Survivor's guilt

I had a day in clinic last week that hurt, emotionally. It was like my scheduling staff actually were trying to inflict psychological harm, because the morning was entirely booked with widows and widowers. I had 10 patients, all of whom were single and lonely, abandoned by their spouses who died.

Widowed patients are sometimes hard to see, but it's particularly bad when half those widows' spouses died under my watch. It's particularly painful to see the wife of Mr M, such a gregarious and lovable guy, a guy who had a massive coronary event and died at home, and now, his wife comes in like clockwork, every 6 months. Her medical problems have all gotten better, now that she is no longer subject to his bad habits of going out to restaurants all the time or indulging in sweets. She puts her faith in me that I am providing solid medical care, but really, her sample size to rate my performance is miserable. I killed the only other patient of mine she knows.

Mrs H is also so upsetting. She talks about her husband every time she comes in. He was a gentleman with such refinement and character, who never had a stern word. Even when he was angry, his words were like Socrates. She reminds me all the time that she has nothing to live for. She doesn't mean that in a bad way, and she's not even depressed, but that the efforts I put into extending her life, they are efforts she is ambivalent towards. If she died tomorrow, she would be fine with that, because the love of her life is dead.

One of my staff tells me that I should feel honored. Here are people that have been acutely exposed to my lack of ability to prevent the hand of fate. But they saw what I was able to do, and they want to continue with me. They are saying in each visit, "It's not your fault. That is life." I feel like really, they are silently consoling me. Because I mourn their losses too, because they are my losses also.

1 comment:

Nikhil Autar said...

Hey Buddy,

I'm an ex-leukaemia patient, I was diagnosed at 17, and am now studying medicine, while writing about my experiences on both sides of the table too.

Though I'm not practicing yet, I'm only in 2nd year (in Australia - we can go from high school, at 18, into undergrad courses), through my writing and speaking about my experiences, I often talk to and help other cancer patients. A lot of them have passed away too.

But one I got really close to. He was around my age at diagnosis, then his non-hodgekins relapsed 4 - 5 years alter and he went in for a BMT. I gave him tips for getting through it all, I talked to him about how I took a step back and focused on what I could control, rather than all those things I couldn't, and after talking to him, I got him to realise what I did - that you always have a choice on how you view things; no matter how tough the situation. I kept reinforcing that through his treatment, and he stayed that way through it.

But then he passed away suddenly.

For a long while - I was stuck in a pit, asking "Why Him?" of all people... and without even realising it - I was questioning everything... if what I'd done had helped him... whether I was making a difference to people's lives... whether there was a point in continuing to fight on and live (with my condition - it would DEFINITELY have been much easier to slip away... that's for sure).

After a while of that though - i talked about my feelings, and the person I talked to was my father. After a while - he told me this. That I needed to step back, and realise that I couldn't do it all. That I'm still helping people, and will still do so in the long run... if I looked after myself first.

Hearing those words allowed me to take my own advice - so I took a step back and looked at what I was doing and questioned WHY I was beating myself up over it. And that's when I realised that all that depression, the anger, the sense of hopelessness was coming from me. That I had a choice on how I viewed it. I still didn't see any reason to look at it any other way though... until I started questioning WHY I was sad and beating myself up. And when I did that - I realised that in the end Paul would've wanted me to be happy... and that he wasn't gone - and that the best way I could honour him would be to learn off him and what he'd taught me. To smile where I could, as he did. To not be too hard on myself; that I should take care of myself. And to always remember - when it feels like the changes I'm making are insignificant, when it feels like there's no real purpose to life - that, when I felt that way - I'd remind myself that even if all I was doing was making my small corner of the world, the lives of 1 or 2 people better; then that was still HEAPS.

At the time - i couldn't see anything else but his suffering and pain. And when I went into clinical depression after that - the only thing that got me to a point where I could get out of it was talking to someone. I am happy to be that someone for you if you wish mate - I've been through similar things. I know they're not the same. I know after a while, seeing that so much does overwhelm you. But I want you to remember what I learnt from all of this. Rule number 1 of medicine - men and women die. Rule number 2 - doctors can't change rule number 1.

But we can still delay it for those who want to keep going. We can still make their final days better - for those who won't. And it's those lives, and that impact that we should focus on.