Emotional detachment

You asked me whether I had breakdowns taking care of cancer patients. You said it would seem to be quite depressing and frustrating at times.

Nope, I had not. I haven't been overwhelmed by those negative emotions thus far. Perhaps I was subconsciously resistant to those thoughts or maybe I was too busy working to ponder things over.

Dunno. We're all taught to be empathetic toward those who suffer. Nevertheless, working where tears and death are almost always around the corner, one can not survive without some level of emotional detachment. In health care, if one takes everything personally, sooner or later one may explode.

Still, I'm not iron-hearted. Delivering bad news to patients and/or their family remains daunting to me.

Stan* has cholangiocarcinoma, cancer of the bile ducts, which is notorious for its resistance to chemotherapy. Once the disease progresses, there is virtually nothing in the current medical armamentarium that can help. Stan's cancer has gone beyond control. Time to stop. I told him so, but he, probably too shocked or frightened to absorb the fact, desperately asked for therapeutical trial of the latest chemotherapy/targeted therapy regardless of the effectiveness, the side-effects or the cost. I insisted on 'do no harm' and somehow refused his requests mercilessly. Yet, I actually felt a bit shaken behind the professional facade. I felt as if I'd become one who deprives poor people of their last hope.

A patient collapsed unexpectedly this past weekend. The intern, who took care of this patient, cried the whole morning, blaming herself for not being preemptive enough. Seeing her lose her composure, I feel a great sense of loss. I can't think of the last time I cryed over a dying patient. I feel the emotion no more.

Am I too nonchalant or too business-like? Hopefully not. There aren’t any checklists for us to follow on how to maintain boundaries when faced with the emotional demands of others.

I'm still trying to find balance.


* the name has been modified.