Heart-wrenching photo of doctor crying goes viral. Here’s why.

CryingDoctor Outside of a Southern California hospital, an ER doctor is crouched down against a concrete wall grieving the loss of his 19-year-old patient. A paramedic snaps a photo of the tender scene. His coworker, a close friend of the doctor, posts the photo (with permission) online. Minutes after the photograph, the doctor returns to work “holding his head high.” Thousands of people have commented on the web. In their own words, here is why the photo went viral: 1) Humans crave raw empathy. The photographer captures a poignant moment in a stoic profession that trains doctors to remain professionally distant. The voyeuristic photo reveals the emotional reality of doctoring—and a side of physicians that people don’t usually see—while uniting us all in our common humanity. 2) Unexpected death is universally heartbreaking. An ER doc, Smeee, writes:

When it comes to our work, nothing is harder—and I mean nothing—than telling a loved one that their family member is dead. Give me a bloody airway to intubate. Give me the heroin addict who needed IV access yesterday, but no one can get an IV. Give me the child with anaphylaxis. But don’t give me the unexpected death. . . . We can only do so much, and we can only hope to do our best. But it’s that moment, when you stop resuscitation, and you look around, you look down at your shoes to make sure there’s no blood on them before talking with family, you put your coat back on and you take a deep breath, because you know that you have to tell a family that literally the worst thing imaginable has happened. And it’s in that moment that I feel. And I feel like the guy in this picture.

3) Doctors are not allowed to grieve. A surgeon, TheGreatGator, shares, “We are never formally trained to deal with loss and/or with giving the worst news of a families life to them.” Another doctor, boldwhite, writes:

I know what that person is feeling. Yesterday one of my 17-month-old patients died. I was in the bathroom crying in private between patients several times yesterday. I’ve cried in stairwells and hallways. It eats at you. Life is very fragile and the pain of losing those we are trying to help becomes a scar that doesn’t go away. It has shaped who I am as a person.

4) In medicine, crying is unprofessional. That needs to change—now. A premedical student volunteering in the local ER tells me about a female physician who cried after losing a child. He thought her behavior was unprofessional. I asked him to consider, “Who did she harm by crying?” Meanwhile, a physician tells me she’s been cited for unprofessional conduct for crying at work. Her boss told her, “Unless you are dying, crying is unprofessional behavior and not to be tolerated.” Some physicians and young doctors-in-training are uncomfortable with tears. Grieving is a healthy reaction to sadness. Humans bond through shared pain. Please do not punish your colleagues for their willingness to be vulnerable with grief-stricken families. Real doctors cry. 5) Patients want doctors who cry. Patients are comforted when doctors grieve with them. Vicki Allemand Scott, a mother on Facebook, concurs, “When my daughter passed away the doctors and nurses formed a wall in front of us until she was gone. ALL of these wonderful people were crying just as much as we were. I will never forget the kindness and compassion we were shown by these special people.” 6) Real men cry. Men are socialized not to cry. This photo honors a man for having the courage to cry. A son, livinbandit, shares:

My dad is an ER doctor, and has been for as long as I’ve been alive, always working nights. He doesn’t usually talk about patients, but he would talk about the gross things he’s had to deal with around the dinner table with the family. The times that I do remember though, however rare they were, were the times he would come home, and cry in my mother’s arms because there was someone that he couldn’t save no matter how hard he tried . . . He didn’t think any of us kids were watching, but I seemed to always see. I’ve never had more respect for my dad then when I would see him cry because he felt like he could have done more . . . Even if he couldn’t have.

7) More than anything—doctors need your empathy. What happens when the physician in the photo pulls himself together and gets back to work? One commenter on Reddit, PM_YOUR_PANTY_DRAWER, suggests the sad reality:

The part most people fail to realize, is that this man now has to compose himself, walk into another person’s room, and introduce himself with a smile and handshake to the next person. Sometimes healthcare workers walk in to see someone new and before even introducing themselves, out comes; ‘We’ve been sitting here for 45 minutes and . . .’ or ‘That guy next door has been moaning forever and nobody is helping him.’ You literally had to direct yourself 100% at someone grappling with death, and the rest of the show goes on around you. There’s times where you run, and rush, and hurry, and skip eating, and go 12 hours without urinating, and you’d give your firstborn for a cup of water, and through it all, you lose, you get complained to, and you get zero sympathy from your coworkers or management. I’ve been covered in phlegm, urine, feces, blood, infectious drainage, sweat, and tears. I’ve had to go from ensuring a person continues to breathe, to a room full of angry people because grandma wanted a Tylenol and the call light has been on for 10 minutes, and we’re going to another hospital, and we want another doctor, and this place is getting a call to the administration, and I’m going to call a lawyer, and I’m calling channel 6 news, and we know so-and-so and he’s going to hear about this. Healthcare is a life of fighting, defending yourself, sacrificing yourself, working weekends, missing holidays, and sometimes things like losing a patient makes you want to throw up your hands and say ‘fuck it, I’m out.’ But you can’t. You do it because you love it. You do this thankless and unappreciated job because you want to. I can’t believe I’m in 6-figure debt and gave up the nights and weekends of my 20s so I could voluntarily do it. But I couldn’t see myself doing anything else.

One doctor, jimbomac, has a simple request: “Let me tell you those ‘thank-you’ cards probably mean more to us than you think . . . we do hugely appreciate when people like yourselves take the time to say thanks.” 8) Doctors who don’t grieve get sick.  Unprocessed grief is dangerous for human health. My Facebook friend, Joe Jacobs, writes:

I had a friend who was consuming heavy amounts of cocaine in the 80s trying to deal with a doctor’s life. He was a Cedars doctor making big bucks and living a prestigious life so I asked him why and he responded with. Paraphrase: I’m an oncologist who thought I would be able to help using the latest cure methods. I find myself head of the ward of incurables and it is my job to ease their pain and watch them die and then watch the response of family members to the outcomes.

9) If you don’t cry, you die. In my recent article, Physician Bullying: ‘Not Allowed to Cry’ I discuss unprocessed grief as a root cause of physician bullying, abuse, depression—even suicide. Both men I dated in med school died by suicide. Brilliant physicians. One overdosed at a medical conference. The other overdosed after work. In just over a year, we lost three physicians in my town to suicide. Gunshot wounds, mostly. One local doc lost seven colleagues to suicide—so far. Our profession punishes doctors for grieving and restricts the medical licenses of those seeking mental health care. So rather than process our grief, many docs turn to alcohol, drugs, firearms. 10) The physician in this photo is a modern day hero. CryingDoctor QUOTE Pamela Wible, M.D., is a family physician and pioneer in the ideal medical care movement. She hosts physician retreats to help her colleagues heal from grief and reclaim their lives and careers. Watch her TEDMED talk “Why doctors kill themselves” and her TEDx “How to get naked with your doctor.”

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114 comments on “Heart-wrenching photo of doctor crying goes viral. Here’s why.
  1. trudy martinez says:

    Thank you so much for your much needed work. The health care system we all work in is so productivity and bottom line oriented that there is no support for taking the time to be human with our patients. It is a daily challenge to be positive with our patients, but even more, with ourselves.

    • Kathleen Farrelly says:

      I have every single thank you note I have ever received from patients and family members. I also have a Christmas ornament I put up every year. I treasure these mementos that remind me I made a positive difference in someone’s life. We cherish these reminders. Thank you.

  2. Eleanor Flower says:

    I am 86 yrs old this year, I have been in nursing since I was 17 yrs old. I do not work for money now, I volunteer.
    I have never forgotten many of my sick, dying, sad with ills patients. I often wonder how some of them are now. I don’t see them in our town.
    There are special moments in our long hours of working with the sick that never ever leave our hearts and minds. Just because we (used to wear white) care for the ill, we are tender hearts but rarely do we have time to cry right then, we cry later, when we think, and have time to play it all over in our minds and heats. I loved nursing, always have.

  3. Jan-Eric Esway says:

    [–]ZippyDan 337 points 1 day ago*
    It is not about doctors or medicine; it is about people. Most people are basically good. But everyone has bad days, everyone can be lazy and selfish, some people are just always jerks and fewer still are outright evil. The point is you are going to find amazing doctors, horrible doctors, and mostly average doctors. That’s true of any group of people.
    permalinksaveparentreportgive goldreply

    Dear ZippyDan,

    I don’t know you and I don’t know what your intentions were when you wrote this post, so please don’t take my response personally as it is generated only from the emotions I felt when reading your post, which are based on my experiences as a physician and person.

    Having said that, I will try to explain.

    I believe your initial statement: “It is not about doctors or medicine” is completely incorrect. At the same time, your comment: “It is about people” is absolutely true.

    The image captures a moment when an ER physician is outside the hospital after he lost a 19 year-old patient.

    At this moment, I can only imagine what the physician may be feeling…
    What did I do wrong?
    I can’t breath
    I’m so tired
    What am I going to tell the parents?
    Is there anyway they blame me for this?
    Why did I go into Medicine again?
    God, I wish I could just go home and spend time with my family
    Am I going to be facing a lawsuit
    I really wish there was someone I could talk to
    I can’t let them think I’m “weak” or
    I am “cut-out for this kind of work”
    Come on now, “Be tough!”

