into her day with her other medications, how she might feel taking it. We reviewed her other drugs and medical conditions and I assessed her level of understanding to be high. Job done.

But what about the other part of my job? When she told me about the cancer returning, I looked into her eyes and could see the shock… and the fear. What she needed in that moment was human connection; a hand on hers and someone to listen to her.

When I looked around for the time I needed all I saw was the impossibility. At least a dozen patients waiting for me to sign off on their medications, one waiting to learn how to use their new inhaler, and two patients nervously waiting for me to administer their injections. At the same moment I heard one of my technicians say I was wanted on the phone by a physician.

Time…..I didn’t have it. I couldn’t take her into my office and be that presence for her.  So I spoke medication, touched briefly on the agony of the diagnosis, and resisted going too deep.  I know too well the fragility of emotion, and without the privacy to truly be present to her situation, she needed to keep from falling apart and make her way home.

But somehow I feel I have failed. There have been times when I have taken patients into the office who have been grief stricken, going through withdrawal, requiring in-depth discussion of an issue…. But today, I was stretched too thin.

And so…I take it home with me.

I have had colleagues tell me to leave the job at the door. Walk away to my family and rest assured there will be more patients and problems tomorrow. I have learned that at times I can and must do it, and at other times I simply can’t. But perhaps it’s the “can’t” moments that make me a better professional…..a better person. There are times when I experience humanity laid bare….a rawness of emotion, a fragility to life. These experiences become a part of me whether I invite them in or not. In the end they are an univited gift.

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9 comments on “Uninvited Gift

  1. I love the notion of the ‘uninvited gift’. While we both do many many things in the work that we do that make a positive difference in the lives of the people with whom we work, we still come across those raw cerebral moments when we realize that people are facing circumstances where our positive impact is only a drop in the bucket. But taking the time to reflect on those moments once, twice, and twenty times really is a gift. It’s a gift to ourselves as we renew that somber wisdom we have that spurs us to recognize and act upon those moments where people need compassion just as much as professional advice. And that’s a gift to them too.

    I’ve come to rationalize to myself that I’m only a cog in the wheel of a bureaucracy. I like to think that more often than not my work as part of the bureaucracy makes things better and that ultimately it’s the bureaucracy that’s broken, not me. Otherwise I would have the time and resources to make a significant difference all the time not just some of the time.

    Thanks for this post Carlene. Your words gave me the chance to wrestle with my own thoughts about effectiveness and the human condition. It’s particularly pertinent to me this week as I had to call Children and Family Services not once, but twice. Dislike!

  2. coleksyn says:

    Thank you for sharing your thoughts Carolyn. I have felt rather weighed down by being unable to “do my job” as I would like sometimes. “A cog in the wheel” is a helpful analogy. I sometimes feel I have more power to change the circumstance than I actually do; but you are right in saying that the “somber wisdom” is what keeps us open to moments when we CAN truly be present. It also keeps me motivated to keep working towards improving my practice.

    I had hesitated to blog about this but in the sharing have found it easier to let go. And certainly hearing your reflections, so similar yet in a different profession, has been so helpful.

  3. It doesn’t take much effort or time to acknowledge the other person – a look, a touch, a gesture, a word, a pregnant silence, a smile.

    You looked into her eyes and saw her. I hope she noticed that. More on this by @whatedsaid here: A little empathy.

    I told you about my dad. My eldest sister, also a doctor, has the same gift. They are able to make you feel you matter in many ways, including being able to cut out medical jargon without making you feel stupid (rather, empowered and informed). They take “it” home with them. Usually, we only hear the good stuff though. I am proud of them; privileged to be related. *I’m getting teary writing this*

    As a care-giver, you must remember to take care of yourself, too.

    So go ahead, take it home with you. Share it with your family. Telling stories and role-modeling are incredible ways to teach empathy.

    And here’s a virtual hug for you, my friend. xox

  4. Phil Little says:

    Carolyn is right – we are but “a cog in the wheel of a bureaucracy”. However it is our choice to be a useful cog or an irritant type cog. In the event you described perhaps you yourself became both the irritant and the irritated. That is good because it forced you to deal with the limitations of space and time. There is so much to do and you simply cannot do it all and definitely not alone. Wouldn’t it be nice to have superpowers so that we could zoom in and solve so many problems and protect people from the “system”. No you didn’t fail. You were touched which means you went beyond the prescription bottle and the label, you met the person within the possibilities you were allowed. Others were waiting for you. Perhaps in a moment of quiet – are there ever any moments of quiet? – you can reconnect and inquire about the medication. An excuse but perhaps professionally allowed but the message comes across – “you are a person, not just a client”. My guess is that this person already understood your concern. As for taking it home – there is a difference between taking home the work and taking home your humanity. Your shift ended but your connection to the person was your choice at work and keeping that person in your heart is not wrong. Keep the work out of your head when at home. Trust in your own ability to reach out as much as is possible.

    • coleksyn says:

      Thanks for the comments Phil. I really appreciate your wisdom and have been ruminating quite a bit since writing the post.

      This post was also published on KevinMD and received a comment about how I failed the patient and should be ashamed. It gave me pause to really consider what failure was and if I was failing in fact when I have to choose one over the other in limited time. It is a tricky balance to not expect perfection from oneself but to strive to keep reaching for betterment in a not so perfect situation.

      I have indeed followed up with the patient as I try to with others. It is not the norm, but I think so important in a system where followup is scarce.

      The reflection and growth that comes from the writing and responses to blogging is why I do it. It was difficult to share such an imperfect moment but it has pushed me beyond my original thoughts and feelings on the situation. Thanks for being a part of that.

  5. John says:

    Great post. I relate to wanting to document those moments (in or out of healthcare settings) that give you pause for reflection.

  6. John Lynn says:

    If I need meds in the future, I’d want my pharmacist to be like you.

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