Why I Keep Writing

[Commentary by Dheeraj Raina: This post is published under Uzma’s byline because it’s a previously unpublished post of hers. To read my approach to her unpublished work, read this. I know Uzma wanted to write a longer post about this. She was unable to complete putting many thoughts on paper because of the unpredictable ways in which cancer and its treatment interrupted life repeatedly. She started writing for herself. Over time, she heard how much her writing helped others. After learning that she never could ignore the obligation to write for the sake of others. That’s why she felt a great emotional need to complete her book before death came.]

From my inbox :

“Hi Uzma–

I want to introduce myself as a fellow warrior. I’m a physician and saw your blog thanks to a Facebook group yesterday. I read your Carpe Diem/Crappy Diem post and I have had the exact same musings. I am (age) yrs old and was diagnosed with stage 4 breast cancer last May. Initially, I was quite ill (liver mets). I have been back to work since September (was still in my initial chemo at the time) and am back in treatment (now near weekly chemo because things got worse in January). I’m feeling pretty great, all things considered. I have a husband and a young child.

Anyway, I wanted to say hello, and to let you know that I’m here working, alongside you and fighting. And actually, I’m fighting back tears after reading your blog posts, which contain many things I have thought about for the past year. Thanks for writing and making me feel not so alone as a doc and mom.”

We became friends. She is currently in hospice and the inevitable is looming and as I grieve I hold on to her words.

A Note About Uzma’s Previously Unpublished Posts And Select FB Posts

Uzma was an astute observer of human emotions and behavior — her own and others’. Between her diagnosis of breast cancer in 2013 and her death in 2019, Uzma wrote prolifically. Her writing was incisive, irrespective of whether she was writing to inform, persuade, amuse, or vent. She found the words to express what many of us could not. She shone a light on feelings that, but for those apt words and her willingness to say it as it is, would have remained hidden and unexamined.

As I am going through things she left us, I find writings that are clearly drafts that she meant to publish after working on them. They are in various stages of completion. I will post on this blog, under her byline, those drafts that are complete enough to hold their own. I may add commentary or other notes and adjust formatting for the sake of clarity and more comfortable reading. But I will not otherwise edit her words. I didn’t edit her words when she was alive and won’t do it when she is gone. If you do add words in the main body of her unpublished work, I will indicate clearly which words are mine.

Sometimes I come across her posts in Facebook Memories that can stand on their own as full post — some are short, and some are long. I will plan some of those selected writings into posts on this blog to have a redundant mechanism of keeping them and also so that they are easier to find than Facebook Memories. When I do this, I will make the title for the post as most of her posts on Facebook, like most of the rest of ours, don’t have titles. I will indicate the original date of the Facebook post when I add it to Uzma’s blog. I realize that many of the Facebook-to-blog posts won’t be about breast cancer, but I think you, her readers, will be okay with that.

A doctor’s take on the photo of the grieving doctor going viral

The grainy photograph of an ER physician hunched over in grief after losing a 19 year old patient is going viral.

Although some may argue that it is voyeurism of a very private moment of grief, I feel a sense of relief about this opened window. I am a doctor. I understand this precise moment. I know the exact feeling of loss, when the heart rate of the patient starts to drop and despite heroic efforts, life starts to slip out of your sterile, gloved hands. As the beeping monitor records the decline, your own heart sinks gradually with it. Your mind knows but the heart makes you push once more. But its futile and you know what is to follow. You have seen it before, it’s your occupational hazard— dealing with death and accompanying grief.

One would think that being repeatedly exposed to death would make a person more resilient or habituated to such an outcome, but it stabs the heart every time. No death is identical. Each patient has an individual connection with us, humans, dressed up in our white coats. Death is never business as usual.

Yes, we, doctors have feelings too. We try hard to deny it, mask it, shelf it and hide it. But they reside abundantly within us, lurking underneath the cover of  “I have everything under control,” “Trust me, I know how to do this,” ” I will be there for you,” “I wish to help you heal.” We fall in love with the new born babies we deliver. We admire the feisty 75 year old widow who is vigilant about her health. We celebrate our patient’s remission from cancer, and we feel pride in our patients’ improved cholesterol. We do it all. Just privately, on our own, most of the time secretly.