    But he’s alone.

    No one can see him.

    So he has a few precious moments to be a human-being, and cry, before he has to go back inside and act like “everything’s OK” and today is “just another day at the office, and he’s just living the dream.”

    So really, the image IS about Doctors AND Medicine AND people! Doctors are, after all people who devote themselves to helping other people through the art of practicing Medicine.

    The next comment in your post is that: “Most people are basically good. But everyone has bad days, everyone can be lazy and selfish, some are jerks and some are outright evil.”

    I agree with you that most people are basically good. But I would like to shed light on some issues, so that hopefully a few people will read this and, perhaps, come to a better understanding of what it really means to become and be a physician.

    Nearly all physicians go into medical school healthy. During medical school and residency, depression and mental illness quadruples and 50% of students and residents are suicidal at some point in their training.

    Despite this problem, those who ask for counseling are ridiculed.
    One of my fellow residents committed suicide and anyone who talked about him was punished.

    Residency was 5 years of 100 hours a week, and you were lucky to get out of there without severe PTSD.

    One of the residents was 1 month away from graduating, and after 36 hours of no sleep he fell asleep driving home and died. He had 5 children and there was no talking about that either.

    Things only get worse when you start working in practice. You’re at the bottom again and you have to pass your boards and there is a 25% failure rate. If you don’t pass, you are pretty much out of a job with all of the new federal regulations that have affected hospital privileges.

    So you are now 36 years-old and you have $250,000 of debt and there is certainly no way you are going to make it if you “can be lazy and selfish” or a “jerk,” let alone “outright evil.”

    You may “have a bad day,” but you definitely can’t show it. If you do, you will be given a negative rating on any one of the numerous online patient review sites, and that won’t bode well for business or your possible future partnership.

    And if you show any signs of distress, prepare yourself for disciplinary action by your state Medical Board, which will become part of your permanent record.

    And “bad day” better not mean you screwed up any part of patient care, because that means you’re going to have your 1st lawsuit.

    Even if you didn’t do anything wrong but upset your patient (the #1 reason for a lawsuit), the lawsuit is going to put you out of work and scrambling to pay off that $250,000 with some other type of work.

    Putting all of this together, being a physician is pretty damn difficult.

    That’s why it is the deadliest career!

    More than 400 physicians die each year from suicide! That means 1 MILLION patients lose their doctor every year because of suicide!

    The sad part is that no one sees it coming, because we aren’t allowed to be people and Doctors, like this ER physician who is able to cry only because no one is watching.

    Becoming and being a Doctor is kind of like climbing Mount Everest or K2. It’s an incredible accomplishment, but not everyone survives; and those who do often lose part of themselves along the way.

    When you say: “That’s true of any group of people,” I have to argue that Doctors are more than just “any group of people.”

    We are an amazing group of people.

    If we do something good, tell us you appreciate us!

    We are human-beings, and we definitely like to hear it!

    Every time I hear it, I smile and am glad I’m a Doctor!

    • Kim says:

      Thank you for such endurance and dedication!

    • Maria B says:

      Thank you for saying it for me so eloquently
      and courageously.

    • Karla Galvez says:

      I appreciate your dedication, resiliency, hard work, the sacrifices you’ve made, and good heart. I have always looked up to doctors; I even prepared myself academically so that one day I would become a physican. But one of the toughest parts for me has been realizing the harsh realities and challenges physicians face every day. The truth is I want to dedicate my life to a profession that will also take care of me when I need it along the way but most importanly, leads by example and takes care of their hardworking doctors and offers them the support they need to not only be successful at what they do, but also help them cope with the impact their profession will have on them. For how can I envision being able to help others to the best of my abilities when my health and wellness is non-existent and a second priority to the team I work with?

    • joyce g says:

      joyce I have always had an issue of the long hours required of the interns. how do they expect mistakes not to be made when the dr. is so tired he/she can’t see straight. seems that when I have been in the hospital I have always gotten the interns that are just learning the ropes and I tried to be as friendly and accommodating as possible. I have also gotten the nurses that were in training and it doesn’t bother me. they have to practice on someone and if I am that person so be it. I have no patience for the whiners and complainers that can’t get what they want the instant they want it. I get the new cashiers and sales persons. maybe I have a certain look that says she is not going to be a b about the time it takes for someone learning. I have had some real special drs. and nurses and some that weren’t so special but I try to be as nice to all of them as possible. I appreciate the time it takes for them to do the job and the job they do. it is not something I could do but I am so glad that there is someone that finds it as rewarding as they had hoped. don’t punish them for showing emotion it only makes us realize they are really human and we need to see that side of them too. too often the impression is they have no feelings or don’t see us as a human but a disease but that is not true and the sooner we realize it and acknowledge it the better we all will be. so a big thank you to all the nurses and doctors that have chosen this as their lifes work. believe it or not you are appreciated by more than you know.

    • Thelma La Rosa Fernandez says:

      You really got it right and saying it very eloquently. I hope patients and their significant others can see and understand the dedication doctors give to their patients and that doctors are also people; they are human, have feelings, empathy and the desire to give the best that they can to the needs of their patients and that like every human being can also be at their wits end after a long day at the ER or the wards.

    • Carla says:

      Thank you for your hard work and dedication. You are really in an ungrateful career.

    • Nichole says:

      Excellent response! Thank you!

    • Gary Levin says:

      Thanks for taking the time to write your post. I would recommend it to every young, or older physician. ER medicine is particularly difficult in that respect, as well as family medicine where one builds trust with a family..

      GML

    • Nikki P Walker says:

      This message is for Doctor Jan-Eric Esway, MD. who posted your blog 3/2015.
      Being your patient was a great blessing to me. Recovered 94% of the use of my leg, where most people my age are affected for life. Without you, I would not be who I am today. Add that, how many times, for the many patients you’ve cared for, priceless! Thank you so much. Please contact me so I may contact your practice.

      • Pamela Wible MD says:

        Will get this to him Nikki!

        • Debbie McDonough says:

          I, too, am searching for Dr. Jan-Eric Esway. He did an amazing job of reconstructing my ruptured Achilles tendon and is no longer at the same medical practice. He was the most compassionate doctor and so knowledgeable. I am hoping he is still in practice. If so, I would like to schedule an appointment with him. Would you be able to get this to him and hopefully I will hear back with information as to where he is now practicing?

        • Nikki P Walker says:

          Thanks Dr. Wible
          My middle name is Pihos.
          My father played for the Philadelphia Eagles. He taught me “WHEN YOU FALL DOWN,.YOUGETUP!”
          Dr.Essay is truly one of a kind, a super great doctor.

    • Roger Shepardson says:

      If this is Dr Esway, I would like to talk to you. I am a former patient of yours from the Ortho Va. Group. You left the practice just after my surgery. I’m the guy that used to pressure wash your house in Richmond..Please send me a response..Thanks

  4. I recently heard on NPR radio, before I saw this blog, doctors are in the top 3 of professional that end their lives. I can imagine this is so high because they are bullied into performing.
    I personally want a doctor that is human, and has and shows emotions.
    I think when people have to bottle up and hide, being human, this can only be a recipe for disaster.
    I had an excellent doctor at one point. he was really everything a person would want, he took time, he was a thinker, after a million years in our little hick community he still cared about his patients. He was then ‘taken over” by the huge counties wide corp. I think at that point he was bullied. I lost my doctor and all my medical care and he said he needed a job.
    I think we both suffer. I suffer physically and have died a little more everyday sense being black listed.
    I only imagine what this guy might be going thru…. Please throw my dr barber a life line… I can’t…. but I really feel he might really need one. He never fired anyone 30 years- then his CEO, fired a really sick person, me.

    I hope someone will look out for the best doctor I ever had, up until my care got Abandoned. Please, don’t let him suffer , if he is. I think he might be in distress…
    I can not imagine he is not suffering greatly. I am working on changing the laws and still trying to find reasonable care. good luck to me too.

    • Pamela Wible MD says:

      Thank you SO much for writing and sharing your story.
      If you give me your doctor’s contact info, I will contact him personally!

      I will heck up on him. . .

      I think you should write to him to.
      Maybe share this article and YOUR response
      in a letter to him. He WILL appreciate it!!

      ~ Pamela

      • Lola says:

        I am a Physician Assistant and I have been working in Medicine for over 20 years and the doctors I respected most were the ones who allowed themselves to feel. When you allow yourself to really feel for your patient you are bound to feel pain when they hurt or die. This is the human condition. I worked in Hospice for a time and although I knew my patients were dying that didn’t stop me from grieving their loss. I allowed myself the release of tears, at home, and comforted myself knowing that at the end they knew they were not alone.

