It has been almost 1.5 months since Dr. A. was assigned to me as one of the two junior doctors working with me. Both of them are first-year residents.
Dr. S. is very sweet, hardworking, and eager to learn. Most of the time, she is the one doing all the work. Dr. A. is a first-year resident too, but S., being a fresh graduate, is more junior, and maybe that is why she wants to learn so eagerly. Fresh graduates are usually more ambitious and energetic.
Dr. A. graduated in the same year as me. She worked in various hospitals in different roles instead of pursuing residency, so you could say she already knows a lot about medicine.
I have been noticing A. for quite some time. Since we are the same age and graduated in the same year, there cannot be the typical senior-junior hierarchy between us, or maybe I cannot form that dynamic because of my own hesitancy. Obviously, S. is far junior, and it feels sensible to treat someone nearly 8 to 9 years younger as relatively more junior.
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I know that A.’s mother passed away almost 2 to 3 months ago. Her death was sudden due to a cardiac arrest, and initially, for a few weeks, she was on leave in mourning. After she returned, the hospital gave her the oncology rotation to work under me. They are primarily internal medicine residents and do not need to work in oncology during the first two years, but because the hospital is short-staffed, they sent them here temporarily. They probably assumed oncology would be comparatively less hectic and would allow her some space to recover before returning to full intensity.
Mostly, S. and I deal with the patients. Initially, A. was on leave every other day. Some days she had mourning rituals; other days her siblings were sick, and so on. Over time, I developed irritability due to her constant leave, lack of interest in ward work, and authoritative attitude. I wished I could find a replacement for her, or tell HR that I did not need her and that S. alone was enough. To be honest, her presence did not make much difference to me.
Being the eldest daughter after the loss of her mother, she definitely has a lot of responsibility on her shoulders. She cooks, cleans, sends her siblings to university, does grocery shopping, and manages everything else. She is very talkative, and every morning she narrates what happened the previous day, usually circling back to memories of her mother.
I could not interrupt her and tell her to stop talking about her mother all day, nor could I say anything harsh to someone already struggling through such a delicate period. Still, I had grown tired of constantly hearing about her grief. Maybe because I am a good listener, I absorb too much. Even conversations not directed at me remain in my head and keep piling up there until they overwhelm me. Then comes a point where I want to throw the entire pile out of my mind, and while doing that, a lot of damage gets done.
When I keep treating people kindly and listening endlessly, eventually there comes a day when I explode. My patience runs out, and on that day, all the niceness and emotional restraint I built collapses.
A few days back, her younger sister developed enteric fever. She asked me for leave, and I did not want to make things difficult for her, nor did I have the courage to tell her she had already taken a lot of leave. To avoid conflict, I asked HR for a replacement because S. was already post-call. HR refused and told her she could not take more leave. She thought I did not understand her, and some friction developed between us. Although I behaved normally afterwards, I noticed she did not greet me the next day.
Then, for many days, she remained on the phone talking to people at home about IV medication administration for her sister. It irritated me because physically she was present in the ward, but mentally she was still at home.
Today at 3 p.m., when I had to leave, our driver informed us that he would pick us up an hour later because the van was at the repair shop. I had to return from the gate to the on-call room. She was sitting there because she was on call.
Initially, we talked about a patient whom we discharged today. When doctors talk privately after a frustrating and exhausting shift, especially after spending the entire day maintaining composed faces for patients and attendants, they often discuss how draining the day was, which patient was particularly difficult, or what could have been handled better.
The patient we were discussing was an elderly lady with acute myeloid leukemia. She had initially been on chemotherapy but was now admitted with sepsis in extremely poor condition. It was obvious she had a poor prognosis and was not fit for anything beyond palliative care.
The day she arrived, I counseled the son in detail regarding her prognosis and limited life expectancy. Although she was one of my most favorite and affectionate patients, and I was already grieving the realization that I would soon lose someone who had showered me with love over the past few months, there was also a strange acceptance inside me. Whenever she came for chemotherapy, she used to kiss both of my hands. This time, she was not even recognizing me. Her son understood everything. I explained that if she deteriorated further, we would advise against chest compressions or ventilatory support. He agreed completely.
Both S. and A. looked at me with amazement, seeing how calmly and compassionately I explained everything without sounding insensitive. That was experience speaking. I still remember the years when discussing limited life expectancy with attendants felt unbearably heavy.
After I left, the patient deteriorated further, and A., being on call, contacted me regarding the management plan. I adjusted the medications and advised her to get the DNR papers signed as a formality. Verbally, everything had already been decided between the son and me.
