Parting is Such Sweet Sorrow
I had just popped out of an exam room, bursting with the fierce energy that radiates from mind and body when working in perfect harmony (also known as having a good day at the office) when I caught my nurse placing a chart quietly on my desk. She backed out of the room like gentle Rosencrantz and Guildenstern taking their leave from the evil Claudius. Not considering myself as particularly wicked, I wondered what gave rise to her timidity. I glanced down. The chart, which bore the name of a beloved patient of ours had the word “Expired” and today’s date written across the front.
Somewhere deep inside me I heard the sound of a tree falling. Its crash shook me as I stood there, leaving me more exposed to the fury of the skies. I placed the chart on the top of a pile of tan folders and went on to my next appointment.
Later that day I experienced a flashback: I recalled attending a dinner party during my fellowship given by a retired Tennessee family practictioner. He had enjoyed a long and prosperous career and fascinated the table that evening with tales of medicine “back in the day”, when he would deliver country babies at night by the light of his car’s headlamps since many families had no electricity. He told us that on the day of his retirement he received a citation from the town signed not only by his long-time patients but by his patient’s children and their children, all of whom had grown up under his gentle care. He had ministered to some folks for nearly fifty years.
Fifty years! What a contrast to the career of medical oncologists. Unlike family doctors who get to watch many of their healthy patients grow to be old and healthy, oncologists seem to be constantly running a crisis center. We scramble throughout the day putting out the fires of suffering, taking calls from emergency rooms holding more patients in search of relief, monitoring a dozen situations in our treatment rooms, always bracing for the next catastrophe. While we toil the silent killer inside our patients rages against the deadly molecules assaulting it. Both patient and cancer struggle to survive the assassin’s strike.
Then after a period of time, it is over. The day comes when most of our patients, to put it bluntly, really don’t need us anymore for they are either in remission or dead. Even those incurable cancers that we are trying to turn into a chronic, livable disease, that require months and months of intense care, will someday take the lives of our patients. Even those who have been cured of their disease and must be followed for long-term complications will eventually return to their primary care physicians, reveling in the thought that they are finally free from our scrutiny.
Can we blame them? Wouldn’t we be thrilled to forget our anniversary date of being diagnosed with cancer, it had been so long in the past? I’m sure many patients when asked who their oncologist was would love to reply with a smile “You know, I can’t remember his name.” Rather than complain, oncologists should consider this their highest honor.
Please forgive us though if we stand at the window of our office and watch new mothers carrying in their babies, or elderly couples helping each other down the entrance ramp, and sigh with the thought of that day when we will no longer be needed. Don’t think that we are discouraged - if nothing else, oncologists understand the nature of our profession. We realize that after decades of service, the only citation coming to us is the one that hangs in our memory and in the memories of all those lives we tried to help during a time of anguish. Why does this please us? Because we know that if we remain true to our calling only two words need be written on this commendation:
“Well done.”
I remember sitting in my oncologist’s office for the first time, my head filled with new acronyms and big medical words I had just learned. With all the questions I wanted to ask about the disease, only one seemed to come out. “Why is this your passion?” I asked the overly energetic doctor with an electric smile. She turned to me and quickly replied, “Because there is so much hope. There is just so much hope. Of all the work I could be doing this is the most rewarding work I could ever do.” With that I knew I had found the perfect doctor for me. There would be time for all the other questions. And even though it has been just under a year and a half since that day, I always remember to say thank you and share the positive things as well as the complaints. Deep down I have always wondered how you do it, how you face it every day. Thank you for sharing this and letting us all see inside the mind and heart of an oncologist.
Comment by Jeannette — November 12, 2005 @ 9:47 pm
[…] I’m also including this post from The Cheerful Oncologist. […]
Comment by Real Cancer, Real Lives #6 — November 14, 2005 @ 5:51 pm
This is a powerful summation of what oncologist’s go through. The importance of the moment, the immediacy of doc-patient relationship is made very clear, especially in contrast to what family doc’s experience. Thanks for the insight and glimpse into what you go through, I’ll be linking to this.
Allen
Comment by Allen Searls — November 15, 2005 @ 12:39 am
A beautiful post; well said.
Comment by Kim — November 15, 2005 @ 8:23 am
Whereas a patient’s view would be ‘you’re free’.
Minerva
Comment by Minerva — November 17, 2005 @ 12:38 am
This is an amazing and touching post… I myself was diagnosed with cancer at 16, and am now an oncology pharmacist. i know what it’s like to want to be free from the clinics, from the treatments, from the health care professionals associated.. but i also know how incredibly much i, as a patient, appreciated every little thing the oncologists and their team gave to give my life back to me. it may not always be expressed by the patient, but i believe that every single person who knows someone or is themselves touched by cancer, appreciate with all of their heart everything that oncologists give to fight the battle against cancer with their patients.
thank you.
Comment by Teresa — November 18, 2005 @ 11:39 am
Thank you for sharing your thoughts as an oncologist. It has helped me to walk in the shoes of those that have served as my oncology professionals. I have “left” them now, as you have said, as one that no longer needs their services… a ’survivor’. Yet, as you say, the insidious disease seems to plague so many of the best and brightest. Thank you for serving humanity in the way that you have chose. We hope to have spent our days of this incredible life wisely, indeed to earn those two wonderful words.. “well done”. May God continue to place His hands into yours.
Comment by denise — November 19, 2005 @ 4:59 pm
“Well Done”! I am a 32 year old breast cancer survivor. Six short months ago I didn’t even know what an oncologist was! How grateful I am for dedicated practitioners in this field of practice! Although we may not always return to your offices…you will ALWAYS remain in our hearts!!
Comment by Dana — November 22, 2005 @ 1:00 am
I also guessed that the patient had gained some weight, and most likely had a lower body temperature as well given the shift away from a hypermetabolic state. TY for a really inspiring blog. I’m an NP who has worked with oncology patients and lived through the cancer experience with several family members. Blessings to you.
Comment by Linda — December 4, 2005 @ 9:15 am
The guy in the white coat, on the other side of the desk, gets up several days of the week, knowing he is going to have to tell people that their life will end prematurely. No amount of cash, free stethoscopes or drugs can make that a good way to wake up. He wants to do his best for you; he will use all of his hard learned skills, so please give the poor sod a break. My experience is that he needs to laugh as much as you. Help him. Enjoy life. All of it. Even the crap. LAUGH! I also found with one consultant (they are often little Gods with their minions) that when I wound up this internationally known surgeon about his shaky hands, incompetence and frequent visits to the golf course, it put him and his whole department in an amiable frame of mind. He is a 20 hour a day, 7 day a week guy who is incredibly skilled. He is also a human being.
Comment by Cancergiggles — December 16, 2005 @ 11:45 am