After receiving the news, I walked around stunned, not knowing how to feel or how to react to the situation. I was strongly affected, but what was I feeling? I could not say. I struggled to understand, and I was afraid at first to ask for help. I was not yet ready to speak. It took a while for me to realize that what I was experiencing was grief and that what I was dealing with was, in essence, my first death.
In the moments after learning about Laura’s results, one of the strongest feelings I had was a real sense of mourning. It was a loss after all, and I could not help but wonder how Laura and Matt were feeling. The termination aborted not only the child but the dreams, feelings, hopes, and experiences it represented and engendered.
I spent almost two weeks in silence trying to process and understand my emotions. I decided to speak first with my father, whom I have often used as a guide and a mentor when faced with circumstances that challenge me to think in new ways. I phoned him and asked him whether he would be willing to listen, not necessarily to advise me or answer my questions but simply provide me an avenue to get my thoughts out and help me analyze them.
My father reminded me that people will make many different choices. As a physician you don’t need to decide for all the people. They are your patients. They are not breaking the law. Your responsibility is to support them, without passing your own judgments.
My father has an analogy that he often uses to describe emotions when he’s advising my sister or me. He says that emotions are like a wave and one must learn to surf on them. Our consciousness is only the surface and below that is a much deeper, more complex subconscious. Sometimes, if the emotion hits us just at the right time and place—and we are ready for it—we may even stand up and surf along. It’s these moments where the emotion can truly drive us and take us somewhere new, further than we have ever been or we ever thought we could go.
I worried at the time about falling to pieces and knew that what I needed was not someone who could discuss the ethics or practices or technicalities of a procedure but just someone who could provide support to me. Without realizing it, this was my introduction to a key component of my professional duty as a physician: balancing one’s own emotions and opinions against the needs, thoughts, and feelings of our patients.
**
It is all too easy to default to one’s own beliefs, but the trick to becoming an open, caring clinician is to be able to solicit and support your patients’ needs at the time of their care, rather than your own. This is not to say that you cannot have feelings in response to a patient’s situation. Our role is to learn to manage our emotions so that we can instead focus on the patient. I should emphasize that managing does not mean ignoring or putting them aside. In fact, it takes real skill, focus, attention, and even mindfulness to be able to tune in to these emotions and get a reading on one’s own body and mind; this can inform our approach to the patient.
We do learn a lot about our patients and about their medical conditions, but we would be fooling ourselves if we thought that we knew everything about them. In fact, it became exceedingly clear over the course of the year that I had gotten to know Laura much better than my mentor ever had a chance to. Dr. Bertill had seen her within the medical context, and Laura’s friends and colleagues had seen her personal and social life, but where did that leave me? Straddling the third space, not quite physician, not quite friend.
Hi Galina,
Matt and I are doing much better. It’s still difficult but I can now talk about it without crying, which is a huge improvement. I’m back at work as well which helps keep my mind off of things a bit. I have an appointment with Dr. Bertill coming up—are you able to attend that? If not, I can see if she can reschedule. I hope you had a good spring break and that you were able to enjoy your time off!
Laura
One of the important pieces of this experience has been developing a relationship over time with Dr. Bertill. I have to admit that when I first met her I was a bit worried about what the experience would be like and whether the two of us would hit it off or not. I was hoping to have a very warm, helpful, and incredibly dedicated mentor who would have time to teach me, explore with me, offer suggestions, and connect me with others. Instead, I found that she, too, had little idea about what we should be doing as it was her first year as a mentor with the program. The boundaries, settings, and expectations were malleable, waiting to be set by us.
What I learned from Laura is that being a patient means being vulnerable, being threatened by something from within or outside of oneself. Perhaps the greatest lesson Laura demonstrated was that being vulnerable did not mean that one was helpless or that one had to be passive.
Laura was really the first patient I met who had read about her condition on the internet. She had researched all her providers and made a choice about which physician to visit based on online recommendations and expertise. She had the confidence to seek the best care for herself and also the competence to navigate the health system and find and demand excellence. I was impressed by this and that Laura did not allow her illness to possess or overwhelm her.
Laura and Matt invited me for a visit to their home in a suburb outside of Boston on the second weekend in May.
I brought along some chocolate for us to share and Laura had lovingly put out a mixed platter with sliced baguette, homemade green bean and avocado paste, and a fresh slice of brie she had picked up from the local grocery store. Today we would not only be sharing histories, sharing opinions, or sharing stories, we would be sharing that most fundamental of activities that bring two people closer—we would be sharing a meal.
In my last meeting with Dr. Bertill, we reflected on how this experience had been for each of us over the past year—the ups and downs of treating and spending time with Laura—and both the expected and unexpected outcomes of participating in this course.
Dr. Bertill believed that taking on a professional role was part of her responsibility to the patient. She wanted to demonstrate expertise, confidence, and competence so that the patients, too, could feel that they could rely on her as a physician, that they would have confidence in her, and feel their care was in the right hands.
It is hard to instill confidence if you are susceptible to your emotions, however. Dr. Bertill said, “When you sit with your patient, you must listen wholeheartedly, but you must also remember that you have another roomful of patients waiting for your help.”
You cannot let yourself empathize so strongly with one patient who leaves you empty and incapable of helping the next one. I think the balance between sympathizing and holding my emotions back is one of the lessons that has been hardest for me and that I anticipate I will continue to struggle with throughout my training. I learned during this experience that sometimes our own emotions in a situation are unpredictable.
As we wrapped up our final meeting, I asked Dr. Bertill if she had any words of wisdom to impart. She said, “What I’ve learned is that every patient is so different. You cannot predict a patient’s response, especially when they are faced with a difficult medical situation that is scary or concerning to them. Some of the women in my clinic come in and they are just scared and worried. Others are cool as a cucumber. But all of them are our patients, and our role is to be sensitive to their specific needs, whatever they may be.”
Be sensitive, be helpful, and tend to the needs your patients express. This is both the simplest and the most difficult thing—and it is what we physicians must learn to do.
Galina Gheihman is a member of the MD Class of 2019 at HMS. This essay, titled “Heartbeats,” appeared in The Soul of a Patient: Lessons in Healing for Harvard Medical Students, a compilation of student essays edited by Susan E. Pories, MD; Samyukta Mullangi, MD ’15; Aakash Kaushik Shah, MD ’16; and Mounica Vallurupalli, MD ’13. The names of the patient and the physician/mentor in the essay have been changed, and the piece has been edited for length. It appears with permission from the publisher, Gordian Knot Books/Richard Altschuler & Associates, Inc., Los Angeles, California (www.richardaltschuler.com).
Images: John Soares