How Do Doctors Deal with Emotions? The Life Beneath the White Coat

One cloudy afternoon, Sowmya remained seated after her consultation. A software engineer who had become an artist and writer, she possessed the inconvenient gift of noticing what others missed. She wondered how doctors could listen every day to fear, anger, secrets, needless words and unbearable silences without being affected by them. Where, she wanted to know, did a doctor keep all that sorrow? It was an excellent question. Medical college had taught me where the pancreas was located, but not where a physician should store grief.

A clinic can contain an entire lifetime between two cups of tea. One patient announces a pregnancy; another learns that the disease has returned. A wife reveals that her husband has not spoken kindly to her in twelve years. An elderly man discusses his bowels with the seriousness of a finance minister presenting the Union Budget. The doctor must enter each world sincerely, understand its private weather and leave quickly enough to open the door for the next one.

People imagine that repeated exposure makes doctors emotionless. It does not. It makes us skilled at postponing emotion. A doctor may tell a family that nothing more can be done, answer the same desperate question in four different ways, steady a trembling shoulder and then walk into the next room, where someone wants to know whether mangoes increase cholesterol. Medicine permits very little interval between tragedy and triglycerides. The heart has not recovered; the appointment schedule has simply moved on.

I learnt this through an elderly patient whose name I still remember but will not mention. He had a mischievous smile and the rare courtesy of treating everyone, from the senior doctor to the cleaning woman, with equal respect. Illness gradually took away his appetite, strength and finally much of his speech. During one of his last visits, he held my hand longer than usual and quietly assured me that I had done enough. Doctors are trained to reassure patients. Nobody prepares us for the moment when a patient reassures the doctor.

A few weeks later, his son telephoned to say that he had died peacefully. Several patients were waiting. I expressed my condolences, placed the phone face down and called the next name. A woman entered seeking treatment for sleeplessness. I listened, examined her, wrote the prescription and explained the medicines. Outwardly, the consultation was complete. Inwardly, another conversation had not ended. That evening, someone at home asked whether I wanted dosa or chapati. I chose dosa. This is how doctors often return from the edge of suffering, not through grand philosophy, but through dinner.

Some patients remain within us for years. We forget their haemoglobin, scan findings and blood pressure, yet remember the cracked strap of a slipper beneath the chair. We remember a daughter folding her father’s spectacles after his death, a mother wondering whether her unconscious son could still hear her, and a relative thanking everybody too politely because grief had not yet found its voice. Medicine preserves records in files. The doctor’s mind keeps an entirely different case sheet.

Research calls some of this professional grief, but the phrase is almost too tidy for the experience. A doctor’s grief has no funeral, no condolence visitors and often no permission to exist. The family has lost someone; the physician feels almost guilty for mourning. So the death certificate is signed, the notes are completed, the hands are washed, and work continues. The hands become clean. The memory does not.

Doctors survive by developing boundaries, but a boundary is not a wall. A wall keeps suffering out; a boundary allows us to approach it without drowning. Too little distance and every patient follows the doctor home. Too much distance and the doctor remains in the consulting room while his humanity waits outside. The difficult art of medicine lies in caring enough to understand another person’s pain without making that pain entirely one’s own.

Humour helps, although hospital humour can sound alarming to those who do not live around illness. It is rarely contempt for suffering. More often, it is oxygen in a room where everyone has been holding their breath. After hours of fear, one ridiculous remark in the duty room can allow a doctor to return to the ward with steadier hands. Humour does not make suffering less serious. Sometimes it prevents seriousness from crushing the people trying to relieve it.

Doctors also turn to colleagues because only another doctor fully understands the private trial hidden inside one question: Did I miss something? A difficult case may be reviewed ten times and every decision found reasonable, yet the mind continues its midnight cross-examination. Experience makes that accusing voice quieter, but never silences it completely. Perhaps that is fortunate. A doctor without self-doubt can be more dangerous than a doctor with too much of it.

And yes, doctors cry. Not always beside the patient or in front of the family. Sometimes it happens in a washroom, a parked car or beneath a shower where water provides excellent confidentiality. Occasionally, tears arrive months later, summoned by a familiar name, an old song or an empty chair. Emotion does not respect chronology. What the doctor successfully postponed at noon may return without warning at midnight.

Burnout begins when postponement becomes permanent. It does not always arrive as dramatic collapse. It may appear as irritation with innocent questions, consultations completed too quickly, humour turning cruel, or a morning dread of people once felt privileged to treat. The doctor continues working, the prescriptions remain correct, and the clinic stays crowded, but something warm has quietly disappeared from the work. Strength, when demanded every day, can become a beautifully decorated prison.

Walking, prayer, music, writing, friendship, family and professional counselling are therefore not ornamental acts of self-care. They prevent accumulated sorrow from hardening into indifference. The finest doctors I have known were neither detached nor emotionally flooded. They could remain moved without becoming paralysed. They understood that curing, comforting and accompanying are three different forms of medicine. When cure was no longer possible, they did not mistake presence for failure.

I finally told Sowmya that doctors do not successfully manage every emotion. Some emotions are understood, some shared, some postponed, and a few quietly become part of the physician. That evening, after the last patient had gone, one chair remained slightly pulled away from my table. During the day, an anxious mother had sat there, then a widower, then a young man frightened by a report. Each had arrived carrying something invisible and left a little of it behind. I switched off the light and remembered Sowmya’s question. For years, I had believed that doctors carried their patients. Standing in the darkened clinic, I understood the other half of the truth: on certain difficult days, without ever knowing it, our patients carry us too.