Mr. X. is a man in his 80s who was cured of his cancer. The question remains: at what cost?
The biologic therapy and radiation which eradicated the cancer left him with the inability to swallow and need for permanent PEG tube. Due to overall frailty and multiple comorbidities, he never graduated from the SNF and continues to reside there today.
I inherited his care after he completed his definitive treatment in the metro area, two hours from our community, and he wanted to have a local oncologist follow him to avoid the trips back and forth. A family member came to the initial visit but has not accompanied him since. He talks about the busy work and lives of his children, and he does not begrudge them that they do not attend his appointments any longer.
He is several years out and thus to be considered a success of cancer therapy. However every time I see him, I wonder about his quality of life, and if he would have chosen this path if he would have known it was going to cost him his independence.
On his most recent visit, I was running behind in the clinic day (not an unusual occurrence). As my MA handed me the chart, I told her to go ahead and room the next patient in 10 minutes, to try to make up some ground on the schedule, telling her my visit with Mr. X. would be quick. I should have known better.
In the course of our usual discussion about his tube feedings and his daily routine at the SNF, he suddenly blurted out that his divorce had been “the biggest mistake of his life.” He shared with me that if he had to do it over again, he had no regrets about his medical decisions, but it was the demise of his marriage, which had ended years before the cancer, that was his biggest regret.
As the visit went in this unexpected direction, I simply listened as he told me more about his life as a younger man. I knew it had been way longer than 10 minutes when I finally exited the room. I gave my MA an apologetic look as she handed me the next chart.
As I rushed to complete the EMR depart process so I could move on the the next waiting patient, I realized that there were not many boxes to check or diagnoses to bill for. I thought about how from an administrative standpoint this visit would not meet criteria for meaningful use.
It crossed my mind that although there was no checkbox in the EMR for it, the visit was obviously meaningful to Mr. X.
It had been important to him that I know that at one time he was a productive, successful man, and not the current shadow of himself, elderly and frail, alone and living with deep regrets. Although it did not sound like he had reconciled with his past as of yet, perhaps the extra time the cure of his cancer has provided will ultimately allow him to do so.
It had been important to me that I had provided him a safe space to share these things.
I think when we can provide this kind of care, it also checks off something inside us that sustains us to go on to the next patient.
Wouldn’t it be great to see some checkboxes like this in the EMR?
- Listened to my patient and learned something about him/her that tells me more about who he/she is as an inner person.
- Restored my sense of purpose as a physician by being present for my patient and allowing them to trust in me.
- Renewed my inner spirit by connecting with my patient’s inner spirit.
Jennifer Lycette is an oncologist who blogs at the Hopeful Cancer Doc.
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