Afreen Papa

Emotions are an integral part of our lives as humans. They can act as a strength or a weakness, depending on the situation at hand. As a medical student, I feel that our emotions are constantly challenged as we meet different patients through our journey of becoming a physician. Learning about diseases in a classroom is very different than encountering these diseases in clinical settings. During rotations on different wards at a hospital, I have learned that the perception of a disease becomes very real when it is written on a patient's chart as compared to a textbook page.  

One of my most haunting experience in term 5 was when I had to explain to a mother of a two-year-old that her child might not be the same as other children. The two-year-old boy, X, was born preterm and had complications to which he developed hydrocephalus. He had to go through surgery and had a shunt placed. However, due to the increased pressure seen in hydrocephalus, his development had been affected. The physician I was working with chose me to explain the consequences of that on his growth and later life to the boy's mother. I was nervous as I took a seat beside her on the bed where she sat with her son, and tried my best to explain what hydrocephalus was in basic terms, to tell her that X was developmentally delayed. X was speaking one or two words and he could barely walk without support. Normally by two years of age, most kids are walking and running, as well as talking in sentences. After I finished explaining, I asked the mom if she had any questions for me.

"So, you are saying my boy won't be like others? Will he get better?" she asked innocently.

My throat went dry and my breath halted! I didn't know how to answer that question. There was a slight chance X would recover, but there was a lot more possibility he would not. I did not know how I was supposed to tell a mother that. Sensing my uncertainty, the doctor stepped in and handled the situation. But the ray of hope I glimpsed in X's mother's eyes that day is something that I will carry with me for a long time; not because it will remind me of my failure to deliver bad news to a patient's family as completely as I'd been expected to, but because it was a reminder of how much I still have to grow and learn.

Breaking bad news is a skill that every physician learns. As a medical student, I believe it is the hardest thing to learn. You can learn the diseases, the symptoms associated with them, the treatments, but dealing with people's emotions is a struggle that we all face. How do I decide when is it acceptable to hug the patient? Or when silence is better than words? How do I not let my tears flow when the mother of a 2 year is crying because her child has cancer?  

The day I met X and his mother, I constantly thought about them and what I could do to make X better. Unfortunately, I had to accept that there was not much I could do. As much as it hurt to accept that reality, it has also motivated me to push myself further to become a better student. It has encouraged me to not only learn the details and statistics of disease, but to learn about people and how to behave in those types of situations.

It can be difficult to keep emotions in control while at the same time trying to be professional, especially when working with a patient with a poor prognosis. Each patient deals with bad news differently. Factors such as the patient's willingness to receive information about their disease condition, the amount of information they can handle in one encounter, their education level, the amount of support they have at home, changes the way we interact with them. As physicians, we must learn to tailor the way we deliver that information accordingly.

The balance of maintaining the professionalism that is constantly expected of us and the empathetic human inside of us is extremely hard. What does being ‘too emotionally involved' with our patients really mean? Does it truly affect their treatment? And if it does, is it in a positive or negative way? Who decides where those lines should be drawn?

I have yet to discover the answers to these questions. However, I have learned a few things this past semester. Interacting with the patients in the hospital has made me realize that the process of growth and learning is going to be a long one. Every day will bring new challenges.