Behind the White Coat - The Doctor No One Sees

*“It kills me sometimes, how people die.” (Markus Zusak)*

People often look at us and see suave, composed doctors. They see our white coats, our stethoscopes, and perhaps the confidence with which we speak. They come to us when they are frightened, when something hurts, or when they don't know what is happening to their bodies. They expect us to have answers. They expect us to be calm when they are scared, strong when they are weak, and hopeful when they have almost lost hope. And we understand that. We chose this profession because we wanted to be there for people when they needed someone the most. But sometimes, we wish people would look beyond the white coat and see the person underneath it.

We get tired too. Don’t we?

There are days when I walk into the hospital feeling completely exhausted, but I still put on my smile, my white coat and begin my day. I see my colleagues in the clinical areas listen to patients, examine them, make decisions, write prescriptions, answer questions, and try to reassure worried families. In the Blood Centre, I too have my daily routine of handling multiple tasks. I smile even when I don't feel like smiling. I say, “Don't worry, we'll figure this out,” even on days when I am carrying worries of my own. And when the day finally ends, I sometimes realize that I have spent hours taking care of everyone except myself.

There are patients I remember long after they leave the hospital. Some faces stay with me. Some conversations replay in my mind when I am lying in bed at night. We are taught to accept death as a part of medicine but knowing that death is inevitable does not mean that it doesn't hurt. Sometimes we go home carrying the weight of a patient's story without anyone knowing. 

And perhaps that is one of the hardest parts of being a doctor, namely, learning how to carry things quietly.

I was reminded of this in the most painful way when we lost Dr. Prayas. He was jolly, warm, approachable, and always ready to help. There was something very normal, very mundane about him. He could make people laugh, ease someone's worry, and offer a helping hand without making it seem like a burden. He was the kind of doctor and colleague people felt fortunate to have around.

And yet, when Dr. Prayas himself needed help, when he was fighting a battle that perhaps many of us did not even fully understand, we could not save him.

That realization is difficult to put into words.

We spend our lives learning how to recognize illness, manage emergencies, and save lives. We are trained to act when someone is in danger. We become accustomed to being the ones who help. But sometimes, despite all our knowledge, all our training, and all our intentions, we are helpless.

The loss of Dr. Prayas left behind a question that is difficult to ignore, that is how well do we really know the people standing beside us in white coats? Perhaps the happiest person in the room is fighting a battle no one knows about. Perhaps the person who is always helping everyone else is quietly running out of strength. Perhaps the person who makes everyone laugh goes home to a silence they never speak about. We may work beside someone for years and still never know what they are carrying inside.

We often notice physical illness because it has visible signs. Mental suffering is different. It can hide behind a smile, a joke, a busy schedule, or an apparently successful life. Someone can be surrounded by colleagues, friends, and family and still feel profoundly alone. Someone can be exceptionally good at their job and still be struggling to make it through the day.

Dr. Prayas taught me, through his absence, something I wish I had never had to learn - sometimes the people who are there for everyone else also need someone to be there for them.

We are often told to be strong. Somewhere during our medical college and training, many of us learn that admitting we are struggling is dangerous. We learn to keep going even when we are exhausted. We learn to attend another shift after barely sleeping. We learn to postpone vacations, miss birthdays and family gatherings, and tell ourselves that it is all part of the job. We become so good at taking care of others that we sometimes forget that we also deserve care.

There is an unspoken expectation that because I understand illness, I should somehow be protected from it. Because I know about depression, anxiety, burnout, and stress, people may assume that I know exactly how to prevent them from happening to me. But knowing the science of mental health does not make me immune to human emotions. I can understand anxiety and still feel anxious. I can recognize burnout and still experience it. I can tell a patient to rest while knowing that I desperately need rest myself.

Sometimes I wonder when I or my clinician friends became so comfortable saying, “I'm fine,” even when we weren't. Maybe it happened slowly. Maybe it was during those long nights when sleep became a luxury. Maybe it was after the first patient a colleague lost. Maybe it was when we realized that there was always another emergency, another case, another responsibility waiting for us. Or maybe it was simply because everyone around us seemed to be struggling too, and we didn't want to be the one who couldn't cope.

But the truth is, I don't always cope. Sometimes I feel overwhelmed. Sometimes I question whether I am doing enough. I can also comprehend when sometimes a difficult case makes my clinician friends doubt themselves. Sometimes I see my busy colleagues going home completely drained and have nothing left to give to the people they love. 

Sometimes I need someone to ask me how I am - not as a doctor, but as a person.

I think that is what we often forget about doctors. We are not machines. We have families we worry about, relationships we try to maintain, dreams outside medicine, and lives that exist beyond the hospital walls. We experience heartbreak, grief, loneliness, fear, and uncertainty just like everyone else. The difference is that we are often expected to hide it behind a professional smile.

I don't want to be admired for how much suffering I can silently endure. I don't want exhaustion to be considered proof of my dedication. I don't want to ask for help to be interpreted as weakness. I want to believe that I can be a good doctor and still be a human being who sometimes needs to stop, breathe, cry, and say, “I am not okay.”

Because perhaps taking care of myself is not selfish. Perhaps it is necessary.

We have spent years learning how to recognize the symptoms of illness in others. Now it is time that we start learning to recognize them in ourselves, to start learning that rest is not laziness, that vulnerability is not weakness, and that asking for help does not make us less capable. We should accept that we cannot keep pouring from an empty cup and expect ourselves to remain compassionate, patient, and present.

And perhaps the memory of Dr. Prayas should remind all of us of this. Let us look beyond the white coat. Let us ask our colleagues how they are and actually wait for the answer. Let us notice when the person who is always cheerful suddenly becomes quiet. Let us make it safe to say, “I am struggling.” Let us stop treating emotional exhaustion as simply another price of being a doctor.

Because sometimes, by the time we realize someone needed help, it may be too late.

I have slowly learned that healing is not only about treating diseases or saving lives. It is also about recognizing pain, sometimes even when that pain belongs to the person who is supposed to be doing the healing.

Dr. Prayas was there for so many of us, always ready with a smile, a kind word, or a helping hand. When he left us, we were forced to confront the painful truth that we could not be of help to someone who had spent so much of his life helping others. His absence is a reminder that behind every cheerful face can be an unseen struggle, and behind every white coat is a human heart that needs care too.

So today, I am trying to take care of that person, the person behind the white coat. And I hope we learn to take care of one another a little more, before another silence reminds us that we should have asked.

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