We grieve too, we grieve it all. Loss of lives, limbs, functionality, mental sharpness, independence with our patients.
We feel emotionally exhausted at the end of a busy clinic. For, we put our needs aside, block our affect and open ourselves to our patient and give them a piece of ourselves.

We go beyond protocols to add the human touch, we stay a little longer than needed, we hear more than the time allows, we call the pharmacy after hours if needed, we may show up our day off just to make sure things are taken care of, we eat the dry meatloaf from the hospital cafe on Christmas, take a phone call on vacation and sometimes, check our emails when away because we feel…we feel for you and we truly care for you. Sometimes, our ride home is our catharsis where we cry as we leave the hospital, having tucked away all the patients for the day.

We agonize over reports that show worsening of disease. We hate to deliver bad news. We do it, but it punches a hole in our own soul every time. We try not to panic, we are expected to be calm, we are expected to have nerves of steel in crisis, to run the code, to do the emergency tracheostomy, to do that urgent operation. But nervousness and anxiety aren’t unknown to us.

We may not say to you how sad we are when you miscarried, we may not disclose how shaken up we were when you slit your wrist in depression, we may never tell you how afraid we were, when your blood pressure dropped precipitously in the ICU, but we went through those feeling. We felt those jolts of emotions, rising and receding.

But we keep moving swiftly, from one room to another, from one loss seamlessly to another victory while we try and make sense of our feelings. Our training teaches us to modulate our feeling, gradually learning how to deny fatigue and sleep the acknowledgement they deserve, to hide our tears and to tone down our laughter. The bedside manners are considerate combination of empathy, compassion and subdued feelings. Medical training comes with the process of keeping emotions out of the exam room. The notion that we should not let our feeling effect our work comes early. Feelings cause conflict and ambivalence, feelings may make medical care precarious. We are asked to be strong. We prefer not to know what they did, when treating prisoners, for we don’t want negative feelings burrowing in our hearts. We avoid getting too attached to the terminally ill, but fail at it miserably. We try and justify our attachment to patients as if it were illegal, “But she is so sweet.” We suffer for every patient, it just isn’t visible.

You may never know how a small thank you note that you sent made our day after seeing two very young families who have kids with cancer, you may never know how we teared up when you left a handmade afghan for our newborn baby. You may never hear about us saving these notes in our drawers to offer us solace when we confront death or saying a quick prayer for our patients. Many of you characterize us as angels, while we struggle to even be human. Perhaps being an angel gives us freedom to not feel. May be, we are your angels. We try and comfort you. We try to heal you. But inside we are humans, very inadequate, very vulnerable, very much like you.

We beat ourselves up when we make a mistake. We go over it again and again. We stay up at night. Sometimes ,in the middle of the night when we wake up, a patient may pop into our heads, someone gravely ill or immensely kind. We write prescription for a sleep aid for you as we chug down coffee to offset the lack of sleep caused from being on call.
We learn how to separate our life and intra-psychic world from the care of the patient. We, however, aren’t never successful. Put a few doctors in a social setting and the conversation will inevitably transition to patient care. Just ask the spouse or partner of a doctor, how many times they have seen their partner sob for a patient? How many times they have heard “I can’t sleep because Mrs. Brown is in the ICU”? How many times they have had dinner with us while we are preoccupied with a patient issue, how many Friday nights we came late for the party?

The pain and worry that we go through is as real as the compassion for our profession. We aren’t provided counseling for grief for losing patients. We may on occasion wander in the office of the hospital chaplain or find a colleague in the hallway to share this agony, but most of the time the clock keeps ticking and the rooms kept getting filled with the next patient.

We transition from disclosing grim prognosis to revealing a positive pregnancy test. It’s a bipolar range of affect that we navigate every day and day after day. But then, every so often there is a death. The one that is more gut wrenching than the others, that feels like a punch in the stomach and we double over, we may cry loudly just to get it out, because if we keep it in the patient in the next room won’t get what they need – a whole, compassionate nurturing doctor. And we owe it to them.

So we, like my colleague grieving outside the ER, find that moment to let it go, be human for a little while, embrace being vulnerable, and take a deep breath before opening another chart, another life, another kind of emotion.