I Don’t Care

Jackson needs to get out of his dark house – with its curtains drawn closed all day – and see the daylight. He needs to receive, and then practice using, a new lightweight wheelchair. He needs to feel liberated. He needs to get involved with a local support group. He needs to move forward to the next phase in his life. It is a phase I will not be a part of.

Over the last 2 months, I have been Jackson’s home care physical therapist; he is now ready to transition to outpatient physical therapy and he was discharged Friday as a result. Over the course of the last 2 weeks, he and I have had multiple discussions about his anticipated discharge. Yesterday, when I reiterated (again) that it would be my last visit, Jackson said:

“So you aren’t coming back anymore? Your coming here to see me is the only thing that makes me want to get up in the morning.”

The nursing case manager, who was also in the home for a visit, was touched by his words. “He is really attached to you,” she noted, “Are you going to keep in touch with him?

“No,” I replied. “I am not.”

You’re kidding me – why not? He is obviously attached to you,” she said, surprised and unable to understand.

“It’s not what I do.”

.      .      .      .

What I couldn’t say – but wanted to – was the truth: I don’t care.


I don’t.

I can’t.

Every day I walk into the homes of six or seven different patients. I already find it challenging to muster the energy to do my job when I walk through yet another door. Every day I return to my own home exhausted after actively and respectfully listening to the minutiae of every patient and their family members – I listen, because I understand that it is important to do so and I know that I am one of the few representatives from my agency who does.

Unfortunately, empathy does not come naturally to me, but is instead carefully reasoned. I appreciate what others (and their families) are going through socially, economically, and emotionally as they struggle through a variety of maladies, conditions and hardships. I understand that every patient presents a challenge to work with in their own unique way and I spend a tremendous amount of capital trying to consider how such variables are intertwined throughout each person’s life as I do the best that I can to provide care. But care is a service I provide, not a thing that I do.

I care about my children.

I care about my wife.

I care about my parents.

I care about my brother and my niece.

I care about a few dear friends.

I care about who I am, who I become and how I do my job, but that job is to provide short-term care for individuals who most often have long-term problems and complaints. And while there are some therapists who create lasting relationships with their patients, that is not what I do.

At the end of the work-day, I am tired. When I pull into my driveway and turn off my car’s engine, the day is done. When I step into my own home, I have already committed as much as I can to each patient in the finite time that I am responsible for their care and I will often commit a significant amount of my own personal time (later in the evening) reading, listening and writing in an effort to be a better therapist when I return to work the next day.

I think it is wonderful that others choose to stay involved with, and attached to, their patients after discharge, but I cannot become close or emotionally attached to my patients, so I don’t. Perhaps those other therapists are better people. Perhaps that makes them better therapists. Maybe one of them might have been better suited to work with Jackson. Maybe not.

Either way, there will be yet another new patient on Monday who requires care. I hope mine will suffice.


3 thoughts on “I Don’t Care

  1. Empathy does not come easy to me either, although its something i work on. Sometimes I dread when a patient tells me a family member has passed for example, because I don’t really know how to react besides the typical “i’m so sorry.” Sometimes I wish I can do more, but don’t know how. Every now and then I get the patient that it’s easy with. Why? Does this limit me as a therapist. In addition my first observation when I just began home health was the absence of light. Were they like this before? If so does this aspect of their personality put them at greater risk for health problems/persistent pain? Or is it simply a effect of what they’ve been through?

    • Thanks for reading and taking the time to reply.

      Ugh – death is a tough one. While I have stopped asking others, “How are you?” when I first engage them, so too have I stopped saying,”I’m sorry,” in all situations unless apologizing for something that I had direct control of. This was a much easier habit to break; I have found that a more fruitful conversation develops from a reply such as, “My condolences. This must be a difficult/challenging time for you…” The patient usually engages and steers the conversation in a direction that seems less awkward. Sometimes they break down and cry – I am comfortable waiting with a hand on their knee or shoulder (in silence) as well.

      The absence of light is interesting – I have different experiences. This particular patient was in the extreme dark, but was in a ‘tough’ part of town, where most keep their shades drawn, but you have me considering that light is something that can be afforded by the middle-upper class. Apartments typically only have windows at each of the rental, so little light (or fresh air). Apartments also tend to be in more developed areas where there are more buildings that surround, again blocking more daylight. For construction purposes, windows are VERY expensive. It is the middle-upper class that can afford a house, in an area (suburbs) where they can have property that is spread out to afford direct sunlight and a property with an abundance of windows. Something for me to think about and consider, Mark.

  2. Pingback: Do you need to care to be caring? Sympathy, Empathy, Compassion, and Caring in Healthcare

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