Emma watches me carefully peel the scotch tape off the iridescent paper and unwrap the small white box. With surprise and pleasure, I lift the lid. Then, conscientiously balancing Oohs and Aahs with You-shouldn't-haves, I slowly remove the delicate teardrop earrings embedded with pale pink pearls from their cottony bed and hold them up to the light.
Emma studies my face to assess how much I like the costume jewelry she picked out. The earbobs are truly lovely; my momentary happiness, genuine. What goes unnoticed (I hope) is the invisible wall rising inside me.
Her gift is unnecessary. Treating her many illnesses is routine in my practice. As for Emma's string of emergency room visits and frequent telephone calls, that just comes with the territory. Her bills are paid; she owes me nothing. Once Emma leaves my office, I quickly close the lid on both the gift and her gratitude.
As a physician, I believe my detachment provides an effective response to patients' thankful praise or presents, just as my professional calm helps me deal with patients' distress or ire.
What's so terrible about basking in patients' gratitude? Why not delight in patients' presents?
Ethicists warn physicians about gift-born bias and clouded clinical judgment. The side effect I fear most is a swelled head. Satiated egos can predispose to medical errors. For the sake of my patients as well as myself, I must guard against expecting or wanting gifts or praise.
My approach to patients' gratitude serves me well. By erecting a wall around my emotions, my affections or concerns for patients won't interfere with my ability to deliver bad news or prescribe risky treatments. Yet I sense something is awry.
Only after I develop cancer do I begin to understand my mistake. Years after receiving her gift, as I experience life on the other side of the stethoscope, I yearn to call Emma. More than wanting to tell her how much pleasure I get from those earrings, I need to talk with her about the ache in my chest.
Ever since my first round of cancer treatment—which began just before Thanksgiving 1990—I've suffered from a recurring discomfort. As predictable as the sunrise, when the leaves turn red and yellow and the days get noticeably shorter, the ache in my chest crescendos until it is almost intolerable.
With our holiday of thanks approaching, I wonder if the ache is the swell of gratitude for the medicines and technology (and factors beyond comprehension) that enabled my survival. Or could it be my heightened appreciation for the simple things, a gratitude that nearly explodes inside my chest? If so, why does the sensation persist despite my prayers of thanks and savoring of ordinary moments?
The reason for my discomfort eludes me until my husband, Ted, asks me to proofread his paper on Adam Smith. All I know about Smith is that he was an 18th century English economist who wrote about self-interest as a driving force in the economy. I didn't realize that Smith was a moral philosopher, too.
Smith believes that benevolence—kindness toward another—acts as a sort of glue that binds individuals together in society. He theorizes that people are wired to respond to kindness with gratitude, and this gratitude compels people to want to return the kindness.
Reading on, Smith's words jump out and resonate with me like a plucked string. In describing the feelings experienced by a recipient of an act of kindness, Smith says (and I'm paraphrasing here): Until I have brought compensation by doing something that promotes their happiness, I feel loaded with a debt that their services have laid upon me.
My doctors and nurses insist I don't owe them anything. Oh, but I do! They have treated me not only with cancer therapies but also with kindness. My gratitude for their kindness builds throughout the season of Thanksgiving, until I find just the right gifts and deliver them in late December.
People nowadays despair that medicine has lost its humanity. Physicians lament that they've become depersonalized mechanics fixing bodies, not people caring for and about other people. But medicine is—and must be—about more than a market exchange of goods and services.
The care of the patient must be built on the same natural human emotions that work in societies as a whole. The exchange of simple kindness, as Smith suggests, is the cement that holds us together.
In my office years ago, my mistake was thinking the pearl earrings were just for me. If I could go back in time, I would open wide my mind and heart whenever a patient thanked me, whether with a gift, a card or simply a hug.
Reveling in patients' gratitude relieves the burden of their debt and nurtures healing alliances. By allowing patients space to give thanks and by accepting their thanks, we hold onto that which makes us human.