        The field is extremely difficult and if you dare speak up you will be jobless. I had to report a nurse once who left my patient without her pain meds for 9 days. My patient suffered extreme pain for 9 days without cause. This nurse was a danger to the patients. Guess who got the sack? I guess they were afraid I would go to the State Board. I never intended to do that I just wanted her disciplined. I was relieved to hear she was gone from that nursing home after a time by friends. I have no regrets for speaking up. I can not just sit there and watch someone literally torture a patient.

        The business of medicine is what is killing the medical staff more than the loss of their patients. If a doctors/nurse/PA/NP is allowed to show they care there will be a lot less law suits and depression b/c they will feel understood and not shamed for being human. As for me I will only go to a doctor who cares and shows emotion. God Bless this doctor that he gave himself the time to grieve. He will not be able to put up the front he has to for long if he doesn’t.

  5. Whitney says:

    Several things come to mind. A couple of them:

    I wish that med and nursing schools would change their concept of death and dying from the current thinking of “enemy” that we “fight” and either “win” or “lose”. There will always be death, so this paradigm is inherently unrealistic and positions professionals as “losers” at times. My position on this is informed by a philosophy and cosmology that other professionals often don’t share, but it’s up to each of us (professional and lay alike) to reflect on dying and “untimely” death and suffering and meaning, and form our own conceptual framework. Lord knows our schools typically did not guide us in this.

    I’m a hospice nurse now but was a high risk antepartum nurse back in the days of protracted hospitalizations for pregnant women with obstetrical or med/surg conditions. My job involved a LOT of anticipatory grieving and perinatal bereavement. One day, I turned a corner to find one of my least favorite OB residents slumped against the wall outside a pt room, a strip of US images dangling lifelessly from his hand. I didn’t like this guy because of his cockiness and cavalier attitude I’d seen too much of. Anyway, I squatted next to him and asked what’s up. He waved the strip limply and said, “This is my THIRD IUFD (fetal demise) this week. I…don’t think I’m cut out for this. I don’t think I can do this any more.” I took a deep breath and told him about how I am able to accept that things happen that we cannot change, but that I believe it is a real privilege to be in a position to care for someone on what will probably be the worst day of her life, if we can just release the need to “fix” it. He took a deep breath himself, nodded weakly, arose and re-entered the room. I knew then that his cocky attitude was a shield against showing his deep insecurities and fears. I can’t recall his name now, but I’d like to think he’s a couple of decades into a fulfilling practice.

    • Pamela Wible MD says:

      Brilliant philosophy Whitney (which I share) . . . enjoy the moments we have, life is a mystery, embrace the uncertainties, and be here. . . love is the only thing that matters in the end. Love is enough. “Work is love made visible.” ~ Kahlil Ghibran

  6. martha tanner says:

    Thanks for such an excellent article on this subject!!!!

  7. Nanshr says:

    Long ago I worked for a surgeon known around the World. He would travel around the World to speak and teach. Patients would come from around the World to be treated. One day I asked him why he stopped treating cancer patients. He said that when he did surgery, he could no longer see well due to all his tears, he did not want to work without a clear field. He said it pained him so much when he would be eye to eye with the cancer that was eating at his patient. I had thought he was quite the bully, but it turns out that was his false exterior. He held the pain inside, but he could not hide the tears when wearing laser goggles to catch those tears. I had new respect for him.

  8. Butch/Texas says:

    I have sent quite a few thank you cards to doctors over the years. I quit because I thought they may be taken wrong or just to much and adding to there junk mail. Thank you for letting me know it is OK to do, Will be sending more now that I know they do help. Helping them to feel appreciated was the whole purpose anyway. Thank you for everything you do…Butch

    • Pamela Wible MD says:

      YES Butch!! Please do . . .:) <3

    • Georgianna Ainslie says:

      I am a Certified Nurse-Midwife, in practice for almost 30 years, involved in OB for almost 40 years. We have great days, and we have seriously tough days. I don’t think people know how much we appreciate notes/cards of appreciation and support. Whenever I teach new students I tell them to keep every card, letter or photograph that someone sends them, because there will be days (or weeks or months) when nothing seems to be going well, and those cards will help them to remember that what they do IS important, and it DOES make a difference for women and families – even if the one they are dealing with today is difficult and unappreciative and complaining about having to re-schedule a clinic appointment because I had to go attend a birth (for heaven’s sake! Of course if it was them, they would want me to cancel the whole day’s patient load to attend them!!) Thanks for your work Pamela – it matters. And thanks for your appreciation Butch/Texas – it matters too.

      • Joyce S says:

        I have an ongoing thank you card file that is a permanent fixture in my desk drawer. Started it 20+ yrs ago and still need to dip in there and re-read some of the sentiments on those days when I just need a little reminder!

  9. Craig Einhorn says:

    In addition to giving the news that a family member has died I have an idea for another article you can write. How does a doctor tell someone and their family that the patient has a terminal illness and will likely die in only months?

    I remember when I was 20 and my 24 year old brother was diagnosed with chonrdo sarcoma of the sphenoid sinus. My parents drove the two of us to NYC to see an expert. He examined my brother for a few minutes and then the four of us met with him in his office. He told us there was no hope and my brother would die soon. He also explained that he was not trained to give this kind of news to families and that he didn’t know what to say. He remained distant and unemotional. It was an odd and uncomfortable moment for my family.

    We left and my brother told me, “That 15 minutes cost $400″. That was in 1985. He passed away less than a year later.

    • Pamela Wible MD says:

      Unbelievable that we are still not taught how to do this properly in medical school.

      • Amanda Herrell says:

        I’m a second year osteopathic medical student and we did have a simulated encounter last year where we had to give someone the news that they had inoperable cancer and less than 6 months to live. The videos of the encounters were critiqued for humanism, compassion, etc. and we also had a scheduled activity afterward where we sat down in small groups with a clinician and discussed the assignment. Our standardized patients are awesome actors and really made this feel real for us. Though it was very difficult and awkward, I am so glad we had this opportunity. Hopefully, when I encounter this kind of a situation in “the real world” of medicine, I will be able to take what I learned from this assignment to guide my approach.

        • Pamela Wible MD says:

          So good to hear that this training is happening!!!! Most of us received nothing like this. I surely did not.

      • Fight On! says:

        At Keck-USC we had a seminar / standardized patient encounter on “breaking bad news.” That training also came in handy when informing a former boss I’d be leaving my abusive job! 🙂

  10. Years of unshed tears > depression. I am so sorry that medical school is so cruel. I pray it will change and very soon. It’s not doctors who harm people – it’s the system that bullies them.

  11. Bodhi Goforth says:

    Thank you Pamela, for sharing your light, love, empathy. Your vision and persistence are exemplary. And I feel honored and blessed to have you in my life.
    Much love and big hugs,
    Bodhi

  12. Stephanie says:

    When the doctor told me my husband had just died unexpectedly I started to drop my head into my hands and out of the corner of my eye I saw a look of sheer panic come over her face and some part of me said “pull it together you need to take care of HER”. She clearly couldn’t even handle any part of my grief and I shut it down. It is beyond reason in this day and age that medical schools do not prepare doctors for the worst thing that can happen to them and to their patients. It is – in fact, inexcusable.

  13. Ronny says:

    God bless this Angeles. …Doctors! !!!

  14. Aur0ra says:

    I am a family physician and I can completely relate to this. I used to work ER – I remember having to tell families about the death of their loved ones. It was nothing short of an awful experience that kept me awake for days afterwards. The memories are still vivid in my mind and heart years later.

    I witness and experience grief daily in my outpatient practice. I was concluding a patient visit by wrapping up a discussion with one of my new patients who had established with me. I was feeling rushed, as I had 3 people waiting for me due to my overbooked schedule in my assembly-line job. As I rose from my stool to shake his hand and made a tentative plan for his next followup-up visit, his eyes narrowed and he raised his finger as if to say “But doc I have more.” Feeling frustrated that he needed to talk more as I now was running 20 min behind, but realizing what he wanted to say was important, I resigned myself to being behind schedule and brushed over the potential anger that my waiting patients would express to me in due time. I paused and waited for him to speak. He confided in me that he had just lost his child due to a tragic motor vehicle accident 4 weeks ago. His eyes welled with tears as he told me what happened. I sat back down on my stool and listened. I sat facing him – no typing, no computer, just me – and gave him my full attention. When he was finished, I looked at him and, my eyes filling with tears as well, said, “I am so sorry.” I meant every word. He looked back at me with earnest, nodded, and said,”Thank you. There is nothing more to say, is there?” “No,” I replied solemnly with just as much earnest, “There isn’t.” He stood up and was now ready to leave the exam room. We exchanged pleasantries and he left with his next appointment scheduled.

    I went into my office grief-stricken at hearing, seeing, feeling, and witnessing this man’s raw pain and bewilderment at the tragic, sudden death of his son. I knew that my role as his physician was to bear silent witness to his pain and to provide the space for him to express his grief in the way that he needed to do so. This is my sacred duty as a healer and a physician. This man needed to talk, and it was my duty to listen.

