Difficult Questions

“How do you find the right balance?”

When a medicine intern asked me this question, I must admit that I was not sure what to say.  She was talking about the balance between caring too much and caring too little. 

When you care too much about your patients, you risk distress from bearing the burden of their disease, pain, and eventual deaths.  You may use up your emotional reserves and become burned out.  As with any strong relationship, you risk getting hurt.

When you care too little, you fail to provide people with the comfort and support that are part of the healing process.  You may also feel unfulfilled, unable to truly engage with your work.  You protect yourself, but risk becoming hardened or cynical.

Both extremes are problematic, but how do you find the middle?  In medicine, we are used to quantifying variables.  Every lab value has a normal range.  It is relatively straightforward to tell when an electrolyte level is too high or too low, run through possible explanations, and provide treatment to correct it.  When a normal range cannot be measured, we feel distinctly uncomfortable. 

The appropriate balance of caring is subjective and dependent on the circumstances.  It is also a challenge that is never solved.  We can continue to reflect on it long after our formal medical training is complete. 

I let the intern know that I am still working on this balance myself.  My tendency is to err on the side of caring too much.  I am willing to take the risk of distress, if it means that my patient gets the benefit of feeling cared for.  But in order for this approach to be sustainable, I have to make sure that I also have the means to decompress and recharge.  I have to be ready to be emotionally available for the next patient as well.