One of the frequent questioned I have faced from both medical and non medical people is – How do you deal with sickness and death on a regular basis. As an oncologist caring for cancer patients sickness and death is fairly routine. With out some defense mechanisms, burn out is inevitable.
During my early years in practice, the images of sick patients, especially if they were young kept me awake at night. I remember clearly how I used to excuse myself while seeing patients to wash my face to keep me awake. Cancer patients depend on their oncologists to give them hope. A sleepy and tired doctor cannot impart much confidence in patients suffering from potentially serious illness.
During a trip to India in 1978, i came across an article in an airlines magazine about a message from The Bhagavad Gita, often referred to simply as Gita.
Gita is set in a narrative framework of a dialogue between prince Arjuna and Lord Krishna who was his charioteer and his mentor, as part of Indian epic “Mahabharatha”. Gita is a 700 verse Hindu scripture dating back to around 3000 BCE.
Gita is the eternal message of spiritual wisdom from ancient India. It is not a religious discourse. One sentence from the article that cought my attention was
“Detachment Without Indifference”
This could easily be misinterpreted as not caring enough. That’s why the key words here are,
Let me explain. With every patient I have seen I tried to give them the best care possible based on latest guidelines. When I was unable, I sent them to someone who knew more than me. This is what any doctor would and should do.
In spite of the best treatments, some patients will have progression of their cancer. Guilt and sadness are common symptoms among oncologists, when a patient expires. It will be hard for cancer doctors to be effective with that mind set, not to mention the toll on their personal lives.
It took me years to try to understand and practice Detachment while maintaining total engagement and compassion with patients. It may sound selfish but in order for doctors to be upbeat and project an optimistic (realistic) approach to patients and provide the best care possible , it is vital that physicians take care of themselves .
Playing tennis and golf and listening to music were the outlets that recharged my batteries.
Human brain cannot be turned on or off with a switch. Practicing detachment does not mean being indifferent. I cannot overemphasize this point. It also does not mean that we have to become like a robot.
How did it help me – Once I have done everything I can to offer the best available care possible to my patient including referring to a larger center with more expertise, i have eliminated guilt, thus minimizing the mental burden. It does not mean there is no sadness if the outcome was poor.
Practicing detachment without being indifferent has also helped in day to day life and relationships. Practice of detachment helped me to accept things that I have no control over. But, if I can play a role, I will take action. An example is a natural calamity such as an earthquake or a financial help for blind in a poor country.
Detachment does not mean one has to act to be at peace. Feeling is natural. In the 40 years or so since I have come across the article in the airline magazine, I can sincerely say that very few things upset me. Unless I am the culprit, guilt has not been a burden. I accepted the fact that I have very little or no control over what is happening around me.
Only control I have is how react to happenings around me. I have a long way to go. But it has been a good journey.
If there is no inner peace there is no happiness.