The emotions that I went through in training are parallel to what happens to a patient upon learning of a diagnosis of cancer, any major illness or any life-changing situation such as loss of a job or marital breakup. The following were taken from the previous blog (When I Grow Up) to illustrate a slew of emotions that patients go through.
“I did not sign up for this!!!!!” I said to myself. “No! I was promised that I will save them. Probably, it’s just because the patient was already weak when he came to me. The next patient will be ok. I will make sure”. – DENIAL
I was still seeing patients but I was so irritable, cranky and restless most of the time. I did not have a lot of patience talking with the relatives. I just wanted them to disappear. – ANGER
One day I would feel ok about continuing then another day I would feel really bad and get at the brink of resigning. But I would then find myself talking myself out of it and saying to stay for another day and see if I try harder and take a little break, I may be able to go on.- BARGAINING
If I transfer, I will disregard all the 9 months that I have gone through. I will start from the beginning all over again. I could not decide. I got depressed. – DEPRESSION
That was the most sincere thank you I have ever received and suddenly I knew that I was here to stay. – ACCEPTANCE
Denial, anger, bargaining, depression, acceptance or DABDA as we call them in medical school. These were popularized by the psychiatrist Elizabeth Kubler Ross. Patients also experience a host of other emotions such as loneliness, alienation, fear, loss of control, helplessness, hopelessness, anxiety, low mood, worry, insecurity, disbelief, desperation, shock, numbness, confusion, abandonement, betrayal, uncertainty. The list is endless. There is no particular sequence or duration of their occurrence. Patients’ reactions vary a lot and are often unpredictable.
People often ask me how I deal with the situation and what I say. It is very difficult to answer those questions because there are certain cues that I have learned to be sensitive to that are difficult to explain. However, what is important during these times is support, physically and emotionally. Our mere presence or simply being there can already give a lot of comfort. What to say? Patients may not actually hear what we say because the thoughts in their minds are so blaring that we must allow them some quiet time and respect their need for space. I often ask whether they want to be alone or be with someone. I allow them and even encourage them to cry because crying is comforting and it is a normal thing. I don’t try to cheer them up, at least initially, because it may be perceived as a sign of disrespect and a lack of acknowledgement of what they are going through.
I always remember the 5 P’s of caring for patients: Presence, Patience, Pampering, Prayer and Physical comfort.
Most importantly, I need to deal with my own emotions, fears and discomfort. Imposing them upon the patient will be a big disservice and will only further harm the patient.