He sat there holding his wife’s hands and hugging her as tightly as he possibly could. Tears were streaming down her face, and she was vulnerable to the diagnosis I had just bestowed upon her. Cancer, the “C” letter word nobody wanted to hear, suddenly invaded the lives of this newly married couple.
Multiple thoughts were running through my mind before bestowing her this fatal and life changing diagnosis to her: How do I tell her she has metastatic end stage pancreatic cancer caught tragically late? Do I proceed to the point? How many family members should be present?
As a hospitalist physician who has invested many years of her life in medical school and ultimately residency training, nothing really prepares a physician for this moment. Yes, I can diagnose myocardial infarctions, recognize superior vena cava syndromes , manage diabetic ketoacidosis and more. Even the National Practitioner Data Bank and DEA give me full reign to prescribe a whole slew of medicines and narcotics to aid in making patients healthy and pain-free.
Yet, this pancreatic cancer was a death sentence that would ultimately create emotional trauma in the patient and the family she would leave behind. All this weighed upon my shoulders as I walked into her room and pulled up a chair beside her bed where she lay resting.
The dialogue ensued as follows:
Me: Sarah, I have the results of your CT scan.
Sarah: Yes, doctor?
Me: (I proceed to sit down next to her … to be eye level with her.) My face is serious as I look at her and say, “Unfortunately, the CT scan shows more than we expected. (Long pause.) It reveals a large pancreatic mass with multiple lesions throughout your liver and lung.”
Sarah: (Her husband proceeds to grab her hand and cries out.) Is it cancer doctor?
Me: I am afraid so. (My voice begins to tremble.)
In a matter of a few minutes, this patient’s life was turned upside down. She begins to weep into her husband’s chest but somehow manages to thank me for taking care of her for the past week and being “one of her nicest doctors.” She even stands up to hug me. I leave the room really quickly with tears forming and sneak into the bathroom as I begin to cry.
Now as a physician, is it wrong to cry? I don’t think so. We are humans and not God. We visit each patient on our daily rounds and form relationships with each patient. Each patient is either a mother, a father, a daughter, a son, a farmer, an accountant, someone who is stubborn or noncompliant and the list goes on. In Sarah’s case, a woman stricken with end stage pancreatic cancer; she was a school teacher and a mother who recently married the “love of her life,” as she proudly described her new husband to me one day.
There is only so much in our medical arsenal that we can do. And when we run out of medical tools, medicines and interventional procedures to save a person life’s, we physicians feel helpless. Yes, we should distance ourselves emotionally if it affects our medical decision-making but when it boils down to patient care, feeling for a patient and his or her family makes medicine humanistic and real. Being a physician is unique and unlike any other profession out there. We are in the front lines entrusted with a huge responsibility to keep people healthy and to keep people alive. When patients die, and it is out of our control, it certainly is OK to cry. It is good for the soul and all in God’s hands anyway.
Lizbeth Marie Hingst is a hospitalist.
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