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Colette Charles ~

I was a second-year resident, doing a twenty-four-hour shift on maternity care. I'd spent some arduous nights on call with my attending physician, Dr. Campbell; now we sat at the nursing station, joking about what this one might bring.

"You must be a black cloud," she teased, accusing me of being one of those unfortunate residents who seem to attract medical emergencies. I laughingly protested, but in fact these quiet nights worried me. I felt on edge, waiting for something, anything to happen.

Finally the emergency department called to say that a possibly laboring mom was on her way up. We got her name, which was Cecilia, and I feverishly dug out her chart.

When Cecilia was wheeled into the labor room, she was smiling, and the man beside her--her husband, Harvey--also seemed at ease. I studied her face and demeanor, wondering whether she would deliver tonight or be signed out to the incoming resident tomorrow morning.

As Nurse Angela got her settled in, I reviewed her history.

She was thirty-six weeks along. Kind of early, I thought.

She already had three children--all boys. According to the ultrasound report, this one was a girl. How nice.

She was Group B strep negative and had suffered a miscarriage a few years back. With this pregnancy, for unclear reasons, she'd had only a few office visits. "No toxic habits," her chart said. What a relief.

I headed into the room for the triage assessment and sat talking with the couple as Angela hooked Cecilia up to the monitor.

Harvey sat on the edge of the bed holding Cecilia's hand while Angela traced circles across her abdomen with the fetal Doppler device, and we all waited to hear that familiar galloping heartbeat.

There was no sound.

Looking puzzled, Angela tried again. Nothing.

Our eyes connected. The fear in Angela's gaze mirrored my own.

I looked back at Cecilia and Harvey and kept on talking in what I hoped was an even tone. Angela excused herself "to get some help with the monitor."

She returned with Dr. Campbell, the ultrasound machine in tow. Gently, Dr. Campbell palpated Cecilia's abdomen.

"Cold gel," she warned before squirting it across Cecilia's belly.

Seconds later, the image appeared on the screen. It was a maternity provider's worse nightmare: a nonviable fetus, her little heart still. My own heart started racing.

Dr. Campbell sighed, and tears started rolling down her cheeks. I felt surprised, but also intrigued. Although at this point in my career I'd shared more than a few sad moments with patients and their families, never had I openly cried, or seen another provider do so.

Quietly, through her tears, she told the couple, "I'm sorry...."

Cecilia's wailing filled the room. Harvey threw his arms around her in a brokenhearted embrace.

We left them alone for a moment to decide on their next steps. Despite having seen Dr. Campbell's tears, I fought to hold mine back.

"Do you want to be a part of the delivery?" she asked.

"Yes," I said. "But I'll probably cry."

"We're all going to cry," she said, kindly but matter-of-factly.

Once Cecilia had received medicine to stimulate her contractions, the delivery didn't take long--but it was more emotional than I could have imagined. The room was quiet, but my mind was so loud. It was calm, but the chaos in the parents' eyes was so palpable.

Dr. Campbell and I delivered a very beautiful baby girl with the cutest little nose. She was tiny, but definitely a person.

There was no resuscitation. There were no congratulations. There was no laughter, no joy…just pain. There were tears and blood and sorrow.

Dr. Campbell cried openly as Harvey cut the cord. In fact, she'd cried openly throughout the entire delivery. This gave me permission to cry as well--and now I did.

I cried as I helped Harvey put the baby's little hat on her head. I cried as I collected the instruments and removed the blood-soaked pads from the bed. I cried as I washed my hands. I cried as I left the room, helped to pin the purple feather on the door and said a short prayer for this beautiful family.

Then I excused myself and rushed to the call room, trying to pull myself together--because that's what you do in this field, you keep it together. I'd broken that rule; I felt I needed to redeem myself.

I couldn't believe what had just happened. I felt impressed by Dr. Campbell's genuineness--but also confused as to why, even this far into my medical training, I'd never till now seen a provider express such raw emotion.

Dr. Campbell and I went to the break room and sat in silence for a few minutes.

"How are you doing?" she asked kindly.

I had no words. My tears broke free again, pouring down my cheeks. Dr. Campbell gently rubbed my back without saying a word. When her pager went off, she left me alone to ponder.

"I'm sorry for your loss"...."This must be very difficult"...."I want you to know that we're here for you and your family." We use these phrases all the time to express our empathy. Words like these were spoken that night--but I feel sure that it was the wordless, honest expression of emotion that most connected us all.

What does this say about medicine and doctors? Are we all just cold-hearted people, "caring" but not really caring? I doubt that. As residents, we're taught not to be too open with our patients, for fear of harming the doctor-patient relationship. We learn to shed our tears in the call room or the bathroom; anywhere but at the bedside.

