Invite your demons to tea

A few weeks ago in clinic I encountered a really difficult situation. A husband and his wife came to see us in our Geriatric Psychiatry clinic and they were very unhappy. The problem is, they've been unhappy all of their lives together. The husband now has dementia and needs a fair amount of supervision. The wife is fed up and wants to leave but depends on his income.

Now if these folks had family and social capital all would be well. Problem is that the man had walked out on his first wife and children many years ago and was fairly estranged from his kids. He was a serial philanderer. He and his wife began an affair when they were both married to other people.

And if that was it the situation probably wouldn't have bothered me all that much. But the husband and his wife were constantly fighting, and the wife was constantly saying how miserable she was and, here's the kicker: they expected the medical system to fix this. They had the expectation that someone, the government or SOMEONE, would fund the husband's long term care so that the wife could use their income to move someplace warmer. The medicalization of social problems, something that is very common these days.

When I talked with this couple, I had a new emotion: absolutely disgust and lack of any compassion whatsoever for my patient. All providers experience this but as I approach patients with the beliefs that 1) it is my job to treat, not to judge 2) there is some good in everyone 3) everyone is probably doing the best they can for the circumstances they are in and the history they have 4) I've made a lot of mistakes too 5)No situation is every hopeless. SOme are harder than others but none are hopeless. By being open minded I have found a way to connect with most all of my patients.

Not this one. I looked inside for some compassion. None was there.

And this really bothered me. Suddenly, my view of myself as a compassionate person was challenged. I thought and thought for days about what this meant, about how I could possibly help these people whom no one else had been able to help. Nothing.

The next week I talked with my attending Geropsychiatrist and Psycholgist. "I figured out why the case bothered me so much", I said. "I feel zero compassion for him." Now this is probably something you might not want to admit to your attendings but I wanted them to help illuminate the situation for me. We spend hours talking about the psyche of our patients.

My attendings were pleased that I had found this insight and we discussed how examining your own emotions and reactions to patients is so important. "How could this insight help you take care of this patient?", my attendings asked. I did not know. "If you experience a total lack of compassion for this couple, realize that that is how the world sees them too." Eureka! He was right. He shifted my frame of reference.

So I learned to take a look at my most dark and challenging thoughts. To hold those thoughts in my hands and heart with compassion and look at them from all angles rather than block them out. By inviting my demons to tea, I came out with more compassion for myself and even, just a tiny bit, for the patient I thought impossible to care about.