Empathy- a doctor’s perspective

‘Empathy’ – is expressing it is enough?

As a doctor, I had numerous encounters where I felt I have adequately shown empathy, like while trying to calm down the nerves of my anxious pre-operative patients, discussing untreatable conditions and asking patients to make end-of-life care decisions. Every patient was different and every encounter was equally tragic.

Last night, on the night shift, I went to check on a patient who was suffering from a recurrence of laryngeal cancer, post-radiotherapy status with a permanent tracheostomy. She was admitted for pneumonia. After spending a few days in the ICU, she has been shifted to the semi-cabin. I asked about her health status to her guardian, who was her son. He started to talk about the whole history which I patiently listened to ( this is the favorite part of my job, I love to know the whole story from the patient’s perspective rather than the history note on the file). At the end, he said, ” She was doing fine till the day before the admission. I take care of the tracheostomy, a lot of secretions get accumulated there. Now, since the high flow oxygen is in the tracheostomy, the secretions can’t come out and is causing her distress. I was taking proper care of her health with tube feeding and keeping her in a clean environment at home. I want to take her back home. Just after I cremated my father last year, my mother was diagnosed with Cancer larynx. It has been a really tough time for me, both mentally and financially. Can you remove the oxygen tube from the tracheostomy? The heaped up secretions will make her worse, I don’t want her to take any more strong antibiotics.”

He was a middle-aged person, thinly built with a slight stoop of exhaustion. His face was dim with sunken orbits and expressionless eyes. His stress was evident but there is a strong desire to keep his mother alive. Even at his age, losing both his parents in such a short time is going to be really hard. He was looking at me like a child who wants his favorite toy back and is really willing to put everything at stake for that.

Doctors do get emotional. But the hardest part is to not express those emotions but to empathize with the patient and the family while empowering them to regain their strength. I explained to him how her consolidated pneumonia in the lungs in not allowing her to get enough oxygen and the high flow oxygen via the tracheostomy is doing that job. I assured him that once we feel that the need for oxygen has decreased, we will wean her off the oxygen and put her on nasal prongs for oxygen support. He understood and thanked me for listening to him. He slowly slid to his mother’s side and took her hand in between his.

At 2:30 am, I was informed by the nurse that the patient’s saturation has come down to 80. We got into action, a flight of nurses swarmed like busy bees with medications, suctioning, ABG, while I passed the orders, supervised the proceedings and monitored the patient. In between all these, I glanced at her son. He stood at the corner of the room shaken with sadness and despair. He later asked me, “Does this kind of patient ever get better”? I said nothing.

ABG showed Respiratory acidosis and we shifted the patient to the ICU. Once again he followed his mother back to hell. He will have to try really hard to bring her back and he will do it. I have seen a genuine love for her. This is the time when you ask for a stroke of magic to happen by some unknown divine power.