"You should be supporting your patients, not the other way around." I've heard this sentiment often. In one sense it's true. But it also conveys an unspoken message: that I, as a caregiver, should treat myself as less human than my patients--less entitled to fully experience my emotions, or to fully express them.

I've learned to maintain a façade of strength. When I'm having a bad day, and a patient asks me how I'm doing, I brush it off: "I'm fine. The more important thing is, how are you doing?"

I feel guilty whenever I let the walls down and admit that I'm not doing so well. But why?

I feel blessed to have trained with Dr. Campbell. She helped me to improve my clinical skills--and she gave me so much more. She reminded me that staying open to your feelings when you're with a patient is okay, and that being real with your patients is a gift to them. I believe that sharing patients' pain, as she did with Cecilia and Harvey, can mean more to them than any medical intervention you can offer.

I don't break down every time a patient suffers a devastating loss. But now I know that if I ever do, it's okay.

Despite the unspoken message of my medical training, I know that I'm human, too.


About the author:

Colette Charles will graduate this month from the family-medicine residency program at Central Maine Medical Center in Lewiston, ME. She plans to practice broad-spectrum family medicine in rural Maine. Originally from the Caribbean nation of St. Vincent and the Grenadines, she remains an island girl at heart, with a continued appreciation for all that nature has to offer. "My passion for reading and writing goes back to my childhood. I remember writing poems on the way to school about things I'd observed along the way. For me, writing has always been a form of release and reflection; it's how I've processed many positive and negative events in my life. I wrote this story for an assignment calling for reflection on an encounter that surprised you. Writing about this experience offered me healing that, at the time, I didn't even realize I needed. As I move forward in my career, I intend to start a blog that will combine my love of medicine with my love of writing, chronicling my life as a Caribbean physician in rural Maine."

Story editor:

Diane Guernsey

Comments   

# Colette Charles 2018-06-22 09:37
I thank you all for your kinds words and feedback. There is so much to learn in medicine beyond just the medicine. It's part of the reason I love it so much. I look forward to writing more as I move forward in my career and sharing those experiences with you.
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# Ronna Edelstein 2018-06-18 18:07
I cried as I read this moving story. Yes, physicians can come across as god-like, but you doctors were human beings before you earned your medical degree. It is okay to show feelings--as long as those emotions do not interfere with the quality of the treatment you provide. Dr. Charles, I am confident that you will be an outstanding physician with a supportive, genuine bedside manner. Good luck to you!
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# Ann Spicer 2018-06-18 16:34
This post was very meaningful to me as I delivered a stillborn daughter at 34 weeks just over 34 years ago. The physician who delivered my daughter showed no emotion whatsoever instead choosing to entertain the nurses with details of his recent vacation during her delivery. At one point, my husband screamed at the physician, "No one wants to hear about your damn ski trip right now."

The fact that someone who was called to be a physician could be so insensitive haunts my memory to this day.

Thank you for telling this story; physicians should be human.
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# Jo Ann Endo 2018-06-18 09:06
Dr. Charles thank you for your wonderful essay. If you haven't already, I hope you get a chance to read In Shock by Dr. Rana Awdish. https://www.goodreads.com/book/show/33574173-in-shock
There's a reason it has been getting so many outstanding reviews. It's not only about her own experience with the medical system, but also about how doctors, in particular, are typically trained not to show their emotions even in devastating situations. I think it would resonate with you.
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# C Mark 2018-06-17 14:06
Your story moved me in so many ways. As a young mother I was 16 weeks pregnant and bleeding in a military hospital. The absentee physician decided the baby was dead, had pit IV started and I birthed this child alone in a patient room late that night. When the child lay between my legs on the bed I called for the nurse. She finally arrived, wisked " the remains" from the bed as I softly cried to myself. She then pointed her finger at me and said, "Stop your crying, roll over and go to sleep!" She stomped out the door leaving me totally alone. Oh how I wish more caregivers understood the power of showing empathy, compassion and just plain human kindness. If the person you loved the most in the world was going through the experience you described in your piece how would you want the staff to respond? Never be ashamed to let your humanity show.....patien ts and families need it and appreciate it.
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# Virginia 2018-06-17 14:18
I am so sorry to hear this awful inhumanity given you, C. I guess clinicians then and now just can't face such things, so they don't...and we hopefully find someone along the way to hold us. I hope that you did. Sorry, v
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# Janice Mancuso 2018-06-17 13:46
I concur with the sentiments expressed and hope to read more from Dr Charles. But, what compels me to comment is the use of the word “provider” in this beautiful essay on shared humanity.

In “The Provider Will See You Now,” a 2011 NYT piece, Dr Danielle Ofri referenced a NEJM essay on this topic by Drs P Hartzband & J Groopman. “The authors put their finger on what is so grating... They note that the term ’provider’ has a deliberate sterility to it that wrings out any sense of humanity…” Ofri went on, “But the most profound unease created by generic terms like ‘provider,’ the authors point out, is the sense that medicine is turning into a corporate entity.” (Healthcare is now a full-blown industry.)

