Monday, July 25, 2011

Who cares?

Just don't deny it,
Don't try to fight this
and deal with it
and that's just part of it. . .

from Apocalyptica "I don't care"

A colleague that I don't know personally read a story I wrote about one of my F.P's that was recently published. Using the author correspondence, he sent me a kind email and said some things in it that got me thinking. . .

One of the things he said was this:

"I've never been to a patient's funeral, nor am I sure I ever would or could."

He went on to share about how he struggles with personal and professional interactions with patients. In other words, he seemed to be trying to figure out how to manage that thin line between caring for patients and caring for patients. His approach to date had been a "just the facts" one--where he focuses as much as possible on the medical issues at hand instead of holding someone's hand.


I'm not sure this method is too unusual. Like many people, this guy had a bad experience early in his training with caring too much. He'd gotten his heart all wrapped up in a sick child that, although he didn't refer to him as such, had become his F.P. for sure. Suddenly things took a turn for the worse on call one night. Yes. His F.P. on his watch. Unexpectedly things went crazy and the superhuman response required to right the ship was beyond his intern expertise. Senior folks swooped in with their big professor red cape-brains and saved the day. And that child's life.

That's when he realized something. Here he was sitting there holding this boy's hand and asking what his favorite color was. . . .and exploring action heroes and how to do the perfect handstand. . . . which seemed to make his patient feel better but at the end of the day, was not what saved his life. Medical knowledge right here, right now did. Not him and his pesky hand-holding and stargazing. And this guy? He wanted to save lives.

He closed that thoughtful email by saying something along the lines of how he deliberately tries to keep his heart out of it. But. My patient's story did make him wonder about this approach.


So today I guess I'm simply reflecting on all of this. I'm wondering about this notion of going to a special patient's homegoing or funeral or memorial service and whether it's just too weird or not. Like. . .is attending a funeral as a doctor--even if you've been invited--too intrusive or too much? Does it cross a line that caregivers should clearly stay behind?


What about the rest of it--the things like holding hands and asking about all sorts of plans? You know--those plans that have nada to do with nada and that simply serve to create a bond between two human beings. . . . the ones that, when you find out about them, make you care. When all you were supposed to be there for was care.

I can't say that I've ever tried the "all business" approach. Like that guy, I have been frustrated by what I don't know or by those times when me and my little bag of medicine tricks are no match for fickle fate. But when I'm caring for human beings I always want to know. . . .like I can't help it. . . .who are you? Or sometimes. . . who were you? And see, the problem with that kind of curiosity is that your heart gets all up in it. So you find yourself crying in locked bathrooms. Or wrestling down the ugly cry at a funeral.

I've said it here before and have heard other folks say it, too--let your love be a verb. When it comes to being a doctor--especially a Grady doctor--I think I feel the same way about caring. Sure, I read the journals and work to acquire the knowledge, but that's never been enough for me. Even though it's the noun that I get paid for, "care" always ends up being a verb for me.

I love that a one page story nestled in the back of a high impact journal rubbed a probably uber-successful scientist-slash-physician so raw that he just had to send that email. I also love that, after all those years, the feelings behind those moments he spent with that young patient were still so fresh on his mind that he could recount them in fine detail just like that (insert finger snap.) Kind of like the verb care never left him after all. . . . .


Caring versus caring. Or rather caring verus caring + caring. Speaking at funerals. . . versus keeping it "all business". . .all that stuff. Okay. . . .tell me. . . .what do y'all think? For real, I want to know.

Now playing on my mental iPod. . . .


  1. SG Alpha motto: never stop caring. For me, I hope that'll always mean caring and caring+caring.

  2. I believe that there is a purpose to all of our lives. And I believe that healing can be more than just the chemistry/biology/medical school training. I believe that you are living your purpose and that your patients are lucky to have a caring and care giving doctor.

  3. From the somewhat theoretical perspective of someone who has yet to graduate from med school (but has spent more than a couple of decades closely observing all kinds of doctors from many different angles)... It takes a certain balance of courage and vulnerability to be able to both care and give care. To sit at a patient's bedside and give them your soft comforting hands, while being ready and able to don full armor and draw your sword and lance to fight off destruction and death at a moment's notice takes the kind of gentle strength that not everyone possesses naturally. I do want to believe that most people can develop it if they choose.

    Whether you were genetically programmed with that gentle strength, or inherited it as the epigenetic manifestation of your father's unrealized dream, or developed it along the way... you are certainly an inspiring role model. Thank you for being and for sharing.

  4. I want my doctors to really care about me, and I search out the ones who do. Please keep up your wonderful balance of knowledge and warmth. Patients heal better (or die better) when they sense loving care.

  5. As a current medical student-I know the initial education offers no room for caring caring-the real deal caring. But I also think of you as a healer-bringing health to your patients, and going outside the realm of conventional medicine. You are walking a path that many physicians may not do, but I think it is definitely a beautiful approach to healing/helping your patients!

