(no subject)

[rivka]

Some true things really make you feel like a jerk when you say them.

Today I told my research assistant, who wants to be either a physician or a psychologist: "One of the hardest and most important skills for a clinician to have is the ability to go out of the room and leave the patient behind you."

It didn't feel like a very human thing to say.

The impulse that leads her to brood over what will happen to a homeless, bipolar, drug-addicted, HIV-positive research subject she met, who has obviously critical mental health needs and yet couldn't be forced to stay in the hospital for psychiatric treatment - that's a good and human impulse. That's how people should care about each other.

"I told Dr. WardAttending about it, and she told me he was typical," she said miserably.

"Yeah," I said. "That's our patient population."

And it is. There are hundreds more just like that guy. If she carries every patient around with her, it will break her. She needs to learn to do what she can, with all of her caring and skill and compassion, and then leave the patient in the room when she goes out. It's a difficult lesson to learn, and probably none of us learns it perfectly. But I know from bitter personal experience that it is much, much more difficult if you don't learn that lesson.

I still felt like a jerk for saying it, though.

Comments

[hobbitbabe.livejournal.com]

Since she knows that you continue to be a compassionate and effective therapist, she might be more likely to consider believing you than she would Dr WardAttending or someone else she could characterize as callous.


I've had similar conversations with a couple of my teaching mentors when I was all worried about a student who was digging him/herself into an academic hole among some personal problems.

[jonquil.livejournal.com]

I don't see you as a jerk. I see you as somebody who is a great deal braver than I am. I couldn't walk into that room, day after day after day.

[verymelm.livejournal.com]

*nod* Same here. Which would be why my social work degree has an administrative focus instead of a clinical one. I *could* have been a good clinician, but not for very long and not without giving up my life for my patients.

You're not a jerk for knowing where to draw your sanity line - and sticking to it - so that you can continue to serve those who need you the best way you can.

[dafna]

Oddly, my main reaction to this is to wonder whether you're watching "House", where the main doctor's apathy toward patients is an underlying theme. I don't mean to say I think it's correct at that extreme, but I think that I could see doctors enjoying it as a guilty pleasure in the same way that I enjoyed some of the Sports Night stuff about making up the news.

[therealjae.livejournal.com]

Oh. Yes.

-J

[aquaeri.livejournal.com]

I don't think you're being a jerk, either.

While there are a lot of advantages to our society, and getting specific people to specialise on particular tasks, this seems to me one of the major shortcomings.

I think there's only so much of other peoples' misery each of us can carry, and you are in an occupation where you're going to find out exactly how much that is.

[firecat]

I don't feel like it's a jerky thing to say. I don't feel like brooding is a good impulse or how people should care about each other. (I think it's how many people DO care about each other, and it's not evil, and I understand it, but that doesn't mean it's good, especially good in the sense of more compassionate.)

I don't think there's anything wrong or jerky about simply doing what you can and not what you can't. I don't think there's anything wrong or jerky about knowing what you can and can't. I don't think there's anything wrong or jerky about telling other people that they can also learn what they can and can't.

[mittelbar.livejournal.com]

I can't imagine a nicer thing to say, under the circumstances.

[odanu.livejournal.com]

One of the most critical skills anyone who works in a public health or therapy role can learn is self care, especially emotional self care. And it is very difficult. The same people who are willing to bend over backwards to help people in nearly impossible situations are the ones who won't take the time to exercise, or relax, or read a book, because it's "selfish"...but it's absolutely essential, if you're in a helping profession, to take care of yourself first because otherwise you have nothing to offer your clients.

[datagoddess.livejournal.com]

Cluing her in to a survival skill isn't being a jerk by any stretch of the inagination. There's a huge difference between being cold or unfeeling with a patient and not carrying their troubles around with you. The sooner she learns to do that, the better off she'll be.

And helping her learn that lesson is compassionate on your part. You know what it's like to not be able to leave it behind when you need to.

[filkerdave.livejournal.com]

I think in ANY field, it's necessary to be able to walk away and leave your work on your desk, as it were. If you don't, you burn out and you can't help anyone.

I don't think you should feel like a jerk for saying it; you should feel good about saying (maybe not good about the fact that it has to be said, that people DO need to be able to walk away, but good about saying it).

