My colleague, Anna Reisman, a practicing internist and talented writer, published a touching, revealing and instructive New York Times blog post that demonstrates the value of reflective practice. See: The Death House
Anna writes movingly about her angst and ambivlance about visiting one of her patients at an inpatient hospice. Her ambivalence is rooted in her fears and anxieties about what she might experience during her visit, imagining suffering, sadness, hopelessness and a heavy dose of death (.."a steady line of hearses idling in the parking lot like taxis at a train station"..). Her avoidance is also linked, she reveals, to concerns that her patient will be suffering or too ill to acknowledge her presence, and she shares her worries that she will not know what to say to family members who may be present at his bedside. I would guess that most, if not all, caring and compassionate clinicians harbor similar feelings....I know I have had these fears and anxieties when I was clinically active and had patients who were dying. However, Anna also feels a strong desire to visit her patient to pay her respects and provide some measure of comfort to the patient or his family. So, she wills herself to visit the hospice, where she is pleasantly suprised to find a homey, supportive and even healing environment, and, most importantly, a patient who is grateful for her presence. I was deeply moved by her prose.
Anna's courage to share her inner thoughts and feelings in her blog is remarkable, and courageous. As you might expect, her post has stimulated many comments, and though most commend her for her compassion, there are also several posts that judge her harshly for having and sharing negative thoughts and feelings about the hospice. This is unfortuante, as I believe these critics are missing the point. The fears and worries that Anna reveals are ubiquitous among clinicians. These feelings often lead to avoidance of patients during the last stages of life, which is unfortunate for both patients and clinicians. Taking the time to reflect and acknowledge the feelings, in a non-self punitive way, is a step towards challenging them and summoning the courage to confront them. The result is often highly rewarding, and, hopefully, reinforcing.
I hope Anna's post will stimulate others to be mindful and perhaps help them free up their inner capacities for empathy and compassion.
