Be forgiving, be understanding, be respectful. Be kind to yourself. It’s hard to be kind and forgiving and understanding and respectful to others if you don’t practice first. Start with yourself! Trust me, you’re a perfect test subject – and you’re always right there, so easy to find.

Be kind. Others may not, but you know what? If they see you being kind to yourself, then maybe they’ll do the same. And kindness will spread, its roots will grow deep, and soon you’ll stand in a field of it.

Kindness. Such a beautiful flower.

Here’s another thing that comes up quite often: what do we do with our own emotions? Is it ok for us to cry with our patients? What if we get “too close?”

We all have feelings, we all have emotions, it seems a little strange typing it. Our white coats aren’t shields: things get through, heavy things and sharp things and things that stick with us for the rest of our lives.

I imagined it a relic of olden-times medical education, the concept that emotions make us less objective and affect our decision making, but I still hear it with concerning regularity. As if having emotions is somehow bad, or makes us worse doctors.

It doesn’t. Being able to connect with your patients emotionally is important, medicine is about coming up with a plan that aligns with your patients’ goals and values and you can’t do that without exploring the emotions that drive them. It doesn’t mean you have to feel what your patients feel, that’s where this thing called empathy comes into play.

But if you do feel something more, that’s ok. We’re all human. It’s ok to cry with your patients, to feel sad or overwhelmed. It’s ok to laugh with your patients, to give them a hug (pre-COVID?), to look at pictures of their kids. It’s ok to feel angry if something doesn’t go well and happy if it does.

Of course, it’s certainly possible to get “too close,” to become emotionally over-invested. I think frequent self check-ins and reflection are necessary, and healthy, especially if you live at such a busy emotional intersection. Debriefing, and working closely with a supportive team, helps tremendously, and I couldn’t do the work I do without either.

But it doesn’t mean you avoid emotional connection for the sake of objectivity or better clinical judgment. It doesn’t mean you suppress it, or ignore what you feel. We shouldn’t feel guilty, or shunned or shamed, for crying. We aren’t any less in medicine for being human.

In fact, if we can somehow find a way to live in that emotional space, to sit with and embrace what our patients feel and what we feel in a healthy and productive way, then I’m convinced it only makes us better at the work we do.

Better. Healthier. Happier.

An impassioned discussion with my residents this week led me down a rabbit hole of introspection, and I found myself revisiting times and places I have been along the way.

One thing that keeps popping up is the misperception that as a palliative care doctor, I “want” my patients to embrace hospice and to forgo CPR at the end of life. This isn’t true.

I sometimes joke with my residents that with the wealth of resources and knowledge at our fingertips, it would be easy to hand out hospice to everyone like Oprah giving away new cars. “You get hospice! And you get hospice! And you get hospice!”

But that’s not what palliative care, and certainly not what hospice, is about. I don’t “want” all of my patients to funnel into hospice, or forgo CPR.

What I want is to get to know my patients better. To be the best advocate I can, to help them make informed decisions for themselves based on their goals and values. I want to figure out how they define quality of life, learn about what gives their lives meaning. I want to help them protect what matters most in life, and in death.

Advocating for someone who is fully informed and has thought it through and wants aggressive measures at the end of life because it is who they are, because it’s interwoven into the fabric of their identity, because it’s how they want to live and die doesn’t mean I’m not doing my job as a palliative care doctor.

That is my job, as a palliative care doctor.