Tag Archives: physician

Witness to suffering

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As a doctor, a lot of the care that I provide has nothing to do with prescribing medications or performing procedures. Sure, they form a significant part of my training and my day to day work. However, there are also many times where all I can provide for the patients is my presence, to be a witness to their suffering and to create space for them to grieve and mourn.

This was a huge revelation to me in the earlier stages of training – recognizing that there are many things we can’t just “fix” in medicine, and that care doesn’t end with telling a patient “I am sorry, there is nothing we can do”. I never realized how difficult it is to be truly present to witness someone’s suffering until I had to do it myself. It is so easy to give into the temptation to comfort, or to give false hope or even mislead. At the beginning, I told myself that it is because I care deeply about the patients, and it was difficult for me to watch them suffer. However, the more I did this, the more I realized I was NOT helping these patients by quickly wrapping up their suffering in a neat package to replace it with something prettier – I could see how this made them feel confused and lost. Why then, was it so hard for me to change my behavior?

Problem solving engages the prefrontal cortex of our brain – the part that allows us to reason, filter and regulate our emotions. Being forced to turn away from problem solving therefore leaves us feeling exposed, out of control and yes – vulnerable. However, in turning away from problem solving, we can truly be present and focus entirely on the suffering of the individual in front of us. In psychiatry, this is called “holding space”. Having the space to grieve without feeling pressured to go into problem solving mode can be a deeply therapeutic experience that allows one to just “be” and not be judged.

Think about our daily lives – how often do we simply listen to our friends, family or significant others and be fully present to witness their experiences? As children, how many of us had the luxury of this experience when we tried to share difficult experiences with our parents?

I tried to imagine what it would feel like to have someone fully present to witness my suffering, to have an understanding of how this could help my patients. My mind shifted to when I pray or meditate at my altar. Sometimes, I am looking for answers – but more often than not, what I desire is to have the time to sit in my grief and to let it all out, and to have someone sit WITH me in my grief. The sheer presence of my goddesses and spirit guides had always comforted me in my darkest times, and this is what I could do for my patients when there is nothing else I could offer as a doctor. Simply being present in their suffering was a service I could provide in those dark moments.

Now, when I deliver bad news, I sit with them, quietly, with a tissue box in my hand. I stay present with their grief, and in doing so I hold space for them to process their suffering.

It is true that this is much harder with family and close friends – those who we consider part of ourselves and can make us feel particularly vulnerable when they share their suffering. Practice makes perfect and I am still working on it.

Sitting with your feelings

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I was reading “Maybe you should talk to someone” by the brilliant Lori Gottlieb this morning just before work, my little morning ritual, when one message really struck me: it is horribly difficult to sit with one’s own feelings, even for psychotherapists. I am no psychotherapist, but as a doctor, I always ask patients to reflect on their actions, thoughts, and feelings, and encourage them to do mindfulness exercises where they try to notice their thoughts and body without judgement.

The practice of witchcraft also asks one to recognize their thoughts and feelings, so that they can be used to enhance one’s craft and power. An aware witch is a powerful witch – she who rules herself can rule the world.

Why then, is it SO HARD for me, to sit with my feelings? I spend most of my days reading, watching TV, scanning through Youtube, or scrolling through my phone when I am not working in a desperate effort to distance myself from my emotions. In a way, working is almost an escape, because focusing my attention entirely to my patients shifts me away from thinking about myself.

A common concept discussed in psychodynamic theory and in family therapy is that a child who grows up learning that their feelings are invalid, internalize this and grow up to be adults who cannot tolerate their own emotions. The act of noticing and acknowledging their internal processes become associated with deep shame, rejection, and feelings of being misunderstood such that they learn to cope with this by becoming avoidant, not just of their own emotions but of that of others as well.

The difficult part of this is that our thoughts and emotions influence our judgement and worldview whether we acknowledge them or not. Being able to sit with, notice, and acknowledge our internal processes help us realize why we see ourselves, others, and the world the way we do, and lovingly readjust if there are biases at play.

This of course, doesn’t come easily at all. I realized my own tendency to avoid my feelings when a supervisor pointed out how I tend to get flustered if I don’t know something I think a patient wants of me, and how I would completely shift my behavior without even noticing that I am doing this. My supervisor asked me to sit and slow down, and notice the thoughts that arise in my head when this happens. This was an EXTREMELY difficult exercise – at the end, I identified a DEEP SENSE OF SHAME that arose when I felt that I wasn’t giving the patient what she/he wanted. Because this emotion was so difficult to tolerate, I avoided it completely, not even giving myself a second to think about it – unfortunately, this did not stop shame from influencing my behavior. Once I did notice the thought, also called “hot thought” in cognitive behavioral therapy, which in my case was “I am a failure”, I was able to lovingly tell myself: it’s okay to not know everything, you are doing the best you can. In slowing myself down and lovingly readjusting myself, I was able to be more present and authentic with my patients, which in turn made them happier.

When practicing magick, we ourselves form as much of the spell as the ingredients, incantations, and the spiritual forces that we summon to help us. When dark thoughts reside behind the spells that we cast without our knowledge, these thoughts can cause the spell to be weakened or even backfire. See the parallel here?

I still find sitting with my emotions extremely challenging, but I consider it an important part of my journey as a physician and a witch to become more self aware. I will be sure to keep you updated on that journey – wish me luck!