William Rifkin, MD

The holidays are a tough time to be in the hospital as a patient, but it's also tough on us doctors. Perhaps it's the forced jocularity, the sharp contrast between our world inside and life outside. It could also be that those who come to us at this time of year seem to suffer more from psychic than physical wounds. During these weeks, my biomedical training seems of less use than my instinct for simple human compassion. I find myself "unlearning" years of clinical detachment, leaving me exposed to the emotions I recall from my earliest clinical rotations, before I had much knowledge to bring to bear. 

At the clinic where I work, I see a number of mentally retarded patients, most of them brought in by caseworkers or attendants from their homes. Until recently, I had looked on these visits as "gimmies," without much need for complex medical decision-making. I could usually cut precious minutes from them, allowing me to save time to catch up with the pile-up in the waiting room. 

I remember one patient I'll call Abby, whose older sister Jenny would bring her to the clinic every three months. (I've changed the names to protect their privacy.) On one particular visit, Jenny brought Abby in at the height of the holiday season. This time it was obvious that Jenny was exhausted. She sat slumped and disheveled, and I guessed her insides were in a similar state. 

I pressed Jenny, remarking that she looked weary. Before I knew what was happening, she was in tears. I let her cry, making a conscious effort not to dismiss her obvious emotion. Because I was feeling out of my medical realm, I fell back on simple human kindness. I put an arm around her and let her cry on my shoulder as I led her to an empty exam room. Again, out of human instinct rather than training, I asked her, "What's wrong?" 

I suspect that Jenny hadn't been asked this question in a long time, if ever. Although she was clearly embarrassed, the words poured out of her. She related how she had been Abby's primary caregiver for more than 25 years, ever since their parents had become too old. She described the many sacrifices she'd made in her life: lost chances for love, career, and personal time. Amazingly, I detected no trace of resentment-only sadness. 

Jenny told me that she was now experiencing what had once been her parents' ongoing nightmare: wondering what would happen when she becomes physically unable to care for her sister. She said that Abby is well aware on an emotional level of what her parents and now Jenny have had to do for her over the years because she's "not normal." She explained that it was this level of awareness that had made her family unwilling to place Abby in a home. They had always felt that she was their daughter, their sister, who knew and loved them in her way. 

But then Jenny confessed, "It's just that sometimes I feel this is all so difficult and unfair. I mean, there's no one to blame, certainly not Abby. But that doesn't change the fact that I'm tired today, and that this will never end." 

What could I say? That I understand because my two rambunctious, healthy, intelligent boys run me ragged at home on weekends? No, I have no real frame of reference for Jenny's world. In that moment, it occurred to me that my standard response in such situations-"I know what you mean"-is less than helpful: It's belittling. So I simply said, "That sounds like a very difficult situation. I really admire you." 

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Confronted by emotional suffering, this doctor found compassion more effective than clinical skill.

Author | William Rifkin, MD

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