Funny, when asked why they became doctor, most would probably say something along the lines of “to help people.” But the implied ending is “get better.” I would be surprised to learn that anyone became a doctor “to give bad news” or “to help people die.” Yet I find this is much of what I do in my clinical practice as a nephrologist taking care of patients with chronic kidney disease and end-stage kidney disease. Earlier this month I had a particularly hard afternoon in clinic. In room after room sat a person who I had to tell their kidney function was continuing to get worse and that we needed to get ready for dialysis.
It wasn’t hard because the news is a surprise. Not at all. I completely expect chronic kidney disease to get worse over time. That’s just what it does. But no matter how many times I’ve explained this in past clinic visits, the person in front of me responds the same to this latest information—that sharp inhale of surprise followed by a look from my eyes to somewhere on the floor. They were hoping they would be the exception to the rule. And I had just dashed hopes, burst bubbles, and rained on parades all at once. Hard.
Harder is getting them to trust me enough to let go of enough fear to face the inevitable.
Easy would be to just not have these conversations because I don’t have time or because of this, that, or the other logical excuse. But then I would be falling short of my original mission “to help people.”
Hardest is remembering this when it gets hard.