I sat at the bedside of a friend who drifted in and out of consciousness as I held his hand. As a critical care physician, I’m trained to steady myself in the face of trauma, from motor vehicle crash injuries to infections causing organ failure. But nothing in my professional life prepared me for the helplessness of watching him and another close friend — both doctors themselves — succumb to diseases that couldn’t be treated.
One was a college friend who became a successful dermatologist before a sudden and devastating cancer diagnosis around his 50th birthday. The other was a former pulmonologist whose childhood trauma erupted into mental illness, leading to the eventual decision to take her own life.
I felt helpless while watching them suffer as their illnesses accelerated. The bonds of friendship had grown steadily over years and decades; seeing them morph within weeks into people I could no longer recognize was jarring. Always self-confident to a fault, he now seemed eerily unconcerned with what was happening to him. She became increasingly dogmatic that her own body was rejecting her. How could I reconcile who they were now with my memories of our friendship?
At first, I tried to make rational sense of their suffering, trying to match this cause with that effect. But the pieces never fit. Did the oncologist really tell him that this illness was “curable”? She said she was “rejuvenated” by a trip to Mexico, so why did she quickly veer into how she felt her physical and mental desperation was beyond repair?
I tried to reconcile the inconsistencies. Was it because I was not an oncologist or psychiatrist? Was I blind because these were friends rather than patients? My frustration turned inward: Why can’t I figure this out?
Physicians, mental illness, and the problem with ‘passing’
It felt shameful that, as a trained medical practitioner, I could help my patients, most of whom I had just met, but could not do anything for friends I had known for decades. My self-recrimination intensified: I should have visited my friends more often, encouraged them to seek additional expert opinions, or asked others to intervene. Something.
But what was that something? And would it have really made a difference in the end?
As I reflected on these questions — and my inability to find answers — I reflected on the nature of suffering. I thought about how my own experiences with suffering could be described as feeling pain and actively resisting it. Whether the panic attacks in my 20s, or fears of not walking again after a back injury in my 30s, I had resisted strongly, as if they were alien: They weren’t me. It was only when I replaced this fierce resistance with acceptance that my psyche began to ease. My anxieties and fears were part of me, yet they need not define me entirely. In this way, the feeling of doom lifted ever so slightly, allowing for a ray of possibility to peek through — and a step forward.
Now in my 50s, I extended my capacity to hold my pain without judgment to include my friends as well. All humans suffer, and there is ultimately no way to stop it. But life doesn’t succumb to this fact; understanding the universality of suffering liberates us to explore possibilities within it.
This includes understanding the difference between feeling others’ pain — empathy — and holding that pain without judgment — compassion. Compassion doesn’t make the pain go away; it acknowledges pain as part of the lived experience of life itself. Nor is compassion unidirectional; when I show myself more compassion, I can use my precious but finite energy to carry others’ experiences with me rather than waste it by resisting what is happening.
And so now, when I think about my two friends and their difficulties, I think about suffering and compassion in a way I didn’t before. I cannot stop human suffering — not my friends’, not my patients’, not my own. What I can do is sit with it, carry it, and let it expand the way I understand life itself. I am learning that compassion is not the cure, but the company I keep with pain. And sometimes, that helps.
Venktesh Ramnath, M.D., is a professor of medicine at University of California San Diego School of Medicine and a pulmonologist at UC San Diego Health, where he serves as medical director for critical care and telemedicine outreach.