Dr Farah Karipineni is an academic endocrine and general surgeon in Central Valley California
“There’s no heartbeat.”
Three words no one ever wants to hear.
Three words no one ever wants to deliver.
And yet, as a community of physicians, we deliver those crushing words on a daily basis. None of us would ever take the task of bearing this piece of news lightly, but for me, it was not until I was on the receiving end of them that I truly grasped how profoundly a physician can shape the experience of a family member or patient in this particular depth of despair.
I have delivered this news more times than I can count. I would like to say that I recall each time vividly, that I remember each patient’s name, story, and the faces of each family member as I broke the news that ended their world.
But alas, I do not. I recall the poignant ones: the 26-week pregnant mother who lost the fetus in a motor vehicle crash; the 12-year-old schoolgirl shot in the chest; the 40-year-old roofer who arrested in the operating room as we stretched his ribs to massage his heart.
I do not remember the exact words I used to convey this most unwelcome information. What I do recall is the mixed sense of fear, dread, pity and my own grief immediately prior to entering the room. For yes, I would walk away scarred, and my scar was important for me to acknowledge, but it did not deserve to take up space in that haunted room. I had to be fully present for their grief.
And then I became the patient. It was a much-wanted pregnancy requiring multiple cycles of assisted reproduction, our life’s savings, money we didn’t have, a lot of failures, hundreds of injections, and so, so much guarded hope. The words seemed to come too easily to the physician who delivered them, far too easily. They were accompanied by no eye contact, no outward emotion, and no additional words. While I am sure that I was more than a transaction or a diagnosis to this practitioner, there was a devastating failure to acknowledge my humanity in the experience. My mind immediately wandered to my patients—how often had I unwittingly made them feel the same way?
Until I required health care on a regular basis, I was often surprised by how grateful my patients are by what I consider common decencies. Giving them my cell phone number for emergencies. Making them feel heard in the office. Collecting details about their personal lives and families. To me, this all falls under the umbrella of caring for, and about, a patient. Not just a patient’s medical problem, but a person. A human being, just like me.
But after being on the patient side for far longer than I wish, I realize why patients have such low expectations. Humanity in medicine is in crisis. Health care workers feel overworked and under-appreciated, and institutional values center around financial success rather than employee and patient wellbeing. When dollars are our bottom line, and not people, we put every patient interaction at risk of being reduced to a transaction.
Recognizing this challenge in our current healthcare system can be discouraging, but it can also be uplifting. We can make an intentional, collective effort to treat our patients like human beings. We can grasp that almost sacred moment where we inhabit another’s suffering and bear witness to their struggle, in an effort to heal not just their ailing body, but also their ailing spirits. For in those inevitable dark moments when there is no heartbeat, that may be all we have to offer. And it may be enough.