[roozle.livejournal.com]

You know you're not a jerk when you still think it's a difficult act, and a skilled one, to "leave the patient in the room". The jerk just walks out without a second thought.

And actually, from the point of your colleague, it seems like it was about the best thing to say -- you acknowledge that it's difficult, that validates that it's painful for her, but you also show the way to a place where she can be successful.

You rock!

[xopher-vh.livejournal.com]

Well, I'm not going to tell you how you should feel (and I don't think the folks above who used the phrase really meant to either). But I will tell you what I think.

A friend of mine once told me her grandmother's criteria for saying something: 1) Is it true? 2) Is it necessary? and 3) Is it kind? The idea is that any two out of three justifies saying it. It's not infallible, but if broadly applied it would cut down on the number of gratuitous and unkind lies!

At any rate, it sounds to me as if you know it was true and necessary, and you don't feel that it was kind. I would contend that it may have been an unkind thing in local (in the mathematical sense) terms, but much kinder in more global terms than not saying it. Of course, that what makes it "necessary," but the greater kindness was better served. And you were well justified even if it had been unkind, but you know that.

In fact, this is a common thread in all areas of human endeavor, especially ones that involve any kind of service to others: burnout is not good service; therefore to serve others your first duty is to protect yourself from burnout, overload, and so forth. I keep having to remind myself that I will work better in the afternoon if I take a lunch break. (Of course, I'd also get more work done if I didn't comment blogs, but that's another story!)

The other thing is the universal paradox of doing crisis (or just problem) service: If you're the kind of person who should be doing it, it will bother you (and more importantly, people who it doesn't bother shouldn't be doing it). Therefore, I will NOT tell you that you shouldn't feel like a jerk for saying it; I WILL say that the fact that you felt like a jerk proves that you aren't!

[marykaykare.livejournal.com]

If I were able to be believer in gods they'd be a lot like you. I'm awfully glad I know you. (I don't know quite what else to say except asking you to marry me and that won't work and it has just occurred to me to wonder why I need to make a joke while complimenting you. Um. Excuse me now. MK wanders off mumbling and shaking her head)

MKK

[xopher-vh.livejournal.com]

Hmm. Now this was put in as a Reply-to my comment, but it seems more likely to have been directed to the more-obviously-divine Rivka. If not, it's the nicest thing anyone's ever said to me.

[xopher-vh.livejournal.com]

While I was typing roozle said the same thing more succinctly. Gotta work on my verbosity.

[ororo.livejournal.com]

I think what you said comes under the heading of "tough love," really. She may not have liked hearing it, but she needed to and if she continues on her chosen path, I'll bet she'll thank you for it later.

*hugs*

[tikva.livejournal.com]

You're not a jerk. You're sane and healthy.

I get calls from people who are being evicted, are homeless and calling from the nearest payphone, are dying - and sometimes, there isn't a thing I can do for them. It's hard. It's really hard. But eventually, I do have to hang up the phone and move on. And there's no good way to do that.

[patgreene.livejournal.com]

What you told her is absolutely true, and she needs to figure out whether she can do that *now* rather than later.

The reason that I did not practice criminal law, which is what I excelled at in school, is that I don't think I could muster enough detachment to be able to do my job effectively, or at least not for very long without burning out. My third year project writing about a mass murderer in Arkansas troubled me greatly, and I wasn't actually involved in the case.

You have my utmost respect for the way that you manage this delicate balancing act, combining the necessary detachment with compassion.

From another direction

[dragon3.livejournal.com]

Keep in mind that if you don't leave that patient behind when you leave that room, then you are bringing less than you could be to the patient in the room you are about to walk into. You do what you can within the limitations you have to work with.

I try to give my students my full attention and my best advice when they come to see me. Sometimes they won't take the advice, or they have problems beyond my scope, or whatever. It's certainly not as dire as the situations for your patient population, but there's parallels.

[dornbeast.livejournal.com]

I still felt like a jerk for saying it, though.

Collectively, everybody who got here first has said everything that I could say. So I'll just join in on the chorus of, "But you aren't being a jerk."

Peter Eng, blundering wildly through LJ

[jerusha.livejournal.com]

As painful as it would have been to hear at the time, I can only wish that someone had said that to me, oh, about seven years ago.

Learning this lesson may be one of the differences between a career spanning decades and a career spanning months. She, and the patients, are served much better by the former than by the latter.