    I closed my office door. Unable to hold back anymore, I took my glasses off and set them down on my desk and let the tears fall. I took several deep breaths just letting the emotions flow through me like a river. I put my glasses back on, put myself back together, took 3 more breaths, and walked into the next exam room with my waiting patient. I was over 45 mins late, but I didn’t care. My patient needed me, and I was there for him. That’s what matters to me. That’s why I do what I do.

  15. Chagai Dubrawsky says:

    The individual who knows how to sleep in the right mode, is the person who can face tragedies, without going through crisis(Falling apart).SLEEP RIGHT is the way to handle crisis and learn for it.SLEEP RIGHT is essential for life. The three pillars of life are: Eat Right, Sleep Right, Exercise Right.

    • Chris says:

      Lol. Do tell. When I work a varying shift nearly every day and sometimes have only exactly 12 hours between one shift and the next, when am I supposed to work in time to do any of the above?

  16. Josie says:

    Just wanted to say….when my husband and I were married 50years,we gave each of my husbands doctors a fine bottle of champagne to thank them for keeping him healthy all that time…yes I have found some drs who do not have the “bedside “manner and I couldn’t feel comfortable with them,but now I have terrific doctors.the doctors and nurses do a fantastic job and I believe a lot of the time they encounter terrible things and have to give bad knows to a family…their own personal lives suffer too,but the bottom line is doctors do care about their patients and they always do the best they can for a patient.

  17. Sara T says:

    I continue to admire your passion for humanizing medicine and expressing your concern for the health of physicians, especially when they try to stifle their own feelings. My eyes have welled with tears many times in my career when interacting with patients – thankfully sometimes they are tears of joy. It is hard to have compassion without emotion for patients and their families. My husband is also a physician and is proud to be a man who cries. If he didn’t cry when faced with human suffering and loss, I would be so alarmed.

    I share your passion for physician health and wellness and thank you for creating awareness around such important topics.

  18. Julie Greene says:

    Thanks for this enlightening post. I found it quite moving, whenever I saw an immigrant who worked on the lowest rung of the totem pole of a medical institution, say, as janitorial worker, weep openly, in the corner of a corridor, or while cleaning a patient bathroom. These workers never knew I had seen them. Many didn’t speak nor understand enough English for me to ask. Now that I am an immigrant myself, I realize that there was a world of grief behind those tears. I sure know what it’s like to leave your homeland with only a few suitcases, knowing you will never see your loved ones again. I cannot imagine what it’s like for doctors who train or work away from their homelands to endure Western medicine training, and suck it up all the while.

    As for the ER, while it’s nice to romanticize about it, a lot of nasty politics go on in such places. It’s the law to treat a patient in an emergency, but I have seen many patients who are begging for care, who are deemed “sub human piece of sh*t” and then turned away without adequate examination. I have heard those words said in ERs about such patients behind their backs. My friend took herself to an ER with cardiac symptoms but was turned away because ER politics had already decided she was “just anxious.” She had a heart attack. After that, they treated her with kit gloves and kissed her butt to make sure she stayed silent about what had occurred. I myself coded in an ER and given the way they’d treated me in the past, I’m sure to them, I was nothing but “another patient wasting our time.” They deliberately hid from me the fact that I’d coded the entire time I was inpatient. While inpatient, the nurses made it clear they could hardly wait to get rid of me. They rolled their eyes in my presence and rarely allowed me to finish a sentence. Never mind the other abuses. I asked to leave. The internist said to me, “I’d let you go, but if anything ‘happened’ to you after your release, I’d be held responsible. Think of MY point of view. I’ve got a reputation to think about.” This is an exact quote. It was a Saturday evening in August. I told a nurse that this doctor had said this. She shrugged, said nothing, and walked out of my room before I could say more.

    You can imagine how I felt. This hospital and its personnel ruined my own reputation. I was just one more Welfare patient to them. I had no recourse. This led to my fleeing the USA last May, 2014, with my dog and a few suitcases, never to see my loved ones again.

    See my You-Tube that I made shortly after my release, in August 2013:
    https://youtu.be/w2bOe6eZAkU

    Julie Greene (my real name)

    • Char says:

      Hello Julie! I am so, sorry for all of however, whomever and whatever it is/ was that caused you such pain and misery. Sometimes life just hurts. I felt it would be the same as robbery if I didn’t take the time to let you know that I hear you. I pray that you are progressing well. Take care take Christ my sister. Char

  19. Pamela Carbiener says:

    I recently learned of Dr. Wible(you) and the incredible bravery shown in exposing the pain and disillusionment we experience everyday, alongside the joy and privilege of hoping and many times succeeding to improve the lives of our patients. Your message cannot be spread fast enough: every day I see another example of a physician succumbing to compassion fatigue. They are overcome with the regulations, the unrealistic expectations, the belief that our lives are easy and elite, when in realty days go by that we do not eat a meal siting down or sleep more than four uninterrupted hours or even take a shower.

    I used to love my profession unconditionally–bringing a child into the world, helping a woman navigate the rigors of menopause, performing surgery and seeing someone’s life improve still bring me great joy. But fighting to help young pregnant women who are addicted, or a teenager living on someone’s couch, or telling someone they need a surgery they can’t possibly afford in time or deductibles and then fighting to be their advocates in a system that devalues these individuals and the doctors who try to help them, has worn down my strength and resolve. I ask myself everyday to just get through this day and not take personally the woman who is angry about waiting 45 minutes, or the grandmother who is demanding a guarantee her daughter will not have a cesarean section or the husband who is irate that the hormones prescribed to his wife are costing him too much money. I dread the conversation with my staff that I can’t see a patient due to insurance, or must consider a high risk pregnancy a malpractice liability instead of someone who needs my help. I try to tell myself that most people are good and recognize the difference between maloccurance and malpractice and will not hold me to expectations beyond what biology and the circumstances can deliver. I try to tell myself that my family understands why I am never home and falling asleep when I am.
    On days I succeed, I don’t dread the next one. On days that the stress and negativity overpower me I become frightened that I will give in and loss my empathy and my interest in seeing someone leave the office better than when they came.
    If we do not recognize the need to heal our healers they will no longer be able to heal. If we do not recognize it is not a character flaw or professional weakness to admit we are not robots we will lose our humanity. We need to be able to say ” I don’t know, I am sorry, I can’t fix this” or simply ” I am listening”. And above all we need to be allowed to cry

  20. Janet Breen says:

    I nurse in a small Canadian ER in a close-knit rural community, where everyone knows everybody else’s business. We truly appreciate the thanks we get from families, sometimes from the most tragic circumstances. It lightens me up when I see those cards on our bulletin board in our lounge. On the other hand, it burns me up severely to hear of the malicious ignorant gossip about us going around on the community FB newsgroup. I recall one day when I was in triage, and I had a 13 year old come with an injured finger, which, being a kid with no idea of relative pain levels, she called an ‘8/10’, while she was smiling and chattering along with enough time ahead to put eye makeup on before coming in, her mother hovering protectively at her side. The next man, who wound up having a perforated bowel, downplayed his pain as a ‘7/10′, but still looked sicker and I rated him a higher priority, putting him in ahead of the girl. Shortly after. I was standing in the nursing station in time for a panic-stricken youth to run in the ambulance door shouting about a girl who’d landed on rocks while jumping into a local watering hole, and as a colleague and I started to head out to their car, the phone rang. It was the receptionist demanding a nurse come out because the mother of the girl with the hurt finger was demanding to have her girl be attended to NOW, since she was in pain…I went to the trauma pt instead, helping get her out of the car onto a stretcher. Turned out she had a badly fractured pelvis, also positive for ETOH (no surprise). That mother raised a stink and gave me the hairy eyeball, when I called in the next round of low priorities o the siderooms. It’s always the least sick who have the energy to whine, and we have, it seems, a never-ending supply of these, anymore. I sometimes think the whole load of them should be dropped en masse into some part of Africa where they have no access to a doctor, to water, to a clinic, to all the structures these divas think they should have by some kind of divine right. I cry with dying patients’ families. I have driven a sleepless woman with no money who was at her wit’s end over to a depot to pick up homecare equipment for her elderly sick father who was leaving us for her care, delivered it and her home on my half hour lunch break. I hand out extra dressing supplies to people who live way out of town. In a previous job in a psych ER in Toronto, I have gone out in my own vehicle to pick up a methadone carry on a Sunday when business was slow, for a patient who couldn’t get to his pharmacy, simply because doing it the official way would have meant so long a wait they would have been hours past their dosage time and in withdrawal. But, I am getting so angry about the entitlement and just plain ignorant behaviour anymore, I will be glad to see retirement, just a few years on. If I work then, it will be to volunteer, where the divas don’t exist, in a disaster or a war zone.

    • Pamela Wible MD says:

      People have no idea what is going on in the next room. Empathy is sometimes in short supply. Thank you for all that you do . . .

