"Bugle Notes" - Every Tear Earned

Have you ever found yourself with a patient not knowing what to say or do? Maybe you just told them they had cancer or that the last treatment option had failed or a loved one had died. I have, many times, and I always felt helpless, inept, and alone while doubting my abilities as a physician. Medical school had not prepared me for this. I learned firsthand, one difficult, and sometimes heartbreaking, experience after another. I came to understand that often, in those moments, patients do not need another person talking at them. They need someone with them. Words will go unheard as they are already overwhelmed trying to process what has happened. Instead I sat and I listened. I held their hand. Sometimes we prayed.

Have you ever cried with a patient? I was taught that men don’t cry and by extension that applied to boys as well. Early in my life, I struggled with this, though in an innocent way. Movies or books that moved me were a real challenge! “Shenandoah” or the classic movie “Old Yellar” about did me in! But worst of all was the book, “Where the Red Fern Grow”, the classic tear- jerker of all time, especially when your 6^th grade teacher was cruel enough to read it out loud to the class! It was torture. Despite my best attempts, the tears would come. As nonchalantly as possible, I would wipe away the tears, pretending to be scratching an itch. I dared not look at another person. It was the same for all the boys, even the class bully. The girls, of course, cried openly and unashamedly. It wasn’t fair.

I am speaking, though, of different tears. Not the tears of a Romantic or of an innocent child. Rather the tears “earned” through years of intense training, hard work, sacrifice, giving of yourself to patients, and grieving, often silently, when they died. The “sacred trust” that exist between providers and patients creates a bond, an intimacy, unlike any other profession. You learn to compartmentalize your emotions. Otherwise you could not continue. It would become too much. It is already too much for many.

When all else has failed and there is nothing medically left to do, then the real “Art of Medicine” can happen through the warmth of a human touch, a comforting hug, and the sharing of tears. Every tear earned. Through these tears a healing of the heart can happen. The heart becomes more like a “stained-glass window” – broken only to be forged back together stronger and more beautiful than ever. Every tear earned and shed makes you stronger and more beautiful. Thank you for when you do so.

Andy Lamb, MD