My patient X has relapsed.
12 completed days of sobriety, intensive effort by a variety of people, proper supervised alcohol detox to obviate any physical withdrawal, a proper plan made with the drugs and alcohol team but she relapsed anyway. First chance she got really.
Interestingly I feel neither angry, resentful or that I need to fix it. I feel a little sad, but I’m able to shrug my shoulders, accept that this is her decision and that she’s probably not ready yet. She may never be, and may be one of the sad statistics – young people who die from alcohol addiction. I have done what I could, I can do no more.
That realisation, that I can’t fix someone else, comes easier these days both in the recognition and in the acceptance of this as a simple truth. Reviewing the way I managed this, both medically and personally, I’m content that I acted appropriately (except in the moment that I told her I too have had alcohol problems – and I have learned from that and will not do it again) Right now I’m more concerned about the fall out for others who tried very hard to help, and for the future welfare of her child. For the latter, I will do what is professionally right. And that’s it, no judgement, no expectation, no emotional response, just respond professionally to whatever questions I am asked and do my job.
And it’s got me thinking about how I respond to my patients, how my personality impacts on the way that I do my job, and how my well-being is affected (as well as that of my family)
I’m trying to approach this with an open mind; in the past I have judged myself very, very harshly if my personal responses were anything less than 100% perfect, and been super critical of (almost) any emotional response I have had. I think this stems from a belief that a good doctor should “care” about his /her patients but not allow that caring to be seen, not allow it to disrupt their emotional stability and never be affected by it. And I am a very emotional person. I care deeply about a lot of things, and a lot of people. In my personal life I am someone who has a small number of close friends rather than a large number of acquaintance, and these friends matter to me a LOT. If I can help, I want to, and I will try hard to do whatever I can.
Similarly in my professional life there have always been patients who really ‘got to’ me; the 26 year old Polish woman who arrived in A&E desperately unwell with sepsis and died 8 days later on ITU; the young woman with dreadful Crohn’s disease who I nurtured through her dangerous pregnancy; the man I diagnosed with HIV on his admission with PCP pneumonia; the astonishing 36 year old woman who was admitted to a hospice to die from her untreatable leukaemia. I have responded to these, and many more, by giving everything I have – in knowledge, emotional support, passionate attention to detail and hours of painstaking care. Early in my career I was warned, in a kind way, that my compassion could interfere with my judgement, and conversely I was often asked to ‘act up’ by Consultants who recognised that my dedication meant I would always give my best.
It’s taken almost my whole career to truly recognise the tension and balance in this characteristic. That it can be a force for good, and also result in problems.
In X there was another opportunity to go ‘above and beyond’, and to some extent I did. Few other GP’s would have taken on the risky ongoing detox of an unstable alcoholic. But I feel I have learned where to draw the line more appropriately to protect myself, not just emotionally but from the risk of practicing outside my sphere of expertise; the hazards of prioritising one persons needs over the many others, and the loss of judgement that can accompany a personal medical crusade.
I can view myself with compassion now, be thankful that I can still care about the outcome, and yet approach each case with a greater humility and recognition that I alone cannot provide the answers. And not only that I can’t, but that in trying I put myself at risk, (of intense disappointment and self blame; of not listening to others, of exhausting myself) and of disrupting the balance of my work /life.
I feel more kindly and benevolent toward my passionate intense involvement with some patients, more supportive and accepting than blaming critical and judgemental. I recognise that caring and involvement has made many patients feel listened to and as though a doctor is truly trying hard for them, and that this is a good thing. Its not wrong how I feel, it just needs soothing and containing in a kind way.
I think that’s a bit of a gift from this period of therapy and the programme I’m working now. The gift is self awareness and self compassion.
Long may it last.