      • K.Rammohandas says:

        Respected Dr. Pamela Wible,
        Grieving on empathy is not a commodity prohibited to the healers. In fact any brave Doctor on the death of his patient will be heaving and crying atleast inside his/her inner soul.. Dr.Shwietzer had said that he had often cried looking into the wilderness ahead of his makeshift tent while treating the Africans who one by one died due to Malaria.. at a time when Malaria was so deadly.. Crying , in aesthetic sense, is a relief which the Greeks called ‘Catharsis’ which is essential for any human being to retrieve one’s mental disposition .. A most needed Facebook post that no doctor can take slightly .. Thank you Dr. Pamela for the great service you have done.

  21. Lou Palermo says:

    Early in my nursing career, I assisted a patient in creating advanced directives. I conferenced with the family to discuss what would likely occur. I scolded the physician who lacked the courage to have initiated the advanced directive process with the frightened spouse (I have since come to understand how difficult it must have been for him). I became quite attached to this patient and family and the family became quite dependent upon me. I left work one day on the 7-3 shift, praying that the patient, who by this time was imminent, would pass before my return the next day.
    She waited for me. Of this I am convinced because the other two staff members who followed me weren’t as close to the patient and family as I.
    She passed quietly, shortly after I arrived, which family surrounding her, with me at her side.
    You bet I cried. Tears are flowing now as I recall the day. If you can truly completely insulate yourself from such raw emotion, then perhaps it’s time for another field.
    If you have been doing this for a long time, with love and compassion, kudos to all of you.

    • Lola says:

      Amen Lou. I once had a doctor go into the room of a 31 year old woman who had just given birth. She was found to have metastatic cancer. He bluntly told her and walked out of the room. I lost all respect for him from then on. Tough or not it is our job to care. If we don’t care or lack the courage to be honest then we need to rescind our licenses. I went in after he left and spent time with her. Any discomfort on my part was nothing compared to how she was feeling just hearing she was going to die at the age of 31!

  22. Mridubala says:

    Thanks Pamela, this touched me in so many ways. Also, this gave me a new hope and expectation about the physicians. Wonderful message!

  23. Kim says:

    I mean this in a gentle way; in reading the caption with the photo it says the doctor is crying for himself (among other things). I know a lot of medical training involves puffing upmo the young docs ego. So crying in this instance may have had just as much to do with his god-like powers not working this time as in grieving for the loss of the patient. Maybe it’s time to stop feeding the ego and work on feeding the soul. Patients and their families need to know a doctor at least cares. Instead of focusing on treatment or curing, look at healing even if it involves alterb

    • Psych Girl says:

      I did not encounter in my training (nor have I ever heard of anyone else’s) puffing up the doctors’ egos. Attempting to destroy their souls would be much more typical. Those doctors who appear to have “big egos” are probably just letting out the repressed, unacknowledged anger that has built up inside of them during their abusive training… (Hmm, I guess in a sadistic sort of way maybe this *does* mean that their training is the source of their “egos.”

  24. Nina Trainor says:

    Our medical system needs renovation. A trusted doctor and dedicated nursing staff is comforting when you or loved ones need medical help. I want my providers to feel emotions and we need them time to come to grips with losses and unexpected death. Decompression is important in many jobs. They need to be given time for this using whatever works for them…

  25. Marilyn says:

    I have been a nurse and a therapist for many years. One of my most rewarding experiences was facilitating a grief group. People need to know that they need to grieve and cry and expect that others will support them and not dimnish their grief. I applaud what you are doing to promote more compassionate, sensitive training for young doctors. I think doctors and nurses also need to appreciate the impotance of
    spirituality to patients and their families. When my daughter’s surgeon offered to
    pray with her before surgery, it made us all feel more hopeful, and I think gave her a
    positve outcome.

  26. Ann says:

    When my dad was dying and in ICU for nine days before passing, I asked the doctor what he would do when we had to decide between praying for a miracle after the cat scan showed that a stroke had caused massive irreparable damage and letting him go…… And he hesitated. Then he said, if it was my parent, I would let him go. And he cried with me. And then proceeded to give my father the best care, even coming in and monitoring him multiple times on the last day (which was his day off) to ensure he felt no pain when we removed all the tubes and waited. My respect for those in the medical community is endless, and I will be grateful to that kind doctor always.

  27. Patric Anderson, M.D. says:

    A Physician’s Prayer
    By Patric Anderson, M.D.

    Lord
    Make me an instrument of healing
    Where there is anger
    I shall become a friend
    Where there is doubt
    I shall sow faith
    In the face of despair
    I shall bring kindness
    Where there is darkness
    I shall be light
    Allow me to be free of anxiety
    To focus calmly on the moment
    And bring my experience and knowledge
    During critical times 
    In the lives and deaths of my patients
    And their families
    Give me clarity to make good decisions
    Make me humble and grateful
    Give me peace
    So that I may bring love and joy
    To my practice of medicine
    And finally 
    Give me grace
    To recognize I am not perfect
    And grant me the power
    To forgive myself

  28. Suzanne says:

    I am, or should I say, I Was, one of the first people to complain about the long wait, or the lack of compassion, or bedside manner. I admit, I never stop to think what he/she is dealing with behind another curtain or door., but only what I or my loved one is enduring at the moment. As I do still think that some dr.s could show a little more empathy, I do appreciate this article. It will actually make me stop and think from now before blowing a fuse. Thank you

  29. Daniel Herzberg says:

    I will think about this article the next time I go a doctor. Thanks Pamela!

  30. Warren Tripp, MD, FACEP says:

    Thank you to my wife for sharing this link. It means a lot to me. As you know I have had many patients and even co-workers who have died with my care despite my best and other’s best efforts. Life I precious and it is in fact a miracle every day that we enjoy life! I have way too many ghosts knocking about in my mind. Infants, children, teenagers, pregnant women, stockbrokers and of course the elderly who have died in my hands. It is in fact a burden that only recently I have acknowledged and it is nice to see a Web site that doesn’t trash doctors but understands at the end of the day we are all to frail ourselves as doctors. As for suicide I personally have been sadly affected by losing a good friend and Paramedic to suicide as well as a trusted nurse friend.

  31. Gunner says:

    God bless all first responders!!!!

  32. Carol says:

    I’ve been a critical care nurse for decades. We’ve all been there. This doctor is not unprofessional. He’s human, which is what you want from your physician. You’d better believe I’ve cried over patients, often with the family. If you can’t do that, you shouldn’t be in the profession.

  33. Akelina says:

    People also forget that it’s called “Practice Medicine” for a reason. Just because these are Doctors doesn’t mean they know everything and what works for one patient may not work for another. Bless his over worked heart for trying though.

  34. Stacey says:

    My heart is heavy tonight as I read this article. This physician’s story cuts me to the bone as I too have experienced this overwhelming grief after losing a young patient and having to give the news to loved ones. I’ve never expected the uninitiated to understand or sympathize with what it is that we do. Frankly, no one would believe it unless they have gone through something similar. I chose the field of medicine and then surgery because I wanted to do something extraordinary, something that would make the world a better place. Most physicians start here, without the pull of family obligations and the awareness of what will really be asked of them. Two decades later I have left a lucrative position in academic surgery because the bad days far outnumbered the good. I am irrevocably in debt and have lost eight years of my life during which time I have neglected my family and ignored my own health. The sacrifice that is required to train, work, and excel in this profession is something that can only be likened to a six year-long boot camp. Of course, there are moments of incredible satisfaction in which you manage to save a life or relieve suffering. Simple moments when someone says thank you or “that wasn’t as bad as I thought it would be.” But the moments you remember, the ones that keep you up at night, are the ones where you look for the biggest, strongest resident to accompany you to the family room to inform the family that their 18 year-old son/brother/boyfriend has suffered a gunshot wound to the chest and despite your best efforts could not be saved. And you look around for the nearest exit in case their anger is channeled into you. And suddenly you notice the boy’s blood on your shoes and you’re mortified that you didn’t notice sooner. You couldn’t save him. You should have done more. And you quickly make your escape back to the trauma bay as the pager screams again.

    My last night of call I received a 22 year-old woman from a high-speed motor vehicle crash. She was awake but unstable so we went directly to the OR. I spoke briefly with her mother who seemed to feel that things were not in her favor. After 3 hours in the OR flogging this poor, unsurvivable young woman, determined not to call it, performing what some would no doubt consider “heroic” maneuvers on her obliterated liver, I finally pronounced her dead. Heading out to the waiting room, I was already fighting back the tears. I was exhausted, stretched so thin emotionally by the incessant 90 hour weeks and the absence from my own family. I knelt down in front of that mother and told her that I couldn’t save her daughter and that she was dead. The lack of surprise in her face was like a punch to my diaphragm. She knew her daughter would not make it. The look of grief and resignation in her eyes literally broke my heart. I walked out of that waiting room in silent sobs, unable to catch my breath. But a man caught my attention, the friend of another patient who had been shot in the leg and was in the OR with another surgeon. I’m sure he had no idea what other tragedies were unfolding in that waiting room, but the callous, matter-of-fact way he asked “hey miss, how’s my friend doing?” almost brought me to my knees. I wiped my face and swallowed hard. “Uh, I’m not sure. He is with another surgeon in the OR, but I can check on him for you.” That was one of the hardest things I’ve ever had to do. Compose myself in the afterglow of such terrible grief and tragedy, to answer a simple, completely unrelated question with composure and grace. And then to return to the OR to oversee the post-mortem care of my young patient and sign all of the obligatory paperwork. Oh, and then of course to begin seeing my patients on the ward and writing the daily notes. It was 5:00am after all, and a new day was beginning.