  6. I think it's WONDERFUL to care for patients -caring for them as humans. I know I was very touched when my mom died and I received a sympathy card from a dr (and his office) we had in common- a very kind and thoughtful gesture.

  7. "Some people think only intellect counts: knowing how to solve problems, knowing how to get by, knowing how to identify an advantage and seize it. But the functions of intellect are insufficient without courage, love, friendship, compassion and empathy.” - Dean Kootz

    It's a matter of the heart"! I must chime in here! I speak from personal experiences of how the "extra care or touch" from a doctor means the WORLD to a family. That "extra care or touch" makes it easier for the family to breathe, cope, handle, accept and grieve. I applaud every doctor that has ever held the hand of any patient or family during their care or loss. I special thank you goes to Dr. Kimberly "Back Inc." Manning for her labor of love she gave to my mother.

    Front Inc.

  8. There is always a risk with letting someone in and caring, no matter who you are...but in your line of work, the stakes are especially high. Sometimes those who you've allowed in are going to die. As a physician you must then deal with not only the loss of a patient, but also of a person who has occupied a space in your heart--and that's tough. I don't think that every physician just naturally possesses the strength and courage that is needed to truly care, without it impeding their ability to give care. You have been blessed with a very special gift.

    And is it intrusive or does it cross a line? No ma'am. My oldest son died several years back. Prior to his death, he was cared for by a wonderfully competent pediatrician, who came highly recommended by another doctor. For the past 9 years, I have lived just down the street from CHOA at Egleston, which is just teeming with wonderfully competent pediatricians. But you know what? I drive past every one of them each time that I take my youngest son to the doctor. We travel 45 minutes to see Dr. Miller because all those years ago, she let us into her heart. She loved my son in his life, and cried big crocodile tears with me when he died back in 1999. She didn't have to care...she chose to. But that made it even more special, Dr. Manning. It made me feel like my little boy was so important that even this physician whose job it was to deal with illness and death, let him in. And that is what you are doing for your patients and their families. You are sharing that special gift that you've been blessed with.

  9. I find your blog to be so real and so down to Earth. I love the way you write. As someone who recently lost two loved ones in less than a month, I have often thought about the doctors they spent so much time with over the past few months and wished they were more caring when my family members passed. I also think about my ob who I had for my 1st child and then got transferred to another another w/ my 2nd child b/c of being medical complications and wish the office would have followed up to see how we made out, instead of waiting for me to call. Sometimes in life you need your physician to show a more caring side. I commend you for going to homegoing services and for being such a caring individual. Thanks for sharing your stories.

  10. Ant-- Yep, it's the SG Alpha motto--never stop caring. . .and of course, "keep it human."

    Sherri-- I sure try. Thanks.

    White Coat-- Seriously, why are your comments always better than my posts? Thanks.

    Deborah-- Another vote for caring + caring! Yahoo!

    Anon--Even as a med student you have a choice. That doctor who emailed me made a clear one. Maybe he will change his mind.

    SarahD-- I know from your blog how special your mom is to you. I'm glad someone else acknowledged that.

    Front Inc.--Your mom was a special woman. I am so honored that I was able to care for her and know her. Even if I ugly cried while speaking at her homegoing! (Remember the lady with the ball of tissue?)

    Kel-- In a word. . .wow. Dr. Miller sounds like a very special human being.

    Organized--Thank YOU for sharing your story, too.

  11. As a patient, I seek out physicians for my family that have good bedside manners and that I feel truly care about us. I don't care where your degree is from, how many ground breaking clinical trials you've directed, etc., etc. If you're not nice and caring, you won't be my doctor.

    Praise God that my little family of three has been healthy save a few bumps and bruises along the way, but I've had plenty of interactions with physicians while dealing with extended family and dire situations to know what I do - and don't - want in a caregiver.

    My grandmother died over 20 years ago and my mother will still occasionally speak fondly of the nurses and doctors who cared for her in the last days of her life.

    My MIL died 9 years ago and we still speak with distaste about the vascular surgeon who came in, patted her on the leg and said "well, looks like we're gonna have to get rid of this one." o_O. I actually demanded that he exit the room and come back in and speak to my MIL as though she were someone in his family that he cared about.

    Funny that I should read this on the day that I am ordering Jefferson Scales of Empathy to study the behaviors and beliefs of medical care providers across our campus. Great piece.

  12. I think you make an amazing physician and teacher because of how you care. I have posted many of your blog posts on the bulletin at work for our residents/interns to read.... mainly to remind them why they got into medicine in the first place. Mostly because they care and I am so very glad that you care the way you do. :)


"Tell me something good. . . tell me that you like it, yeah." ~ Chaka Khan

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