Keep Smiling

The warmth of the quilt enveloped me, as a blaring cacophony erupted in the background. It was 5:45am and unlike the four days prior it took everything to leave  my sheltered cacoon and step out into the world. Practically inhaling breakfast, it was another day I left my watch behind as I raced to make the bus. It was running late. Predictable.

Now doe eyed and eager, I brushed past the worried faces at the hospital elevator, racing up four flights. Can’t be late. Empathising with our COPD patients, I puffed into the empty doctors’ office. Drat. Why didn’t we start at the same time every day?

‘So what did the physiotherapist say?’, the registrar asked. Illegible, more illegible writing. It was already 2:30pm and we’d barely seen half the patients. ‘It’s just one of those days’ I told myself. ‘Just keep smiling’.

3pm. ‘Isn’t that your patient in Bed 5?’, the nurse yelled, as we finally sat down to lunch. It wasn’t my first MET call. It wouldn’t be my last. Plastering myself to the wall I watched the herds flocking to the scene like sheep. ‘Can’t breathe, can’t breathe,’ the patient gasped.  Only yesterday she had been telling me how upset she was her son hadn’t visited her in hospital yet. A moment I had cherished, congratulating myself for finally finding the time to truly get to know a patient. She remained surrounded. Lines, masks, leads.

‘Increase the oxygen, why isn’t there an alcohol swab here.’ With doctors and nurses engrossed in their individual roles the patient’s eyes moved to me. It took everything to muster my courage and give her a smile. We both knew, but neither said a word. Silence. Flat lines on the ECG. A life lost. My eyes darted over to the corner as her young son and his wife ran into the ward. A single tear trickled down his face. A missed oppurtunity.


Within moments I was rushing to grab a progress note as we moved to the next patient, the only remnant of our previous encounter being my quivering hand as I began to write. It was funny how I forced a smile.

‘Hey, hey, what’s wrong?’ I heard. It had only been a few hours; couldn’t I have smiled a little longer? How did they know? I felt angry. Why was I staring into space whilst the rest of the team continued to deftly craft intricate management plans for our complex patients?

My colleague stood me outside the room, as the team proceeded to see the next patient. ‘You have to learn to forgive yourself’ I heard her say ‘We all knew you knew her better than any of us.’ ‘It’s ok, you are allowed to feel this way’.

Maybe I had needed to hear that a few hours ago.

Maybe the smile wouldn’t have been so forced.

My hand may not have quivered.

We always expect ourselves to work at our best, despite the circumstances. We compare our responses and reactions to others, often more experienced. We feel guilty about taking our own time to process our emotions. Why? Maybe it is our internal drive, maybe we learn it from our environment and peers. But can we really bring the best care to our patients unless we are functioning at our best?



Forgive yourself.

Take your time.


You don’t always have to keep smiling.

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