    This kind of thing goes on every day in a physician’s life. There is no way to expect non-physicians to understand it nor to sympathize with it. But realize that until our system begins to make changes that ease the financial and personal burden of medical training, and views physicians in practice as human beings, good, qualified doctors will leave the practice–whether it be through untimely death or resignation–in ever increasing proportions.

  35. I personally think it is okay for physicians or males to cry. They are human beings just like everyone else. Showing emotions is not a weak thing….its being human. All doctors are not going to cry and it is not always the case. That the doctor in unprofessional or does not have feeling. Everyone react differently to each circumstances different. If crying help the doctor to move along through that day so be it. I also don’t feel that when I doctor cry that showing non professionalism….ijs

  36. Shannon says:

    It’s so good to see that there are doctors with emotions! My sister was recently diagnosed with stage 4 metastatic breast cancer that actually ulcerated out of her breast, the day of her mastectomy, I had the unfortunate opportunity of hearing two surgical residents who were observing her surgery, walking down the hall of the hospital talking about how “f*ing” vascular it was and how he kept cutting deeper and deeper! And saying why did she wait so long and that she already had a brain mass removed! I don’t know how I managed to keep my mouth shut and not turn around and knee them both in the groin is beyond me but to hear that these people who are actually supposed to care about the people they are operating on speaking this way about my sister who they have never met and know nothing about her was so disheartning! So seeing this picture actually puts some faith back in some doctors!

  37. Pamela Wible MD says:

    From Patricia Alcala ~ “I am not surprised at the outcomes of medical practitioners. I was a nurse for years and went back to school to be a Physician Assistant. There is so much abuse handed out in training. At the time I was in school, we still had some 36 hr. shifts. It was difficult. At least at the University that I attended they had a buddy program. All of the first year students were given a third year student to help show us around and be a mentor. The problem was that before we even started our first classes, my mentor committed suicide. She was in her car on her way home still close to the hospital when she stopped at a red light then picked up a gun and shot herself in the head. The person behind her was a physician at the hospital. These things are not that unusual. It’s a sad state of affairs.”

    (comment on http://www.idealmedicalcare.org/blog/physician-suicide-101-secrets-lies-solutions/)

  38. John Schlautman says:

    Great article! My brother is an ER doctor, and I wrote an Ode to him a few years ago:

    He hears heartbeats
    louder than his own
    all day long;

    the only sign of warmth
    in a cold hospital
    and an unforgiving world.

    Where antiseptic smells
    rendezvous with dying bodies,
    he lights a scented candle,

    to spark life into some,
    and tell families of others,
    a candle has burned out.

    His heart beats faster
    as theirs slow,
    and he is helpless.

  39. Michael says:

    I’m currenty in EMT school and love helping people, one of the saddest and yet satisfying compliments I get is “you are always so nice, helpful and you make me feel safe”. Its satisfying because im in emergency medicine because i care and i want to help people, its sad cause so few patients have positive experiences. I get yelled at, spit on, knocked around, but everyday I still love my job. 😉

  40. Relene says:

    Thanks for sharing. 30 March is National Doctor’s Day, I would like to take this opportunity to appreciate my fur kids family doctor.

  41. Heather says:

    As a nursing student, we’re not judged as harshly for crying. We’re actually given some training in death and dying. We hold hands, hug family members, and ease pain. Doctors seem to try and be above it, but I’d love to see them welcome with us.

  42. Kamana says:

    I know its heart wrenching when you do everything you can and still its not enough and loose a life..

  43. Missy says:

    Six years ago, I had to have surgery to remove a very much wanted dead fetus from my uterus. (Insert long medical history of why it was killing me and why I knew I couldn’t have children after that here) I had several nurses and aides check me in and prep me. When they saw what was happening they kept saying, “Awwww! Go eat some chocolate after this, OK?” I know they meant well but being told to get a chocolate bar to somehow balance out after having my baby die was just horrible.

    The anesthesiologist was checking on me after surgery. He took one look at my chart, swore and burst into tears. I never told him how much that meant to me. Having one medical professional acknowledge that I was going through tragedy (and not just having a sort of bad hair day) was somehow comforting.

  44. Janice Bellaire says:

    I’ve been a health care professional for nearly 47 years, employed as a registered medical laboratory technologist in hospital laboratories in OH, MI and now in Maine for 23 years. Since phlebotomy has been a routine part of my employment as a technologist, I’ve experienced many hours of patient contact in the Emergency Dept as well as inpatients and outpatients. Over the years, I have shed many tears for patients and their families, sometimes with the patient/ families, most of the time after I have left the room. I have loved showing kindness and concern for the many patients I have phlebotomized over the decades. It was my empathy that I believe was used by God to lead me into laboratory medicine instead of the continual patient care given by physicians or RNs. I would probably still be shedding tears too frequently if I had become a physician or RN.
    I’m very thankful that I have an outstanding, very kind, empathetic PCP who also was my daughter’s PCP until her death at 42 yrs old 2 years ago. My PCP has remembered our daughter’s birthday, date of death, etc, mentioning it when she has seen me working in the hospital or at a medical appointment with her.
    One of our sons is a paramedic whom I’ve seen shed tears over the loss of rescue patients. He had 2 in one day, one being a child who died from influenza.
    I believe that many more health care providers would shed tears, display their true feelings if they had the training and felt comfortable expressing their sadness/sorrow.
    I pray that more physicians and health care providers will feel comfortable shedding tears over an ill patient or loss of a patient.

  45. Amy says:

    I am a physician and my husband is an ER doctor. He rarely talks about work it is too hard for him emotionally, particularly when children die as we have two young sons of our own. The last time I went to visit him at the ER, a young child had passed away from drowning. I can’t imagine how the doctor working with that family was able to move on with her day and see other patients after such a tragedy. She was crying in the hallway when I walked into the emergency department. All I knew to do was give her a big hug. I am a psychiatrist and it is not rare for me to be brought to tears by stories I hear from my patients. It is an emotionally taxing job, one that does not allow for having a bad day of my own. I take my phone with me everywhere, answering calls, text messages, and emails on vacations and weekends. It eats away at the time I have with my own children but I do it because I care and because of the pure joy that I feel when someone returns with a good report or does something positive they never imagined that they would accomplish. I have an envelope in my office that contains thank you notes and letters from previous clients. I encourage anyone who has had a good experience with their doctor to be proactive in sharing their gratitude. I can’t even begin to express how meaningful moments those joy and positivity are in a career that can be so intensely heartbreaking.

  46. Julian says:

    When my mother died of renal cancer in the 1990s I was holding her hand. After she had died and I informed the duty doctor I went looking for her oncologist on the other side of the hospital. I just wanted to thank him for his care over the previous 6 months. When I told him she had died he burst into tears. He had tried to save her including getting her on a trial for interferon. So I put my arm around his shoulders and comforted him until until he was feeling better, then went home and got on with my own grieving.

    He like many doctors and nurses perform day in day out, battling sometimes against ridiculous odds like punch drunk gambling addicts, hoping that their next patient will be the one they send home. They sacrifice social lives and often their marriages. Many shorten their lives through stress and overwork. They do their work knowing the odds and knowing the damage they do to themselves and their loved ones. I have nothing but admiration for them. They are truly humanity at its best.

