The doctor-patient relationship is even more complex than you think


asco-logo I am often asked by friends and acquaintances how I am able to do what I do for a living, which is care for patients with advanced lung cancer. Depending on the setting and how well I know the person asking, I might say that the treatments are improving all the time (i.e., the casual dinner party response), that the research into lung cancer is very promising (i.e., talking to the family over the holidays) or that I want to help people who are suffering (wait, I think that was my med school admissions essay). While these are all true, the reality is that this can be a terribly emotionally taxing job and that the real reasons can be hard to define even to myself. Luckily I don’t have to look far for reminders.

I recently met with one of my patients, a bubbly elderly woman who as always was accompanied by her devoted husband, to discuss enrolling her on hospice. I first met this patient seven years ago in 2008, very shortly after I started here at the Taussig Cancer Institute. She had metastatic non-small cell lung cancer, and although she was frightened by the diagnosis, she was never anything but positive and optimistic about the future. More than that, she always took the time during our visits to inquire about me or my team. How were we doing, how were our families? My wife was pregnant at the time and in those early days as my patient embarked on treatment I shared with her the experience of being a first-time father, and of being a first time attending at a big cancer center.

Over the years since then, at every visit she would talk about not just her cancer but her life, her faith, her struggles with depression. And every visit, even the ones when the scans weren’t good, or the treatment left her feeling ill, she would end with a request to see my son’s latest pictures. She has gotten to see him grow from a newborn through lost teeth and starting kindergarten, while I have seen her deal with chemo, radiation, surgeries, miraculous recoveries, and not so miraculous recurrences with incredible grace.

On this final visit, more really to say goodbye than to discuss her cancer one last time, I looked around for my nurse and PA, sure they would want to see her. I eventually found them already in the room with her, baby pictures out and being duly appreciated. She had no more questions, was ready to go home and had big plans for what she wanted to do with the time she had left. And when the question inevitably came up, I had my son’s latest school picture ready. Of course, it was sad, but it was more than that. It was a time to savor and appreciate the relationship that had grown over the years, the kind of relationship that is the real reason I became an oncologist and why I continue to look forward to coming in every day.

As doctors, we are supposed to be the ones providing support, the rock that our patients can cling to in times of trouble. The reality is more complex, that in many ways we support each other. Over the years I have given a lot of myself, but have gotten back much more in return.

Nathan A. Pennell is an oncologist who blogs at ASCO Connection, where this article originally appeared.


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