There's Nothing More I Can Do
This statement, when mindlessly used by a doctor to attack a patient's heart and soul, is always, without any exceptions, a lie, and depending on the intention of the utterer, possibly a crime against humanity.
First of all, what is often really being said is: There is nothing more I CHOOSE to do. If the patient requires skills or tools beyond the capability of the doctor, and the most truthful statement is: There is nothing more I KNOW HOW to do, then there needs to be a caveat or addendum: But I will continue to BE THERE FOR YOU in the ways I KNOW how to help. If the doctor cant say this, then its time for them to go back to some sort of school and learn the skill set they are missing that has to do with commitment. And If the reality is that they have that skill set and are choosing not to use it, that is perhaps the most unforgivable stance and its time for that doctor to take a leave of absence or find a different line of work.
This scene plays itself out a million times a day in a million different ways. The patient has an" incurable disease". The patient needs specialty care.. The patient is wearing a TRUMP 2020 baseball cap or is too personally challenging in any one of a million other ways (How about: The patient is an abuser and the doctor cares for his victim.) The doctor is tired and wants to go home. The doctor doesnt want to run late and just wants out of the exam room. Whatever the reality of the situation is, the truth lies somewhere else, other than in those words.
What IS frequently true: I dont know what is wrong, I am not sure how to help, I don't have enough time to just be with you...and so forth.
What I have learned to be true, when the moment feels difficult, when there is uncertainty, aversion, restlessness, doubt, fear: a few deep breaths to gain a measure of equanimity can open the door to presence. Being fully present with a patient in an often dire or desperate situation where "There's Nothing More I Can Do" presents itself as an option, is the Path to Healing, the polar opposite of the dagger-in -the-heart that uttering this fateful phrase yields.
So, here is how it can go: the doctor feels the urge to utter that cruel phrase, but has the presence of mind not to; the doctor has an internal dialogue about what is really going on: I dont have the time, I have aversion, I dont know what to do, etc. The doctor then takes 3 breaths while he plans his next step. He DOES something to indicate his humanity to the patient and then SAYS something much closer to the truth than the lie that is that god-forsaken phrase, with all the kindness and compassion he can muster. This is when magic can happen.
(originally written 5/30/2019, published unchanged 3/27/20, RD)
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