  47. Kimberley Bristol says:

    Arnold Palmer Hospital *How everything was so silent & still everything but the tears of the Doctor ,The Staff ,The Beautiful Faces Of her Sisters and Brothers, Mammaw Aunts & Uncle Cousins and of course myself My BAby was gone!! but the tears in the staffs eyes rolling down their cheeks warm me in a way I will never forget It told my heart she was loved and WE did EVERYTHING in our PoWer to keep my Angel here on earth .. I remember even the ambulance driver whom I sat next to from Melbourne to Orlando look down at my hands (I had every finger crossed and prayed how I prayed) when he look down at my hands I noticed he had tears roll from his eyes, It was then i noted my fingers were crossed and my hands together so tight that they were white as snow… I truely needed to see that they werent just doing a job that They Loved My Child with a passion.. Thank You all.. xoz

  48. Tony Filippone says:

    Thanks for your insight and attention to this overwhelming but unappreciated problem all ER Physicians deal with . I ,for one, work in a high volume,high acuity ER. I find myself dealing with this emotional struggle more than I care to admit. However we all deal with the stresses of our job in our own way, the best way we can.
    I can relate with the ER Physician in the photo as I had a unique but comparable experience about a year ago . I wrote about it to Emergency Medicine News in a Letter to the Editor. The way we react impacts people’s lives . The consequences of those decisions impact our lives. The decisions I made on that day still haunt me.
    Some things are beyond our control, but it didn’t change how I felt after it happened. When it does, it may be time to find another profession . I hope this is helpful . Here is the link to the letter to the editor I wrote for EM News.

    http://journals.lww.com/em-news/Fulltext/2014/02000/Letter_to_the_Editor__Why_Do_We_Do_What_We_Do_.20.aspx

    Thanks,
    Tony Filippone DO

  49. Dawn RN says:

    Dear Pamela,
    I have enjoyed following you! Thank you so much for speaking out about how our jobs effect caregivers.
    I just got off the phone with my niece, who is a PA in a major trauma ER. I sent her this video. On her last shift she cared for 3 separate tragic accidents involving death and severe injury of children and parents. She was clearly and understandably upset, stating, “I love my job! How do I do this? I know we care for a small percentage of people & yet I wonder, it could happen to me, or my child! I feel so anxious right now!”
    I talked at length with her about vicarious trauma, how it affects us and how I have learned to process things, learned to take better care of myself, etc.
    I have directed her to your FB page and to Dr. Amit Sood’s online course “Stress-Free Living”, Mayo Clinic Rochester, MN, part of Mayo Clinic’s efforts to help staff care for themselves so they can be more effective with their patients and live better lives.
    Below is a letter I plan to send to my former nurse managers (I retired from a Medical ICU unit in June, 2014 to care for my father). I loved my job & the staff I worked with. I loved my patients and the process/art of healing.
    And as I look back on 41 years of nursing, I still remember acutely, the emotional pain that I experienced in many different situations.
    I see a great need for what you are doing among nurses too.
    When I told my managers that I was sending this letter to them (and why), I offered to let them share it with any nurse or doctor that is struggling (or may be struggling). They had no idea that I too struggled to the point of seeking help.
    You may also share the letter below…anonymously…for my wish is not to call attention to myself but to the problem that exists.
    Best wishes to you! And again, THANK-YOU!!

    I have been an ICU RN for 23 years at a major trauma center. I have seen much tragedy.
    With much effort, I have been able to avoid becoming “hardened”. I have always believed that to be affective with our patients when they are the most vulnerable: experiencing pain, fear of the unknown and their own mortality…compassion and empathy are as important as the drugs and procedures we deliver to affect healing.
    And with help, I finally learned how to take care of me; to develop that delicate balance of ‘letting go’ of my shift while maintaining the responsibility of continuing care for the patient.
    When precepting new nurses I stressed the importance of learning how to remain objective about what we CAN do, with the very best of our ability for our patients…when we are with them and then, when we leave them in the care of the next nurse, to focus on the beauty in life and to take the same tender care of yourself that you would your patient or a much loved friend.
    After too many years of holding it inside, taking my patients home and into my dreams, I realized that I needed help. I sought assistance for this ‘delicate and necessary balance’ with a trauma counselor, who also trains other trauma therapists how to cope and live affectively at home, when helping those who’s lives are falling apart.
    There have been no “labels” placed on me by this excellent counselor. What I have learned and gained in this vulnerable time with him (as ‘helpee’ rather than ‘helper’) has been unmeasurable.
    As part of my desire to remove the unfortunate stigma that still lingers with “seeking help”, I have decided to be open about this with friends and my former colleagues at work…without details and when appropriate.
    Everyone’s ‘story’ is unique but every human being experiences stress and traumatic happenings with the same catecholamine response.
    Thank you for posting and bringing this much needed subject to public awareness.
    Vicarious Traumatic Stress is very real…with the added stress of medical school and the huge responsibility of caring for very ill patients adding to it’s affects on practitioners, (including other caregivers who are with their patients and their families 8-12 hours of each day.) What we see and experience with our patients can effect us on a deep emotional and physical level.
    As a “caring” profession, we need to watch out for each other, for ourselves and CARE.
    Thank you again for speaking out on this. You have given me the courage to do the same!
    Dawn RN

  50. Greall says:

    People like to think that we have no feelings but we’re human like they are. Each TOD is a loss of a life: a loss of a father,a mother,a son,a daughter,a friend.
    I have cried silently.I can’t help it sometimes.

  51. Lisa Peabody says:

    i do not respond to these because after so many years I feel most dr.s lie lately because the government does not want to care for it’s people. In Florida they did a few legitimate raids on pain management dr?’s and now they have such strict laws it just adds one more stress to a already horrid life. There is a Hugh difference between living a life you can look forward to getting up to each day and one that is just short of mere existence. Where you can’t pretend to smile one more time or say your doing fine when it’s lie to yourself and everyone around you. And if it wasn’t for a shrink looking over my x-Rays and MRI’s and dr’s notes I would not have been referred to a pain specialist and would most likely not be among the living now. But the laws and fearful doctors have put me in a horrible existence once again. My body has been use to the same dosage for several years now and to ask for a very small increase I am turned down after I have followed all the rules asked of me I’m being given a choice to have my nerves in my spine killed when I made it very clear I am terrified of operations or find another doctor to maintain economic my pain like it is nothing that I live through each and every day if it was not for my devout faith in God I would have taken my own life years ago and the way things are going now I feel each day is a curse and a blessing that I did not give up for another24 hours. Pain has robbed me of my youth from 32 to 56 so many lost dreams and hope of a better tomorrow now arthritis has set in on both my knees hands left shoulder and complete thoracic area I don’t even cry any more. Thank you for listening I just refuse to take the mark of the beast in order to get what little pain relief I am getting now when the world turns into a one ruler world I pray God takes my life before I have to make that decision death may be a breath of fresh air from where I stand at this point in my life. Other countries do not find in mentally insane or wrong to relieve them selves from hell on earth but the USA has its laws except for two states I believe. But that is still not my deep hearted wish. Well once again thank you for your time Lisa

  52. Kristina says:

    I have seen the coldness and callousness of doctors many times. My father, who would have been 55 years old this year in September, died last year, February 23rd. He was hurting badly, then extremely, but was still working 40 plus hours a week at his hard job, welding, etc. He kept on and kept on seeing his family physician, and that physician kept on and kept on sending him referral after referral to a variety of other physicians. I took him to various Emergency Rooms, time and time again, and they would give him pain meds and send him away. One Emergency Room even had the audacity yo turn him away completely, saying he was simply ‘seeking pain medicine’ which infuriated me to no end. Finally, after a year of increasing pain, he was hunched over, could barely eat, couldn’t go to work (which I have no earthly idea how he did for over a year in the immense pain he was in), so me and my sister drove him to YET ANOTHER Emergency Room and I stated VERY loudly and clearly that they were not going to send my Father home yet again and do nothing, just like all the other physicians, including his ‘family’ one. So, they kept him, ran tests, and found out he had cancer that had started in his liver and by now had spread to his other organs and bones (hence, the immense pain he was in for SO LONG!) They simply said there was nothing they could/would do except send him home with hospice to die. He stayed for a week in the hospital and they sent him home and hospice pumped him so full of pain meds, he was incoherent and unable to speak or even walk. He wouldn’t/couldn’t eat and they wouldn’t put in a feeding tube, so we watched him slowly wither away. After being diagnosed, staying in the hospital a week, and then being sent home (with hospice ‘care’), he took his last breath in front of his family and passed away. I am infuriated that the whole medical system so blatantly FAILED my Father and my family. The physicians, medical staff, and of course, hospice, treated him like he was nothing. My Daddy was only 54 years old & worked right up until he could not even move. He busted his a** because he was worried about taking care of me (I was in my third semester of the RN program no less, when I was diagnosed with Dystonia and since I never had a job, plus two kids and a divorce from a sorry SOB who isn’t made to pay child support, you can imagine how we get by on $650/month in SSI) and he said he had to pay out a ton of money because of his poor insurance, and had bills coming in left and right from all the physicians he was being referred to, plus his ‘family doctor.’ He was gone a year February 23, 2015 and I’m still infuriated with the Healthcare system… it’s a joke. And to this day, his family doctor won’t release his medical records to us. Things HAVE to change. I feel they are responsible for the death of my Father – that they could’ve and should’ve done MORE. It is a travesty the way patients are treated by doctors, medical staff, the system, etc. I only wish my Father had a compassionate, caring physician when he needed one most.

  53. This really does make you think, we always see that straight professionalism from our doctors, something we almost take as a given, so to see this side of things is very interesting and thought provoking.

  54. Victoria says:

    I just want to say thank all doctors for everything they do. I couldn’t respect them more if I wanted to, which is why I’m studying to get into the field. They’re definitely an amazing group of people. Thank you all very much.

  55. Margaret Alice Lieux says:

    Copy and send Caroline.

  56. Patti Aldridge says:

    I am a pediatric intensivist. I have always cried when I lose a patient; I worry more when I don’t although eventually it comes. I think I was considered emotional when I was in training but am blessed to have a wonderful group of partners and interdisciplinary PICU staff who acknowledge and share in the pain. Even with that, the weight of what we do (among other things) is steering me towards early retirement. Admittedly, pediatrics is a different group of people; it is abominable that all medical specialties cannot recognize the personal side of being a healthcare provider. The public definitely doesn’t get it; hopefully things like this on Facebook will start a trend towards some compassion for our profession. KUDOS to the physician that allowed himself to be seen as a vulnerable, real person.

