There is a funeral today.

I should probably go.

I can’t go.

I won’t get there on time.

I have no one to talk to about it.

I don’t want to go alone.

 

A month or two ago I met a patient, who touched me.  I can’t tell you the medical details, but I’d like to share an outline.  She was an elderly lady, and was brought in to the ED for an acute illness.  She had been sick for a while, and had finally agreed to see a physician.  When I met her, my initial thought was “what a sweet, but stubborn, lady”.  My second thought was “oh no”.

These days, having been working as an Emergency Physician for four years, after a five year residency program and four years of medical school, I have started to make some diagnoses almost immediately.

My patient had signs on history and physical exam that led me to understand the nature of her illness without even having results on paper.

What I didn’t know, was that my CT scanner would reveal something much worse, along with my initial diagnosis.  The “donut of truth”, as some colleagues refer to it, tells all.  It told me a story I didn’t want to retell, and I felt torn in shreds as I pored over the images.

A short while later, I called the daughter and asked her to come back to her mother’s room so we could talk about what the results showed.  I walked back into the room knowing that the calm and peaceful faces in front of me would rapidly be changing into terrified, desperate ones.  As I told my story, which was in English and partially translated for my patient’s benefit, I watched the change come over the room.  I felt the sorrow to my core.  If sadness had a smell, it would be what permeated the air by the time I finished.

 

They thanked me.

Why do our patients and their families thank us for delivering a death sentence?

Why do they look at us with gratitude, when we have just clarified things to an extreme, one that is terrible and heavy and horrifying?

 

It’s so hard to know what to do in that moment.  We are taught in our travels through medicine how to “break bad news”.  But you don’t know what that feels like, having to do it every day.  It’s a weight, pressing on your heart, weighing on your shoulders.  It threatens to pull you under the waves of grief that wash through the room, a tsunami of distress and fear.

It’s all I can do some days to swim desperately to the surface and get my head above water.  I try to remember that for all the darkness, there is always a dawn that breaks.  Night doesn’t last forever.  While I may not be able to save one sweet, stubborn woman or give solace and hope to her family, the next patient may be one I can make a difference for.

That’s why I do what I do, I guess.  For those times when I can change the outcome.  And, perhaps, for the ones when I can’t alter the ending but can make the ride there a bit more comfortable, a bit less petrifying.  Sometimes, I use my smile and my own inner light to brighten up the darkness I bring into the room with me.  I can feel it inside me, wanting to push away the clouds.  I do what I can.  Then I walk away.  And I feel it.  The presence of someone else’s sadness, taken into myself in exchange for any comforting words I could impart.  It really is a give and take, and it is spiritually draining but fulfilling all at once.

So today, there’s a funeral.

A goodbye.

The end of a traveled road.

I can’t go.

But she’s already gone.

 

Thank you for letting me share this with you here.