I would have graduated from medical school this year. That’s right. Just like you, I’d be getting ready to move to another city and take up residence at an academic medical center to begin my clinical training. Things don’t always work out the way we planned: like Lenny and George in Steinbeck’s, Of Mice and Men. Sometimes, the best-laid plans have a way of going awry no matter how carefully we prepare them.
Cancer. I wasn’t worried. It was just a little mole. Melanoma. Only a few microscopic cells hiding in my lymph nodes. If I was older, I might be concerned. Interferon alpha (a) was the prescribed treatment for an entire year. Recombinant DNA. Ineffective, but brutal: fever, chills, every day, and every night. After the year was up, I went back to being my twenty-something self: working, studying, taking the MCAT.
I don’t have to tell you what happened next. The black vine took root in my lungs. Its tendrils grew, tangled in knots, and I became a statistic. Death came totally unexpectedly. Sure, I knew that pain wasn’t a healthy indicator of recovery, but my fiancé and I kept hoping — waiting for the immunotherapy to work. I’m only twenty-eight. I got this; I can beat it. That’s what everyone kept telling me. You’re going home tomorrow they sang as they walked by my hospital room — except that I didn’t. I went to the morgue. The hard conversation? It never happened. No one ever told me or my family that I was actively dying. No one even asked me my preferences. So before you go out into the world to treat patients, let me persuade you to embrace the only acceptable course of action. If your patients want to know their prognosis, give it to them straight.
Everyone knows there are no guarantees with cancer. But not informing me that my medical status was heading south, well, that was a problem. My doctors, who are undeniably just human, let test results and communication details get away from them as we humans sometimes do. It may even be that one day, in your own human frailty, you will make the wrong call when you are harried and busy and trying your best to take care of everything and everyone all at the same time. You may unintentionally set into motion a series of events that you cannot control, but don’t beat yourself up about it. You can’t let the fear of human error paralyze you. What I would wish for right now, in my case, is for all of the suffering surrounding my death to end. It cannot be undone. So what is the point? Unfortunately, I have no control over the way other people lead their lives. Neither do you. So do yourself a favor, and just let it go.
If your patients want to know their prognosis, respect their wishes and tell them the truth. They may get angry at you, but don’t take it personally. Life is extremely disappointing for them at the moment, and you are a just a convenient target. You do not get to see this patient when he leaves your office and goes home to the loving fold of his family. You do not get to see the rally of support from coworkers and friends. So erase the mental image of the distraught patient that just left your office, and replace it with the patient that you have just liberated from everything that isn’t important to him. He doesn’t realize it yet, but you have just given him a gift that no one else can give.
My dream of graduating medical school would have been out of the question, but I would have really liked to marry the love of my life and taken off with her and two of those travel-around-the-world airline tickets. Time is the gift, and time, when finite, cannot afford to be wasted. It slips away by first one appointment, and then another, and before you know it—never starts looking like a good time to tell your patient that their disease has progressed beyond your control, and you cannot do anything to stop it.
I may look over your shoulder from time to time, but I will never treat a patient, and I will never ease their suffering. The only thing I have to give is my story. I have lived inside the skin of your patients. I have danced in their shoes with hope, and I have walked the same walk in their pain. The simple things are the things that matter. Look at your patients when they speak to you. They chose you to be their doctor. They are afraid of what is to come, but they believe in you, and they trust you. Let them know that you will do the best you can to take care of them, and that you will not abandon them in the end to face what we all fear, alone.
My story ends here. I hope that your story will be that you made a difference in the lives of others. Your success will not be measured by how many patients you treated, or how much money you earned, or by how many titles you held. It will only be measured by the legacy that you leave behind, and how you are remembered by your family, friends, colleagues, and yes, by your patients. Your kindness, your compassion, and your love for your fellow man will define you. Love is greater than all, and in the end, love — it’s all we ever really have.
Colin J. Haller
Linda Haller is founder, Examining the Examiner.
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