Paula came to my office on a Monday afternoon, a few months after burying her husband. She and John had been inseparable. They were both my patients, so I knew John had spent the last six months battling lung cancer. They had been married forty-five years when John died. I sincerely offered Paula my condolences on that Monday afternoon. I could tell she was in pain and shared how she missed John terribly.

When Paula came in for a follow-up appointment sometime later, I happened to be short on time that day. I had a full schedule of patients to see. As usual, I was tired, in my mid-career focus to keep the practice afloat. I was polite but a little condescending when she told me she was planning to run a marathon to honor John’s memory. I didn’t take much notice when she shared her intentions. I figured they were just that, intentions that would not materialize.

It was natural to feel skeptical. Paula had never run before in her life. She really never exerted herself physically much at all. Cynically, I didn’t think there was any chance she would make it. Then in my forties, I could not imagine that a woman over sixty could suddenly find her passion for exercise and running, particularly in a full-length marathon.

A few months passed before I heard from Paula again. She looked youthful, reinvigorated. She had finished a marathon. In fact, she was running all the time now. And though it is a story of personal success over grief, it is not.

After telling me about her marathon, Paula suddenly paused and became serious. And then she shared the surprising fact that she didn’t really run to honor her husband’s memory. When John died, she was determined to run a marathon as a way of killing herself by exerting herself beyond her tolerance.

Paula had grown severely depressed after her husband’s death. She was suicidal. But she’d grown up religious, and frankly, she was scared to kill herself in a violent way. She thought if she just pushed herself too hard physically, without any training, her body would give out, and she could end her life.

Regretfully, I realized that I had missed all the signs. Paula had come to me, her caregiver, and I had cavalierly brushed her aside because I was too busy and too tired to care. Of course, I had been polite and examined her joint pains, but I wasn’t really listening to my patient. I couldn’t see what she was going through, and I should have.

Nowadays, it is easy to get burned out as a physician. We absorb our patients’ discomforts and fears. We rush from one appointment to the next, checking the boxes, too distracted to look beyond the chart. A patient’s pain is more than the physical pain they report to us on a scale of one to ten. In fact, often, patients we interact with each day are likely depressed. We might be the only person in their lives who have confidence in sharing their struggles. It is, in fact, a key part of our jobs to listen, to look out for them, and to offer our support.

Depression cuts away at humanity. It makes the person question the motivation for hanging on to life. Most times, hanging on is too difficult for those people who suffer from severe depression. In fact, the pain and symptoms of depression often make it difficult to ask for help, like in Paula’s case.

In our medical profession, we must make time to listen to every patient and show empathy. Somehow, we must find the time to communicate the message that life is worth living and that there is a purpose in life, even when we lose a loved one. We should try to see their sadness even as they try to hide it from us. Let’s make sure we, as physicians and caregivers, take the necessary steps to recognize the signs and symptoms of depression to help our patients avoid becoming victims of that depressive state. It is critical and relevant that those patients we come into contact with daily, who struggle silently, can feel safe asking for help.

Thankfully, Paula didn’t kill herself running a marathon without any training. She finished by sheer force of will and unexpectedly gave her new purpose. She continued running well into her seventies and got healthier and happier. But the fact remains that this story could have ended differently and tragically.

The nature of our work makes it easier at times to remain at a superficial level with our patients—to be polite without really being human. I think it is our duty to take the intentional approach and strive to really listen. We won’t hear everything, of course, but there will be those times when we understand the real cry for help and make a difference.

Francisco M. Torres is an interventional physiatrist specializing in diagnosing and treating patients with spine-related pain syndromes. He is certified by the American Board of Physical Medicine and Rehabilitation and the American Board of Pain Medicine and can be reached at Florida Spine Institute and Wellness. 

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