I am no more immortal than my own patients

I am no more immortal than my own patientsI was lying in bed, watching something with my son when a chat message popped up on screen. It was my dear friend, Narin, whom I haven’t seen in years but remain in contact with (thanks to the wonders of social media).

“Did you hear that Dave died?” she had written. “I just read it in our college alumni magazine. I am so shocked.”

At first I wasn’t sure whom she was referring to, but then she clarified, “David Thomas*… he’s dead.”

As I realized who she meant, I was overwhelmed with sadness. Indeed, had I not already been lying down, I think I might have buckled. I Googled him and  located his online obituary. There was no picture, but I learned he had success in business, was married, and had kids.

As I read it, my thoughts went to my days as an undergraduate. I had left my native island home in the South Pacific to study in upstate New York. As a freshman, I was placed in a suite of upperclassmen. Dave had been in the adjoining suite and although I cannot remember the details of our first conversation, I do recall we discovered things in common, like how we shared the same birthday and that we were both only sons (he has five sisters while I have four). Despite being older than me, we found it easy to talk to each other and almost immediately, we hit it off and during my first year away from home, he showed me around campus, introduced me to his friends and to his fraternity. I ended up pledging that fraternity, and Dave became my “formal” big brother.

I thought we would remain in touch always, but as often happens, when he graduated (two years before me), our lives went in different directions. I went on to medical school and lost contact with him. Despite the passing of years, though, I would think about him every so often–wondering how he was doing and mostly looking forward to a future reunion … someday. Surely, time was on our side.

Learning of his death has been a shock for me, primarily because it was so unexpected — like having the rug pulled out from under you. It has made me cognizant (yet again) of how precious time is — that one never knows how long one has on this earth.

It also made me think about the discussions I have with my patients, particularly those where I have to discuss the difficult and scary issues of cancer recurrence or metastases, when cure is no longer a possibility. I often encourage them not to dwell on the “incurableness” of cancer, but rather to focus on the fact that they are alive today, and very much so.

“Afterall,” I’d say, “one can be hit by a car or drop dead of a heart attack in an instant. It would be over just like that.”

I know for some patients these sentiments do help alleviate worry; but for others, they seem to ring hollow.

“What do you know? You don’t have cancer.”

It occurs to me that I approach these discussions with a certain level of detachment, as if they do not apply to me, as if I am immune to death. Then something like this happens, and I realize that I am no more immortal than my own patients.

Ultimately, Dave’s death has made me pay attention to what I’ve been saying, to heed the very advice I have given to so many others. I must live fully and not delay doing the things that I want to do, such as reaching out to those people from my past that I miss. In the end, life is a gift and none of us know how long we will get to enjoy it.

It is heartbreaking for me to realize I will never have that reunion with Dave. That I will not have the chance to thank him for being such a great big brother all those years ago, to tell him he made a lasting impression on me, and that he was never far from my thoughts.

But for those he loved and left behind, I hope they know that he mattered. This world is a better place because of him, and I am certain his influence was shared by more people than just me.

Rest in peace my friend.  May the journey beyond be peaceful, and I hope I get to see you on the other side.

* Name has been changed.

Don S. Dizon is an oncologist who blogs at ASCO Connection, where this post originally appeared.

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  • Anthony D

    “I am no more immortal than my own patients”

    We know!

    • drdondizon

      Me too, Anthony. Me too. DSD

      • Rob Burnside

        Thanks to the human heart by which we live,
        Thanks to its tenderness, its joys, its fears,
        To me the meanest flower that blows can give
        Thoughts that do not lie too deep for tears.

        “Intimations of Immortality” (W. Wordsworth, 1804)

        • drdondizon

          Dear Rob: Wonderful. I think I will share your quote on twitter! Thanks for posting. Best- DSD

          • Rob Burnside

            You’re quite welcome, Don. A few lines from the beginning of “Intimations” follow—

            “To me alone there came a thought of grief.
            A timely utterance gave that thought relief,
            And I again am strong.”

  • Ron Smith

    A solemn piece to be sure. But surely as you state in your last paragraph that you live in hope for the present based on the faith of the past that you have charity, joy, and excitement for the future when you will meet your friend beyond your passing? It sounds like you have more than wishful thinking. Surely this tiny slice of your existence represents the smallest part of the eternity for which you long?

    I feel that way about Laura. Stacy and I cared for her for some 24 years from birth to her passing. Her tiny little handicapped self, I am often reminded, is not the Laura that I know is whole now and that I will someday enjoy.

    Forever And A Day For Laura Michelle is a free ebook on iTunes that Stacy and I wrote about our experience that might be encouraging. (Contact me at ron (at) ronsmithmd (dot) com if you don’t have an iPad, iPod Touch, or iPhone and I can send it to you in ePub format).

    Warmest regards,

    Ron Smith, MD
    www (dot) ronsmithmd (dot) com

    • drdondizon

      Hi Dr. Smith, thank you so much for your post. I am sorry for your loss of Laura, but yes- I share with you on the hope (I would even go so far as to say- expectation) that I will see Dave (and others who have left this earth) again.

      It’s interesting- the post generated a conversation with a colleague about what is on “the other side”. It was an existential conversation that I found welcoming because although I do not think about religion and spirituality much (at least, not conciously), at times like this I am reminded how important both are in my own life.

