Nightmares of an Oncologist

You don't hear much about this in the media and therefore, dear reader, perhaps you have concluded that the mood of doctors is calm and secure, but let me reassure any doubters out there:

The practice of medicine still is intellectually and emotionally grueling.

Far be it from me to whine about a career that I enthusiastically volunteered for, but would it be fair to allow me to "share" with you some examples of why oncologists sometimes do not sleep restfully? It isn't just because so many of our patients succumb to their illness. It is the way in which such a life was lost - the slow, relentless deterioration of a once healthy being - that breeds fear, anger, distress, pity, and hopelessness in both the patient and the doctor. I suppose these emotions are not unique to my profession, but are they encountered on a daily basis in other specialties? Wouldn't such continuous exposure to sorrow turn any oncologist to ashes?

Well, maybe not - this stress hasn't broken me yet and doesn't appear to be crippling our profession, as cancer providers are more confident than ever in the many new treatments available.

Even so, there are certain traumatic events in the professional life of a medical oncologist that haunt slumber. They are the oncologist's nightmares. They have visited me in my past.

I await their inevitable return with patient frustration.

Rather than dilate upon this any further, let me illustrate, with a brief explanation of their effect, the four worst nightmares of my career:

Patient Suicide: Three times in my career have my patients violently taken their own life after being diagnosed with cancer and before receiving any treatment. One of the patients had an indolent lymphoma, which is associated with years of remaining life. Why, I asked myself did he do it, especially after I told him about his relatively good prognosis? My initial shock of each patient's death led me to blame myself - I felt that my counseling skills must be pitiful if this is the result of a visit with me.

Treatment-Related Death: I have sat by the side of a smiling patient receiving chemotherapy on a bright afternoon only to be standing helplessly next to her in the ICU at 3 A.M,. as she dies of septic shock. Oncologists cannot predict with exact precision which patients will survive treatment, so we must use our best judgment in choosing a course of care, sometimes treating those with a higher risk of complications. Whether a patient is lost due to infection, pulmonary embolus or renal failure the end result is the same - we have failed in our mission to kill the patient's cancer, and we feel worthless.

Hostility: There is nothing more traumatizing for me than to have to meet angry people and try to convince them that I am the one to entrust the care of their loved one. It is a miserable experience to deal with hostile patients or families, and feels like trying to hold a discussion in a burning building with a gun pointed at your heart. The reason why it upsets us so much is not their ire, which is easy enough to understand, but because we often get irritated at being treated in such a manner, and an angry doctor is a inferior healer.

Irreversible Decline: How would you like to take a job where you meet delightful and interesting characters - former World War II veterans, teachers, grandparents, retired musicians, book lovers, ministers - and get to watch them slowly, inexorably lose their appetite, energy, weight, strength, hair and ability to share their lives with their loved ones? I realize this is what every caregiver and family member must suffer when their beloved is afflicted with cancer. It is a tragedy beyond measurement. An oncologist, however, feels that he or she has the power to stop this misfortune - if only the right treatment was given at the right time, with the right amount of luck or heavenly blessing. So we offer treatment, and if it is ineffective, if death then begins its unrelenting assault, gradually transforming robust flesh into a gaunt visage, and all we can do is watch it happen...

That to me is the oncologist's worst nightmare.

Since I have not named this blog The Frightened Oncologist, you may ask "How do you reconcile these distressful aspects of practicing medicine with your chirpy title?"

Ha!

Ever heard of the term fortitude? "Strength of mind that enables a person to encounter danger or bear pain or adversity with courage."

That, my readers, is the secret - if you don't have fortitude, you won't last long in this profession. Fortitude is the power that allows an oncologist to extract himself from the wreckage of discouragement, find another bicycle, and begin again to pedal uphill toward the place where his responsiblity and his patients await.