To Cry or Not to Cry?

Standing around the bedside of the young mum, the children held my hand while dad held hers. I could feel that lump in my throat, the one that always appears, but this time I could not push it back down. Biting my tongue, I was doing my best to hold back tears. Sobs from the 15-year-old in her school uniform watching her father cry, released silent tears that rolled down my face. I went back to the doctors' office with red eyes; my consultant asked me if I was ok. I didn't want to answer for fear of crying in front of her. I nodded, grabbed my bag, and left. I cried all the way home.

Professionalism is an inherent part of being a doctor and so is empathy. Does crying make you appear out of control and unprofessional? Or does it show that you care? I did care. I watched this family visit, plan, and prepare for a moment of which they asked me to be a part. Had I let them down by becoming emotionally involved? These thoughts played on my mind for weeks. I spoke to colleagues for a sense of resolution looking for the right answer, the right response, but opinions varied. ‘Never cry in front of a patient—it shows loss of control.’ ‘It's ok—you showed them how you truly felt.’ ‘My consultant would send you home if you cried.’

Doctors know about stages of grief and have seen patients and relatives progress through them, but what about us—do we grieve these patients? During my palliative care rotation I have ‘broken bad news,’ been present at deaths, and visited the mortuary numerous times; yet I was able to continue with my day as normal. Professional detachment is armor for doctors. It permits emotional detachment and objectivity. However every now and then a chink in the armor results in a true display of emotion.

I believe the skills that have made me a better communicator have come from working with excellent health care professionals, especially those in palliative care. They have taught me things that medical school did not. I have learned tears, physical contact, and laughter can have an important role in communicating.

When I talk to colleagues about my interest in palliative care, I am met with a common response: 'That must be sad.' The truth is there are sad moments; but there are also funny, uplifting, and extremely self-reflective moments. It is a privilege to be with patients at their most vulnerable time. From my experience, showing families you can also be vulnerable in that moment can mean a lot. With time and experience I have stopped questioning my emotional response. I feel comfortable judging situations and when appropriate no longer fear the use of humor, honesty, and handholding. I now trust my emotional responses, making these emotive encounters easier to manage.