The visit: an interrogation on caring

Night.

Patient: “A few weeks ago you promised to do something for me, when I saw you in clinic. Do you remember?”

Doctor: “I recognise your face. I think I remember…”

“Barely! You promised to check my blood results. You were worried that my kidneys were failing, and you said I might have to come into hospital.”

“Yes, yes…what happened?”

“You didn’t ring, I presume you didn’t check. I called an ambulance on the third day because I was feeling so bad. They took me straight in. You should have seen the look on the young doctor’s face, she was horrified. She said she had never seen so much acid in someone’s blood stream…”

“Oh.”

“You were right. I had bad renal failure.”

“I’m sorry.”

“We’ll get to that.”

“What happened.”

“I was rushed into intensive care to go on a kidney machine…but it was too late.”

“What do you mean?”

“I heard the consultant say to one of the other doctors that I was too far gone. Too late.”

“I don’t…”

“I died. Hasn’t it sunk in yet? I died! You’re asleep, and I’ve come to interrogate you. Or perhaps you’re interrogating yourself, driven by guilt. It doesn’t matter really. I get to ask my questions either way. One. Why didn’t you do what you promised?”

“I remember you now. I was worried, but I had no way of telling it was that advanced…”

“The bloods would have told you, if you’d looked them up next day. Want to hear my theory?”

“Go on.”

“It was because you didn’t really care…”

“Of course I cared. I was worried about you.”

“Not enough. You think you cared about me because I was sitting in front of you, my problem was filling your vision…but as soon as I left you began to worry about other people with more immediate problems. If you cared about me, it was for a few moments.”

“I remember our conversation. I asked about you, about your family, I didn’t treat you like a number or a ‘case’.”

“You were nice to me, yes. You came across very caring. That’s why I went home satisfied, feeling safe and looked after. But you know what, I would rather you had actually cared enough to protect me after I left the room. I wish that caring had been strong enough to keep my problems near the front of your mind next day…so you wouldn’t forget. That way, I might be alive now.”

“You’re mixing up the types of care…the care we feel for people, emotions, and the care we provide.”

“Oh, you’ve hit it. Right on the head. That’s my whole point. The care you and your colleagues provide is physical, keeping us clean, fed, warm, dry…giving us medicine. That’s the basics. But I think the care you give would be better if you actually cared about us. If you cared about me, personally, perhaps you would have checked my results. You would have come to work and I would have been on your mind. My fate, my wellbeing, would have been bugging you. That’s the weakness you see, in giving others power over you. If they don’t care, they won’t think about you when you are out of sight.”

“Is it reasonable, to expect a doctor to truly care about all the people he or she sees?”

“But aren’t you trained to care? Aren’t you supposed to communicate warmth, empathy, a caring attitude? That’s what you did with me, misleading me. You made me feel as though I was at the centre of your thoughts, and I was naïve enough to believe it. Of course you weren’t going to rush in to check my results next day, you weren’t going to put aside your other commitments, delay seeing the visibly ill patients on your ward…”

“So you think the caring I showed you was what? Fake?”

“Just shallow.”

“Insincere perhaps. Come on, this can’t get any worse.”

“A form of narcissism. That’s what I think.”

“What?! What do you mean by that?”

“I think that the attitude or behaviour that you display at work is professionalised. It is doing what is required of you, what’s expected, and what keeps us happy. You listen to yourself, the tone seems right, the words appropriate, yes…I’m doing this right you say to yourself. Perhaps you even believe yourself. You reassure yourself that you are a nice person. Sensitive. And then….you go home and forget us.”

“That’s not true.”

“Really. You think about us outside the hospital? I do not believe that. Tell me, honestly, when was the last time you went home and dwelt on a patient, and worried not about the medical decision, but about the person?”

“It happens! I’m telling you it happens.”

“Yes, I believe you. I believe you because of the way you said it just then. You meant it, you tapped into an emotional scar. Someone you had looked after for a long time, someone with a particularly tragic story? Someone young? Someone who reminded you of a loved one? Not a typical patient though. Bur that’s not good enough, to reserve your caring for the odd one.”

“Many patients have got under my skin.”

“Like parasites you mean! You can’t live with hundreds, thousands, living under your skin, can you? But if they have to get under your skin for you to care about them, and not forget to do the little things that you promised them, how can you provide the personalised, tailored care that you pretend to offer when they sit just a foot away from you?”

“I’m not having this. I do care. I feel sad whenever a patient of mine suffers.”

“No. No, no, no. Sadness does not derive from caring.”

“It does. If I didn’t care why would I react with a kind of grief – short-lived I admit, but real.”

“I think the feeling that you experience is complex. You worry that they have suffered because you’ve messed up, or missed something. Just as you felt when I visited you tonight. That was your first thought…Shit! What did I do wrong. Wasn’t it? You might worry that the suffering indicates a deterioration, the possibility of death. That will make you sad, as it would any normal human being. But I don’t think that sadness will stay with you beyond the confines of the hospital. That’s not how you react to someone you care about. Is it?”

“Perhaps it’s not so rare as you think. You know less about doctors than you think.”

“I’m sure there may be the odd one the doctor has grown to like, even to bond with. But I think that’s a rare thing indeed. Let’s approach this another way, if you had time. Imagine we haven’t started this conversation, in fact imagine I met you on the street, imagine I was conducting a sociological survey. And I said, could you care about. What would you have said? Now be honest.”

“I guess my thoughts would have immediately focused on my family.”

“And if pressed?”

“Then I would’ve begun to think about a few particular friends.”

“Yes, that’s normal. Those are the ones you care about. Then still you insist that you care about your patients? Stop pretending. You don’t, not really. You have trained yourself to say that you do, because to say otherwise would seem callous. But be honest, with me of all people. I’m sorry, I don’t mean to distress you. But I want to get the truth.”

“Perhaps we need to consider different types of caring.”

“Yes, that’s where I was coming from all the time. Professional caring. Shallow caring. If it’s the best you can do, admit it. The thing is doctor, I really don’t care if you care. I only care about you doing your job, yes in caring way, and properly, but I’m not bothered if my problems play on your mind. The motivation behind your actions doesn’t bother me. Perhaps you’ll be nice to me, and I’ll have a good experience, if you care about me, but, understanding the depth of feeling behind your professionalism doesn’t make a huge difference. Feel what I’m feeling, empathise, in order to treat me better, yes, but use it as a tool. Dip into my emotional world, don’t inhabit it. But please…if you make a promise, do it.”

“I’m sorry, for what I didn’t do.”

“Forget it. Perhaps it never happened.”

cover to tweet

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One comment

  1. I like the article and how you framed the questions. I believe that what important is the authenticity of caring which comes from the inside of one’s being. There is nothing more one can do!

    Like

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