Unrealistic Expectations

I've cowered behind my gray coat as my hands fidgeted and my mouth sputtered an apology.

I've stood above the body of a dying patient and questioned every single decision.

These are the moments that blacken the soul.  These are the bleeding scars of one who attempts perfection and yet is destined to suffer the realities of being mortal.  I have accepted the weight of these burdens as I will carry them to my grave.  But sometimes it is the subtleties that chip away the edifice of confidence and expose the flesh, weak and unprotected.

Albert hobbled into the office six months after the death of his beloved wife.  Within weeks of developing a cough, she succumbed to lung cancer.  His eighty year old body was healthy, but his posture stooped with grief.  His eyes focused on the ground as he answered my questions in monosyllables.  When he did speak in sentences, he talked of his daughter who was paralyzed in a state of  perpetual mourning.

I examined his gaunt frame.  His blood pressure was good and his pulse steady.  His lungs were clear and his heart lub-dubbed methodically.  We reviewed his medications and recent lab tests.  There was nothing to be done.  I paused and closed the chart on my computer screen.

We stared at each other.

Albert cleared his throat and the light in his eyes extinguished.

She died so quickly!

His head shot back toward the ground, but it was too late.  In the brief second of contact, I saw a window into the depths of his heart.  He might not have even known it himself, but he blamed me.  I could hear the words although he wasn't speaking them.

You should have caught the cancer faster.  You should have saved her life.  No one should traverse between life and death with such minuscule warning.

Like a ton of bricks crashing down on my head, I realized that the only reason he was still coming to my office was that his kids were forcing him to.  I can't explain how I knew all this from one sentence, one look, but I was as sure of it as I was the reflection in the mirror.

He left the room.  My spirit drained, I couldn't muster the appropriate sentiments.  I certainly wasn't going to try to defend myself, although I was certain that I had done everything correctly.

Sometimes, I wish patients understood what physicians experiance.  Not only do we bear the overwhelming guilt when we perform below our own expectations, we often suffer the venom of unrealistic expectations.

Yet to point this out to a grieving family member is to belittle the mourning process in the first place.

We must walk this road alone.