Lessons Hard Learned – Episode 2


This is the second episode of “Lessons Hard Learned”.  This one is a little different.  When I put out the call for readers to tell how they have learned valuable lessons from their practice the hard way I got a lot of responses.

One letter was really powerful – because it was from a doctor who was telling the story from the other side.

I believe this is a truly profound lesson, one we all need to remember everyday of our careers.  We, doctors, occupy a privileged position in society – and it is very easy to forget the impact our words and actions can have upon those we care for.

This is a lesson in mindfulness, empathy and compassion.  I think that the letter speaks for itself – so have a listen.

I would really appreciate your comments and discussion of this story.  And I know that the author would like to engage in this discussion – so please let me know your feelings and share with us all your insights into this most fundamental part of our day to day practice.




  1. Thank you so much for posting this Casey, and thank you to the author, very courageous, and I’m sure this will have profound effects on many medical professionals. I was moved to tears.

    As someone who had palliated both of their parents by the age of 30, (once as a naive 18yo medical student, and once as a senior ED registrar), yet had the good fortune to have a wife with 2 uneventful pregnancies and 2 uneventful births, I can’t imagine the sense of frustration, loss and helplessness the author experienced. I totally concur that when the news of the end of a life arrives, you probably won’t remember the name, or the face of the deliverer, but you will absolutely remember the words, and the way they were delivered. For those that haven’t been through it personally, empathy in this kind of situation is hard to teach.You can only say to yourself, “how would I want this news delivered to me, if it was my child/parent/sibling/spouse”?

    Spending time as a patient, “on the other side of the desk”, is without a doubt the most educational experience a doctor can have, and it’s all the more powerful the more grave the situation. Having it involve the loss of a child is incomprehensible to me, and one of my greatest fears. Kudos to the author for putting pen to paper, and to you for posting it, so we can all be reminded of what profound effects our words, demeanour, attitude, body language and behaviour have on our patients and their families, at what is often the worst moment of their lives.

  2. Casey, and the letter-writer, thank you.
    This resonated so strongly for me, and I cried while listening. There is nothing as powerful as reflecting on how your work looks from the patient perspective. Walk a mile in my moccasins. I’ve walked in your letter-writer’s moccasins, and I agree that I am a better doctor for it.

    The letter confirms the thoughts I have on every occasion I spend time with a distraught family.

    THIS is what I add. THIS is where doing it well really matters. THIS is what I find most heartbreaking and yet most rewarding. THIS is what being an emergency physician IS. The privilege of sharing these naked moments with our patients is what it is all about.

    Thank you. The decision to share it is of course a good one. Your letter-writer is not alone.

  3. Jonathan Ramachenderan says

    Yes!! Thanks for sharing reader. I cannot thank you enough and love how you’ve eloquently translated such a powerful theme into

    As doctors we are share in the most intimate parts of our patient’s lives and our story INTERSECTS with theirs each time they enter our consult room or we pick them up on the screen.

    What we say matters. You are absolutely right. Words linger long after our name and face fade away.

    2 things have shaped me more as a doctor than anything, my two beautiful boys and tragic deaths of close family members.

    With sharing you have blessed me and other readers and your experience will undoubtedly add a tangible and innate level of care and compassion to your practice as a doctor.

  4. Thank you for sharing this. There is nothing as powerful as being a patient or patient’s family member to appreciate the helplessness we can feel in times of crisis, and we must never allow ourselves to underestimate the positive or negative impact our words and actions can have at these times.

  5. Minh Le Cong says

    Casey , I listened to this after winding down from a late night retrieval and must say found it very moving. The follow on comments by Andy, Domnhall , Jonathon and CLiff reflect how the writer in sharing, can inspire others. This is community. The stories that bind us. And for it all, we are richer, not only as healers but as our humanity shows.

    When things are at their worse, we can sometimes be at our best.

  6. Thanks for Sharing and posting Casey.
    My wife and I are both nurses working in a busy ED and are often faced with these types of things.
    My wife just tries to treat the patients and importantly their families as if they were her own and it is heartwrenching at times.
    Its a great discussion to have and one of the hardest things to learn how to cope with as Emergency Nurses and Doctors..our emotions.
    Thanks again.

  7. cheryl martin says

    Thanks for sharing – likewise very moved but agree powerful lessons for us all. Very humbling. At this peri-fellowship exam juncture in my career there is real inspiration here and despite the tragic circumstances immense optimism.

  8. Ewen McPhee says

    Thank you for posting the letter. A very timely reminder that words make a difference, that a human presence is critical at this difficult time. The letter took me back to difficult times I have faced, and highlighted the need to consider ones own emotions guilt, frustration, regret and how they affect our ability as clinicians to respond. I will share this with my practice, the registrars and medical students. Formative clinicians really struggle with this. Thank you

  9. Robin Guttinger says

    Thank you for sharing that story.
    Science informs our process, which is a great technological challenge.
    But our art, which is an equally great challenge, is in the way we relate to our patients and colleagues. In the way we reflect about ourselves. In the way we try to lead the cultural enterprise of health care.
    I was at a talk given to a bunch of medical students where an older,wiser paediatrician and I talked about our careers and offered tips on how to get along with young patients. At the end, after lots of stories and advice, one of the students asked “can you give us just one important tip or piece of advice?”, and after I guffawed that we’d just given her a whole heap of tips, the older,wiser paediatrician turned to the audience and said “Listen”.


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