Emotional toll of being a doctor

Finding the hard but right answer

Location: UK
Audience: All doctors
Updated: Monday 7 September 2020
Topics: Your wellbeing
Alison Burridge is a Core Medical Trainee in Wessex.

During my first week as a foundation doctor, we found out that my dad's renal cell tumour had metastasised to his liver, lungs and bone. By the time I started my final FY1 job in respiratory, he was reaching the end of his life. I was fortunate enough to receive overwhelming support from my team and educational supervisor, enabling me to get home to spend the last two weeks of his life with him, and to help my mum care for him. I found some comfort in the fact that my dad had a peaceful death surrounded by the people he loved the most, but all too soon I was back at work, caring for other people's relatives.

Every doctor has at least one patient whose name and face is burned into their memory.

For me it was the 51-year-old man who came in short of breath the week after I started back at work. I stood with the registrar as she broke the bad news to him and his family. She was excellent and ticked all of the 'breaking bad news' boxes that get drummed into us during our training, but there was no disguising the facts - he had cancer, lots of it, and there was likely no curative treatment.

Later that afternoon I had a rare moment of solitude in the usually busy doctors' office, writing discharge summaries. There was a knock on the door and my patient's 19-year-old daughter came in. She needed to talk to someone she said, she had some questions.

With a sinking feeling I invited her to sit down, and she burst into tears. How was she going to cope without her dad, she asked me. How were her two younger siblings going to react? How would her family survive without their rock keeping them all afloat? I was (unusually) speechless. Here was this girl about to go through exactly what I was going through, but I was her dad's doctor, not her friend. How was I supposed to answer her?

There was a knock on the door and my patient's 19-year-old daughter came in. She needed to talk to someone she said, she had some questions.

Alison Burridge, Core Medical Trainee

I've thought about that moment a lot since that day. Should I have immediately found someone else to talk to her and answer her questions? Or was I in fact the best placed person to provide her with the support she so desperately needed?

As a doctor I wanted to explain that her dad needed more investigations, he needed to be seen by the oncology team and very probably the palliative care team and they would sort out what medications he needed, and provide the family with information regarding the support they needed, where to get it and when.

As a daughter I wanted to tell her that losing her dad would be the scariest thing that had ever happened to her, but she would get through it, and she was strong enough to support her family too. To tell her to spend as much time with him as possible, not dwelling on the fact that he was unwell, but making more happy memories in the time she had left with him.

I struggle now to remember exactly what I did say, it was a bit of a blur, but I think it was somewhat of a mixture of the above. I remember being careful not to tell her my own experience - this wasn't about me, it was about my patient and his family.

More than two years on now, I really do believe that losing my dad has helped me become a better doctor. The concept of a 'dignified death' is easy to understand, but in reality it is harder to achieve. As a physician I pay attention to the more 'minor' symptoms of terminal illness, such as mouth ulcers and hiccups, which can be terribly debilitating, especially when a patient's oral intake is already poor. I have a much lower threshold to phone families than I used to, as I understand you would much rather have a 'false alarm' than miss being with a loved one when they are becoming more unwell or dying.

As doctors, people place so much faith in us and our opinions. Taking the time to sit with a family and explain what is happening, why it is happening, and what to expect in the near future might make you leave work 20 minutes late but that time will be invaluable to that family, and will make their experience more bearable. To us, that is just another patient, but to them this is their parent, child, spouse or sibling, and your face may be the face that stays with them for ever.