Tears in practice

General practice is many things to many people. For some, it's a place we can go to cry

Dr Rita Doyle, Former President, ICGP, Medical Council

May 1, 2024

Similar articles
  • She sat quietly in the waiting room; not lifting her head as I walked through; several times not engaging with me; her head hung down. I called her in.

    “Take a seat there Aine and I’ll be with you in a moment.” The mandatory past history was running through my head; I had known her for a long time. Her history included bronchiectasis and an ovarian cyst that had been diagnosed as constipation in the ED. She had two adult children and four grandchildren, but the dominating feature was the very rapid death of her husband about eight months previously. 

    A quiet, decent man, Aine’s friends told me he did everything for her and they did not know how she would survive without him. Others said they were surprised at how well she was coping. I felt that bit guilty that I had not had time to visit her.

    “How are you?” I asked. 

    “Fine”, came the reply.

    “What can I do for you today?” The standard GP introduction.

    “I don’t know”, she said. “Your girls told me to come.” 

    “Is there anything wrong?” I asked.

    “No”. The more open the question the more closed the answer.

    “Is there anything right?” 

    “No”, she replied, then silence.

    “I haven’t seen you since Tom died”, I said.

    “I’ve been in but I could not face you – I thought I might cry and I don’t do crying.” 

    “Why?” I asked. 

    “Because I don’t do crying”, she shouted as the tears welled up in her eyes. She said she had cried a little at her husband’s funeral but not since.

    We then talked about Tom. He was the doer in the family. They had a good life together and travelled a lot after he retired. They were happy in their marriage. I knew Tom, but then again, I did not know him like she did. As a patient I found him a little difficult – quiet but determined and at times a bit of a challenge to shift in his ideas about health. The tears were flowing now and she repeated: “I don’t do this.”

    “Where does that come from?” I asked. She didn’t know.

    Suddenly I had a déjà vu moment. 

    “I remember you told me that tears were not allowed in your home when you were growing up – you were just expected to get on with it.” Flashback 30 years and she was in my surgery with a cross face on her. I wondered what the issue was, and like most GPs I wondered what I had done wrong – paranoia is common among us. You seem very cross, I said at the time. Was that aimed at me or the whole world, I asked. She proceeded to tell me about the death of her stillborn child – a boy – and how she had not received any sympathy from her family and was told to get on with it. Tears were not part of her upbringing. When I related this to her she could not remember it, but for me it was as vivid as if it were yesterday and it highlighted the value of a long-term relationship.

    Her tears continued to fall, and in true GP style I offered the Kleenex. We talked on about Tom and what she missed about him and how lost she felt. You may come to see me anytime you wish , I told her, “even just to leave your tears. You don’t need an excuse. This is, after all, the ‘Tear Bank’.”


    Alice was upset; screaming, shouting, livid with anger and even rage. She was panicked and terrified and then came a monsoon of tears. Which emotion I should tackle first was the question and the worry. I have learned to live with tears; I am not immune, even on the very odd occasion actually joining in. But on this occasion, I wondered what the overriding emotion was. I could give a clinical diagnosis. She had diabetes which had been lost to follow-up. She now had a WCC of 19,000, a CRP of 360 and a rotting foot. But she knew me; I thought we had a good relationship. How could she stay away?

    “I parked outside your clinic at least four times and could not go in”, she said as the monsoon continued to rage.

    “I am stupid, I am useless”, she wailed.

    “Death would be the best option for me and for my girls. He (the husband) can find another woman.”

    She had it all worked out – death rather than reality was the tune being played and it was not a happy tune. This time it was the kitchen roll that was used to wipe away the tears and a bucket was filled as we tried together to construct a pathway. I would love to have analysed the substance of her tears, or hormones, as there were plenty of them. Her tears were safe with me. She knew that and so did I – after all, we are the Bank of Tears.


    Rachel was well known to me. She had two families. In her second family she had a little girl whose whole life had been sickness; she had cystic fibrosis. She was about ten years old and had come home to die. I had been in and out of the house supporting them. I was interrupted in my surgery one day to take the call that the girl had died. I left the surgery and drove to her house, and when I got out of the car I could hear the raw wailing, like the banshee. I will never forget it.  When I went in Rachel was wailing, her little girl a rag doll in her arms. The priest was crying and asked me had I any words of comfort for Rachel. My own tears were dripping down my face as I said.

    “No”, I said. “This is an abomination.”


    Sarah was 92, or is 92.  She’s a fabulous lady who rarely consulted me; only when necessary. She still walks daily and lives alone. As she spoke to me her tears were flowing; something I had never witnessed before in her. I had been around when her husband died. There were no tears then but just now they were flowing. Her daughter-in-law had recently died in a tragic accident and she was devastated for her grandchildren who were now motherless and, as she said, ‘rudderless’. She said she was too old to act in loco parentis. She sobbed and her tears were safe with me. 


    Linda was a patient of mine for about 10 years. She had huge stress in her life and suffered from depression. She had told me that she was a victim of child abuse. However, she would always say “I don’t want to talk about it.” I respected that. Today she started with “I consider you my friend.”

    I said nothing in reply, wary of the relationship becoming overly familiar. She proceeded to tell me about the most horrendous childhood she had – no sex abuse but abuse of the worst kind. She was locked in her room, beaten and threatened, caught between her brothers and her parents. The tears poured down her face. Vivid details were described.  My heart melted for that innocent child 

    “I’ve never told anyone this”, she said.

    “It’s safe with me,” I said. “After all, this is where you can bank your tears.”

    The science of tears

    Science tells us we have three kinds of tears – not that science matters that much to the crying person. There are basal tears, which are there all the time. They keep the eyes healthy and contain oil, mucus, salt and water. There are irritant tears. These are your eyewash tears, like when you peel an onion or get dust in your eye. Then there are psychological or emotional tears, which occur in response to strong emotions like sadness, grief, joy or anger. They contain stress hormones and naturally occurring analgesics.

    How do we value a bank ? We want one that is reliable, safe and consistent. One where your deposits are safe and you sometimes gain high interest. One where a long-term relationship is valued.

    General practice is the bank for tears – and as such it is priceless. 

    © Medmedia Publications/Forum, Journal of the ICGP 2024