She did as I asked. Miraculously, the patient stabilized and improved. When I saw her today, she was oriented again. But the family wanted to move her to a hospital closer to home, so I discharged her on request.
A. then told me that the previous day had been emotionally difficult for her. On probing further, she admitted that getting the DNR signed, although technically just paperwork, had reminded her of her mother’s last moments. Her huge kajal-lined eyes brimmed with tears.
Honestly, this was the last kind of conversation I wanted at that moment. I did not have the emotional bandwidth to console her. I simply wanted to lie down quietly for half an hour. I had dressed up nicely, I was extremely hungry, and I wanted to spend the evening alone at my favorite place with good food. That delay was already irritating me.
But to be polite, I listened.
She told me how her mother had suddenly suffered a massive cardiac arrest three months ago. Her mother was only 50, healthy, and had no previous illnesses. She underwent emergency stenting but deteriorated rapidly, was put on ventilatory support, and died within two days.
The story was heavy, and I was hearing the details for the first time. Her tears disturbed me deeply. Maybe because I had been hungry all day, emotionally exhausted from the difficult discharge and goodbye to that patient, and now confronted with another wave of grief, I could feel my own tears beginning to form.
To change the topic, I asked about her father. Since she managed everything so flawlessly, I assumed perhaps her father had been shattered by grief.
“Uncle, how is he?”
“Don’t ask about him. Everything is OK.”
Before continuing, she made me promise not to tell anyone because she had never shared this with any colleague before. I promised.
She told me they had been living separately from their father. He had never been interested in her mother or the children. Around the time she graduated, he left them and remarried. Since then, she had been the one earning, supporting her mother, and raising her siblings. That was why she could not pursue residency and had spent years working different jobs simply to keep the household running. Then she told me that the second wife had also left him, and now he was preparing to marry again for the third time, only a short while after the mother of his children had died.
I had never realized she was carrying so much suffering behind that cheerful, talkative personality. She told me how she had to remain the strong one the entire time.
By then, my tears were already flowing. I never imagined I would one day sit crying beside a colleague I did not even particularly like.
She recalled how, during her mother’s ICU stay, her siblings had become exhausted from staying awake for too long, so she sent them home. Then her mother deteriorated. As she narrated the story, I imagined myself standing inside that ICU among the beeping monitors. She stayed beside her mother while CPR was started and watched the entire resuscitation. She described how CPR continued for almost 30 to 40 minutes because she could not bring herself to sign the DNR.
In my mind, I was standing there watching everything. At first, I was silently crying. Then I realized I was sobbing. I could almost feel the ribs breaking under the force of compressions, all because a daughter was still hoping for a miracle.
I understood then why she could not sign the DNR. Imagine having to choose between hope and accepting the loss of the only person in the world who truly belongs to you. I felt something like the cry of a wounded animal escape from my throat. I had never heard such a sound come from myself before. In reality, I was crying loudly in that room while she sat there shedding tears silently.
She told me that it was the 9th of June, the third-month anniversary of her mother’s death. I kept imagining how devastating it must have been: losing a mother so suddenly, so young, while already living with an emotionally absent father. Losing not only a parent, but the only best friend she had.
She hugged me, and my cries became even more intense. It felt as if the loss were personal. I imagined my own mother. My mother is only 56. Hers was 50.
My sobs turned into loud shrieks of pain. I have never cried like that before, no matter how difficult life has been. What was happening to me. She needed comfort, yet it was me crying uncontrollably while hugging a colleague, as though someone close to me had died. As though a doctor had just told me, “Sorry, we could not save your mother.” My cries became louder and louder. She no longer had words to comfort me. I felt her freeze in my arms after witnessing someone cry with such intensity.
A nurse from the neighboring ward came running after hearing the noise. She opened the door, thinking someone had died. Usually, when such sounds erupt from a ward, nurses immediately rush to see which patient has passed away. The nurse kept asking what had happened and why I was crying so loudly. Honestly, I could not even comprehend that those sounds were coming from me. I had never cried like that before.
And in that moment, I realized what attendants must feel when we tell them, “Sorry, we could not save him or her.”
Thirty minutes had passed. People had started calling me because they were waiting for the bus. I just left.
It was one of the saddest days of my life.
I have decided that while she remains with me in this ward, I will not ask her to obtain DNR signatures from attendants again. I will do that part myself.
Damane Zehra is a radiation oncologist in Pakistan.
