Recently, a very young colleague of mine who worked in the same hospital as me passed away from sudden cardiac arrest. We were shocked and deeply saddened by his death. A few days later, I met a common friend of ours who told me that he was under a lot of stress due to some family matters and work politics. He had a lot of responsibilities on his shoulders. He had a few friends and no siblings, was an introvert, and never shared what was on his mind with anyone. Maybe extreme stress was the reason for his cardiac arrest. My friend was expressing his regret over the fact that he couldn’t ask him once how he was coping with all the issues. But it is useless to cry over spilled milk. Catharsis is important for everyone, and if we keep opening up our emotions and problems for too long, the results can be disastrous.

In older days, and even now in the rural areas of Pakistan and India, there is a concept of “Chopaal” – this is an open space where male inhabitants of the village gather at a specific time of day, sit on “chaarpais,” which are actually kind of huge cribs or cots woven from jute, and they smoke or enjoy tea together. They speak their hearts out and share each and every problem of the community and even their own personal problems with each other. There is no shame or judgment if a member asks for help. And I think that’s a beautiful tradition, and that’s why they don’t need therapy as much as city dwellers. The advancement of technology and easy access to smartphones for everyone has made us socialize less, do catharsis, and listen to each other attentively, as in the past, resulting in more mental health problems than ever.

The dilemma of today’s physician is that he has to cater to a lot of patients every day. The workload and lots of issues that are on his mind make him a little bitter and insensitive. He does not have enough time to listen to each and every problem of his patients. The thought that occupies his mind most of the time is to just wind up the clinic and see all the inpatients in time. This makes the patients feel unheard and unseen. When they come to a physician, they have high hopes that the physician would listen to their problems in detail, but these days, we are more interested in just writing a prescription and ordering more workups. Carl Jung, who was a Swiss psychiatrist and psychoanalyst, said, “Know all the theories, master all the techniques, but as you touch a human soul, be just another human soul.” But sometimes, I feel that the physicians are the ones who are ignoring this the most.

Catharsis is important, but I think it should be done in a safe place only; otherwise, you will feel dejected, doubting your own self-worth, and maybe you will start feeling that your words were not good enough to convey to the other person what you wanted to say. You start doubting your own sincerity, that was useless in making them understand what you want to express. It’s like banging your head against a wall or knocking on the same door again and again with no one to open it. Communication is always a two-way road. It’s like one love that remains unrequited if the other person doesn’t reciprocate with the same intensity as yours.

My two cents on this to a budding young physician is this: whenever you are listening to a patient, never give the impression that his or her thoughts or feelings are invalid. There is always room for healthy debate later on. But please do that only once they have spoken their hearts out. If you try to stop them from sharing what they want to, and there must be some reason that they chose you to trust you with their thoughts and feelings, they will be disappointed. You are trying to stop a hurricane, a volcano that will erupt someday, somewhere, on somebody. “Unexpressed emotions will never die. They are buried alive and will come forth later in uglier ways.”

But there is a limit to everything, and sometimes we just hurt ourselves if we help those who are not deserving or worthy of our help. I met a guy a few days back who was working in aviation. He was an introvert and a very private person, according to him, but he started telling me everything about himself, his childhood, the challenges he faced in life, loss of family support, the fear of not being good enough, his complexes, and traumatic experiences he faced during his childhood and adulthood. I kept listening to him for a few meetings because, according to him, he found it safe and comfortable to share these things with me. But one day, when I gave him a hint that I wanted to share something as well, he started behaving weirdly and ultimately stopped contacting me.

Sometimes people are not used to sharing but are only doing this when they are feeling at the lowest in their lives. But listening a lot to everyone, and that too when you are a highly sensitive person yourself, ultimately results in compassion fatigue: “Compassion fatigue is the cost of caring for others a lot or for their emotional pain, resulting from the desire to help relieve the suffering of others. It is also known as vicarious or secondary trauma, referencing the way that other people’s trauma can become your own.” It’s very common among health care workers, especially those who are working in specialties like oncology, palliative care, or psychiatry, that involve dealing with grief, trauma, and bereavement on an everyday basis. To avoid compassion fatigue, I think the most important thing for a health care worker is to take time for themselves, taking time to eat well, stay hydrated, get a sufficient amount of sleep, spend time with loved ones, and stay active.

“The healer needs healing too, the listener needs listening too. The planner also needs surprises. The giver also needs to receive. The thoughtful also needs to be thought of. The considerate also needs to be considered.”

Damane Zehra is a radiation oncology resident in Pakistan.