    • Pamela Wible MD says:

      Thank you Patti. Totally agree and you have inspired me to write a follow-up piece on this blog. Look for it in the next few days. Please don’t retire early. We need you—and your tears. <3

  57. sunshine says:

    I cried reading this. I’m broke and broken and uninsured and have met ever CYA Schadenfreude riddled ER calloused doctor in Miami. Isn’t a drug seeker. I was poor and sick and had no where else to go. No one wants to treat you or respect you or look at you if you do not have insurance, Too many ER visits and you’re just crazy or a drug seeker. I am neither. I have been to the ER twice because my propranolol was not re-ordered, once for an infected toe (which after a script for an $80 anti-fungal and I wound up cutting off the toe nail with box cutters and pliers and using Oragel and caffeine to ebb the bleeding, and and old tube of antibiotic topical; all done in my bath tub, because no MD would help me) once for nausea vomiting due to gastritis, once because my heart angina, but other times YES I was in pain due to undiagnosed (all in my head) back pain which turned out to be a herniated disc and chronic kidney disease and liver issues from years when I did have insurance and doctors tacked on one pill after the other not caring if I lived or died. Now I learned I have found I have been suffering with CLL,(chronic Leukemia which no doctor would admit to until I was put in a psyche ward and if I died there no one would care, I screamed for help and the orderlies just laughed) for 4 years and been self treating with natropathic medicine like hawthorn berry for my heart and blood to prevent platelet aggregation and DIC. The doctors treating me had so much hate for me because I just couldn’t work anymore. Doctors are exploiting people and telling them this or that is good for them and if I had taken all that they gave me in pills I would be dead via doctors orders and apathetic negligence. One doctor acted like a human being. Just one, and I cried just imagining the compassion and could only say ‘thank you” because of the horror the rest of the doctors I’ve met had become. the nurses and techs are no different. I hate each one of those who look on anyone without mercy.

  58. seabird says:

    Currently I’m seeing an orthopedic for a few old domestic abuse injuries. He hasn’t commented on the abuse and yet I don’t expect him too . I’m nervous around doctors because a few have judged and blamed me with regards to past abuse. I could be wrong but I sense he’s trying to show support or reassurance in non verbal ways?

    Sitting on the exam bed next to me maybe three feet away examining my limb. Sometimes gives me a quick light pat/tap to the back of my shoulder with his fingertips. Last time he moved my joint during a exam, sitting on the bed beside me. I winced because of the pain. He said ” You didn’t like that.” I fell silent, didn’t look at him. A minute later quick tap/pat and soft very brief caress to the back of my shoulder. When he does discuss treatment he normally stands or sits normal to long distance away from me. He did comment at my first consult I looked tense.I don’t think I answered him.

  59. Lisa Webb says:

    I commend this doctor because he has true feelings! Being a nurse i understand how he feels. I see children die from illness and cancer and it is heart wrenching. We have to stay strong for the family as they grieve. Have some compassion for your healthcare workers because we need it!!

  60. Gary Levin says:

    The major stressor for myself in medicine was to know how to treat the patient, but the patient was not insured, or his plan did not cover the treatment, and the hours taken away from patient care to do meaningless paperwork for insurers, medicare, constant useless requirement and expensive continuing medical education (that had to paid for)

  61. Jacinta Royall says:

    I just came upon this article as I was searching for a piece of prose in relation to a patients demise and how they so very often reveal their deepest fears and dark secrets that have been festering in the recesses of their psyche for decades .
    I am an ex hospice nurse and cried often with my colleagues over the years .
    We always said …..When you don’t cry anymore ,it’s time to discontinue .
    We were each other’s counsellors and so very very much more ,at such emotionally incredibly distressing times .
    All medical staff ,who work on such intense levels with humanity must have the best and consistent psychological assistance to maintain high standards of care for themselves and their patients .Sadly this appears to be too much to ask for .
    God willing this will change in the future .!

  62. Dr. Wible is right, as always. Doctors are people, too. And, patients forget. I think the reality of medical institutions are that there is a general pretense that is expected to be upheld on both the part of the doctor, and of the patient. Unfortunately, there begins the divide. I wish my doctors and I could both let our guards down, and be 100% real with one another. As a chronically ill, chronically pained patient, I’ve survived years of abuse and stigmatization from doctors, and I am an empathetic person. I actually have seen a doctor cry. I have hugged my doctors (many times), but most just want no part of that. I want to see us ALL be expressive.

  63. ken rothman says:

    This change to the injunction against crying is most highly important to creating a culture that honors and supports healthy doctors and doctoring!!!

  64. Kathryn Cascio says:

    I love all of my doctor’s. I have many unfortunately. I have noticed that many of my Dr’s who work in a huge teaching hospital are very uncomfortable with me when I cry or express sadness about my condition. I had a Dr who showed me such compassion in his office one day, just by putting his hand on my shoulder when I was crying. He moved away but we still keep in touch. I can’t even imagine what Dr’s see and feel. They should be supported always and allowed to be human like the patients they serve. Everyone would reap the benefits.

    • Pamela Wible MD says:

      These huge teaching hospitals should teach doctors that it is okay to cry. Grieving rooms for staff are needed in every hospital.

      • Mari says:

        Teaching hospitals? You think it is alright to use the patient, already suffering, in pain, confused about what is happening to them, to act as a teaching tool? If you really believe that then you deserve everything you get. You care NOTHING for the patient. Your sympathy lies strictly with your peers. If I still believed in god I would ask him to forgive you, but there is no god there are only people pretending to be gods.

        • Pamela Wible MD says:

          We entered medicine as idealistic humanitarians just wanting to help people. We never signed up to be abused or to abuse others. This is a cycle of abuse and needs to be discussed openly. Victims become victimizers and the cycle continues otherwise.

  65. Tammy says:

    August 30, 2008. My son-in-law was accidentally shot in the side with a 22 rifle. The bullet ricocheted around his abdomen ripping everything to shreds. At the time we were in a podunk town of only 12,500. At the hospital two doctors and four nurses tried operating for 8 hours to save this 22 year olds life, as we sat in the waiting room getting up dates every hour. When the 8 hours was up, the head ER nurse came out and said they were life lighting him to our town 15 minutes away by helicopter, but that he probably would not make it, he had lost to much blood because of the bullet shredding his insides he had bleed out. When life lite got there we all were there to say something to him as he was wheeled out. When we turned to go to our cars to race to our town, both doctors and the four nurses were there crying just like we were. They said they wished they could have done more and that they all would be praying for him and us. An hour later I had to take my son-in-law off of life support. The fact that we saw these doctors and nurses being just as human as we were meant the world to all of us. We all remained in touch with each other over the years. The good thing that came out of it was that in the next four years it took all of us down at one time or another, and because we stayed in touch we were able to help each other through those dark times , because, we lived it together we all understood the others feelings. If this had not been the case two of the nurses and one of the doctors would have committed suicide as well as a few of us. We all shared this tragic bond and because of that we were able to help each other through the darkest time of our lives. My point is crying and compassion by a medical professional can be a good thing for all involved. There has never been any blame just love and light through the darkness.

  66. “MY PRIMARY CARE DOCTOR IS A TENDER, LOVING, CARING, COMPASSIONATE, AND VERY EMPATHETIC INDIVIDUAL, AND WILL GIVE YOU A HUG, AND WILL NOT SHY AWAY WHEN YOU ARE JUST SO HLAD TO SEE HER AND WANT A HUG.”

    “SHE IS VERY ENCOURAGING, AND SEEING MY GOD GIVEN STRENGTH ENCOURAGED HER.”

    “NOT ONLY MYSELF, BUT ALL OF HER PATIENTS LOVE HER, FOR GOD HAS GIVEN HER THE GIFT OF BEING A MEDICAL DOCTOR.”

    “HER NAME IS DR.V, AS WE LOVINGLY CALL HER.”

  67. Mari says:

    Doctors fight for and ratify the contracts that bind them to this way of life. They are the ones who decided it was alright to have poorly trained people looking after the vulnerable, not the public. I do have empathy for many who were too naive to recognize what the trade-off meant, but you are the ones maintaining the status quo. You permit patients to be learning tools, nurse practitioners, orderlies giving shots, etc. I am not surprised at this result. But do not expect me to linger long on thoughts of suicidal doctors. How many patients die needlessly everyday because the doctor chose not to believe the patient? How many patients have lost everything because some white-jacketed businessman/woman decides that their clinics reputation, and the doctors in it are more important than the life that is in their hands….sorry. Too many in my family are dead because of deception on the part of so-called doctors. I myself have just been informed that the nystagmus I periodically suffer from is fake. I have never faked anything, ever, and am not about to start now. Grief is a terrible thing…but when death and loss are needless…it never goes away.

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