Yesterday was the ‘Grand Rounds day’, boring! On these days, we basically follow the doctor around as he does his rounds of the wards. Here ‘we’ stands for at least 20 people. And to be able to hear what the doctor is saying through this thicket of human beings, crowding the little place beside the bed where he stands, is practically impossible. But yesterday something was different; there were very few people around one of the patient’s bed. I looked up expecting to see the back of someone’s head as usual, instead I saw such a gruesome site, I wished I hadn’t looked up and had continued staring at my feet which I usually do on grand rounds day. The patient had an ulcer and it basically looked like someone had scooped out a portion of the skin and flesh off of his foot such that one could see the bone underneath. I was so engrossed in looking at the ulcer that I had almost missed the doctor say, “This leg most probably needs to be amputated.”
I hadn’t noticed the woman by the patient’s bed till then.I could see she was trying really hard to be strong but it wasn’t difficult to miss the pleading in her eyes for the doctor to do something, anything to avoid amputation .I guess the doctor saw this too and asked the PG standing next to him, “Is there any way we can save his leg?” Any layman could have looked at the fellow’s leg and have said, “This leg’s a goner!” I guess realizing that giving false hope to the woman wouldn’t be wise, the doctor confirmed amputation.
I looked at the patient to see what his reaction was and it surprised me. He nodded his head and said, “Do it, please do it” It’s then that I realized that to make the pain go away, at that moment, one is ready to accept whatever the consequences of it may be.
As everyone left for the next ward I stayed back to have one quick look at the woman and how she was handling this. She had let the tears fall from her eyes and had then buried her face in her pallo, probably to hide her tears from her husband because she felt that she needed to be strong for him. But as she stood there alone, I wondered if I should go up to her and comfort her and tell her that her beloved would be fine…but would he really? This thought held me back and I chose to walk away…
But I guess, one’s conscience can’t keep quiet for long for immediately after I’d left, I regretted not talking to her nor to the patient because maybe, just maybe, holding someone’s hand or talking to someone about it would have made her feel better if only for a moment.
And I still wonder why I felt worse for the woman than the patient. Was it because the patient so readily accepted amputation, that it felt much more of a cure to his pain and problems than a problem itself or was it because I had watched the woman cry into her sari probably thinking about how she’d have to be a support for him for the rest of her life or how she’d have to run her family all on her own.
Either way, I condemned myself for the indifference I showed that day, even if it was for a little while but then again, hasn’t it become necessary for doctors to be indifferent to the sadness and trauma they see, in order to survive?
About the Author: This article is written by Rumana Khan, a 2nd year MBBS student at KMC, Mangalore.
Editor: Ankita Singh.
I don’t believe one can teach empathy, per se, but we can teach
physicians to express it in a manner which promotes effective clinical
relationships and communication; and to understand empathy in themselves
and process it reflectively. Patients primary goal in seeking medical
care is not empathy, it’s getting their problem fixed. Patients want to know that their doctor cares about what happens to them, which is shown as much by diligence, by being available when needed, by listening to the patient and inviting the patient to express goals, anxieties, preferences, etc., and by making it clear what the doctor believes is necessary to achieve the patient’s goals. Some people want a lot of emotional support from their doctors, others not so much.
Empathy can be good or bad. It can sometimes cloud judgment, producing rescue fantasies, produce countertransference in which the physician is drawing emotional gratification from the relationship with the patient, or cause transgression of professional boundaries. It’s not that empathy is bad, but it needs to be respected and kept in its place.
Yes, medical students have limited technical skills. Yes, they have limited knowledge. But despite these limitations, a medical student can comfort the patient as no other individual can.
Medical students serve as unbiased facilitators of communication as well as provide companionship to those in need. Medical students are able to see relationships and communicate with people by looking at health and community on a broader level. Medical students can express their thoughts and ideas directly and honestly through a clear lens, free of so-called biases, judgments and stereotypes in a way that both comforts the patient and provides him with a sense of well-being.
This ability allows the patient to see the medical student as an ally and not simply as an authority.