The Sudden Death
The sudden death of a patient is devastating to doctors. It is beyond sad, or depressing - it is a viscious slap across the mouth, a painful screaming, a well-placed sledgehammer blow to the abdomen. Some oncologists, especially those instilled with empathy, may even consider such deaths as a failure on their part. This is ironic, because cancer patients usually don’t suffer sudden death like victims of a heart attack. They certainly can die from such events as strokes or pulmonary emboli, but typically they pass away after a predictable decline in function. The slow inevitable loss of a loved one, however, is no less tolerable than a sudden death and in some ways is crueler since it prolongs the sorrow of caregivers and relatives. I don’t care what has been published - in my world, where patients fight for their lives each day, there is no such thing as a good death.
With all the unhappy outcomes oncologists have to deal with both professionally and personally though, nothing brings them to their knees faster than a treatment-related death. By this I refer to a patient dying not from their cancer but from a complication of chemotherapy - usually an infection leading to failure of one or more vital organs. I write this today because over the weekend a patient of mine with metastatic cancer developed pneumonia after his first chemotherapy treatment, and rapidly went into septic shock. He now lies helplessly in the intensive care unit, and I would be a fool if I thought he was going to survive this blow. The buzzing swarm of “what-ifs” now torments me as I try to counsel his family.
Such a loss makes me think, even at the risk of sounding pretentious, of how Lt. General Lloyd Fredendall might have felt after the battle of Kasserine Pass in 1943. The unexpected loss of either patients or soldiers is a tragedy. It must not, however, weaken the will to fight on. Unless doctors can look to future struggles with a thoughtful determination to succeed, they may not get sacked, as Fredendall was by Eisenhower, but they will have nothing to be proud of when they look in the mirror.