      I guess my faith in an afterlife informed this post, and continues to inform my life.

      Best always, DSD

  • Suzi Q 38

    I am so sorry for your loss, Dr. D.

    We are getting to an age where we definitely will lose a few friends and family members, not to mention our own vulnerability.

    When I received the news that I had an ovarian tumor, albeit the tumor was of low malignant potential and was removed, I changed.

    I started being more verbal to loved ones and friends that were important to me. I started giving away stupid things that had both little and major monetary value that I had acquired. I also did something odd.
    I wrote letters of love to all my family members and verbally told friends nice things.

    I called my old boss, who had moved up the ranks to Vice President of Sales at a major pharmaceutical company that I had worked for in the distant past. I realized that he was my best and favorite boss. I looked him up on Zaba search, called him and told him so. He was so happy I called and invited my husband and I to visit him in Rhode Island, where he and his wife live and are retired. He said he wants to take us out on his boat, as he lives on the coast.
    I am going to go, and I hope we both make it for the reunion.

    I realize I am still alive, and most likely will live many more years, I hope.
    I have arranged to take more trips, and enjoy life as much as i can.

    I have seen doctors die unexpectedly. You are right, they are not exempt from death. One day, I would visit them like usual, the next time, their name was off of the door.

    My Mom, who is 89, has “cheated” death a few times.
    Even she told me I was getting old, LOL.

    We can not predict our death to a certainty.
    We can only enjoy each day and each important person in our lives to the best of our ability.

    I so enjoyed today, and it was quite ordinary.

    • drdondizon

      Dear Suzi, Thank you for such a rich post- filled with commentary about living life in the present and to its fullest. It is something so many of us forget, especially as we try our best to get past the intricacies of daily life. Enjoy what looks like will be a beautiful weekend! D

      • Suzi Q 38

        Thanks.
        We are making the effort to pack stuff in the car and spend 4 days at the beach. I want to feel the sun on my face and practice Tai Chi on the shore in the early morning hours. Family and friends will come to stay or visit. Sunsets with my husband, (until he leaves on Monday morning for golf, LOL).
        Then, on Wednesday, reality will hit.
        I have to have minor knee surgery and will be homebound for a couple of weeks.
        One last vacation before this happens.

        • guest

          “I have to have minor knee surgery and will be homebound for a couple of weeks. I am setting up a schedule of sorts…”

          Of course you are!

          Do you have ANY life outside your fixation with the medical system, and your hyper-utilization of same? I think that if a week ever went by without some “medical drama” for you, you would be lost.

          That’s terribly sad.

          • Suzi Q 38

            Such a nice person you are!

          • drdondizon

            We all reach out for support and find some means more comforting than others, right? I’m glad you are forthright in your posts, speaking what is on your mind and how you read relates (or doesnt relate) to you.
            Posting on social media is a two-edged sword isnt it? One can get a lot of great feedback, but it also lays your thoughts out to interpretation, criticism, and dare I say it, cynicism.
            We can only be true to who we are, what we believe, and what we need.

            Plug on, Suzi Q!

            DSD

  • Mika

    “It occurs to me that I approach these discussions with a certain level
    of detachment, as if they do not apply to me, as if I am immune to
    death. Then something like this happens, and I realize that I am no more
    immortal than my own patients.”

    The humility, introspection and grace that shine through in this post are very moving. Thank you for sharing it, Dr. Dizon.

    • drdondizon

      Dear Mika: Thanks for the nice complement, and for posting. Best always, DSD

  • MikaBerner

    While rounding on my patient earlier this week was the first time I needed to break the news to a patient that her condition was fatal and that she was reaching the end of her life. She and her family had been told of her diagnosis, I did not have that information until I needed to obtain records from an outside hospital. Even though she was near the end of a neurodegenerative disease and could not talk I had a strong sense she was very intentional about what she wanted and did not want. I think her family members had more of a rougher time of this.

    It never seems to get any easier breaking the news to patients or telling about options to move to a comfort measures status. I guess if it does get “easier” it is time to move on.

    On to your story, it reminds me of a 2-year long journey in finding out about growing up across the street with someone who really made a difference in the world. Without going into a lot of detail, that person was Steve Jobs, and I found your words so very true for how I felt and feel about him.

    “But for those he loved and left behind, I hope they know that he mattered. This world is a better place because of him, and I am certain his influence was shared by more people than just me.

    Rest in peace my friend. May the journey beyond be peaceful, and I hope I get to see you on the other side.”

    Thanks again for your thoughts. Debi Wong, NP Hospitalist

    • drdondizon

      Dear Debi,

      I agree- it doesn’t get easier to deliver somber news, especially since every person we have the privilege to meet and care for is an individual and one approach definitely does not fit all. I also have had the same experience where it appears that family and loved ones experience the news so much harder than my own patients. I think it goes beyond preparatory grief on their part- it also taps into the powerlessness of watching someone loved face the end of life, and, perhaps, the sense of just how mortal we all are.

      Your message reminded me of one of my earlier posts for ASCO connection- it was to mark the passing of Steve Jobs.
      Though I never met him, he did change the world (and the way I interact with it). That post is here: http://connection.asco.org/Commentary/Article/id/3050/A-public-thank-you-to-Steve-Jobs.aspx.

      Thank you for posting; it was truly appreciated.

      DSD

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