Words have power. Be mindful. Find a substitute. (Many use “clinician.”)

PS It's part of the healing when doctors and nurses and patients share their vulnerability (and, sometimes, tears). We need shared human experiences, now more than ever.
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# Virginia 2018-06-17 09:57
The patient and family are comforted way more when providers own being human. Crying doesn't require the patient to 'care' for you; it truly is an expression of caring for all concerned because it's the most true thing. I remember doctors, nurses, aides and friends taking their crying to the hallway or chart room when struck with my husbands short and sudden 17 days from diagnosis to death. That covering-over of human sharing did not help us -- and as a widow, I steeled against the pain when people faced away (or worse) over the coming months. Few people were 'there' in the abyss with me -- but those who were fill my heart today. Thank you for suggesting we abandon some old, silly teaching for loving each other.
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# S Fry 2018-06-16 18:04
I still remember our Dr at NY Presbyterian who shed a tear when he had to tell me my partner had been in CPR so long that he most likely had lost brain function due to lack of oxygen (he had). It was comforting in that moment to know he shared my sorrow. I'm sure you and Dr Campbell were able to comfort your patient and her family in their loss, and glad to hear there are other Drs who are not afraid to share the emotions of their patients in heart-breaking situations.
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# Resident in training 2018-06-16 09:36
Thank you so much for sharing your story. As a medical student, I delivered a stillbirth with the help of nurses as my attending was in the OR. It was a very moving experience but I never had a chance to talk to my attending about how to process that experience. I am nearing the end of a 5 year residency and have experienced heartbreaking moments with patients while seeing the stiff upper lip of many attendings. What a blessing to have an educator like Dr. Campbell. As I go into practice I am going to try to emulate and demonstrate the importance of acknowledging our own humanity to medical learners. So much is learned in “the hidden curriculum”, and it is up to us to slowly change that culture. Thank you.
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# Pat Engelhardt 2018-06-16 07:40
Oh, how this touched me. I am the mother of 3, losing one as an adult nurse. I'm a retired nurse. My tears are flowing. I didn't work in OBS but the mother in me sympathized with the patient and nurse. It's difficult to be stoic when one had borne babies. I'm praying for the mother and her family.
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# Betsy Kates 2018-06-15 22:30
What a lovely piece. It's humanizing and reassuring to know that there are doctors who are able to be this receptive to their own humanity. As a teacher, too often I caution myself from displaying emotion to my young students. But often - just this morning, in fact - I simply can't help but tear up in empathy as a child weeps in sorrow over the death of her grandfather, or his beloved dog. I have wondered
if they will see my tears as signs of weakness or as a touching of our hearts. I hope it's the latter. This piece helped me to understand that it is, in fact, OK to share our humanity, at the very least.
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# Shari Heller 2018-06-15 21:39
Dear Colette,
Thank you for a beautiful story. I have been collecting doctor's stories for years, and look forward to reading yours someday - I'm hoping you publish the diary eventually. I know you'll make a fine doctor.
a retired nurse who cried often
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# Maggie Mahar 2018-06-15 21:08
Once of the finest stories I have read on "Pulse."

In the past doctors worked in a
mainly male profession where they
were taught not to show undue
emotion.

Medicine, after all, was a Science,
and it was important to make patients feel that the doctor knew best.

This story reminds us that Medicine is still an Infant Science. In many cases, doctors cannot help their patients.

Doctors shouldn't deny this or feel guilty.

If they can't help a patient they should
mourn, and let the patient see their
grief.

Their tears will tell the patient how much they care.

This is what dying patients need:
Caring.

Not the pretense that
if only the patient had been braver & stronger, or if the doctor had been smarter . . . the patient would have survived

Eventually all of us die.

At that point, all of us need someone who is mourning.
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# Doug Babkirk 2018-06-15 20:55
Thank you for touching my heart by opening your heart through your tears and through your writing.

As a fellow Mainer committed to caring for health care professionals, I am heartened by your humanity and vulnerability as a place for live encounters with others.
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# Marianna Crane 2018-06-15 18:26
What a refreshingly honest account about the human connection among us irregardless of our professional status.
Thank you for a touching story.
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# Cortney Davis 2018-06-15 18:06
Lovely. Just lovely. Thank you.
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# Bevili J Billingy 2018-06-25 10:40
Well my tear ducts were stimulated Dr. Charles!!
What a wonderful and heart felt piece it was;as a health care professional myself I am well aware of the "don't get your emotions involved" but sometimes along the way there are those times that we must enter into the patients grief and show our human side.Looking forward to more.
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