Have you ever wondered what is on an oncologist's mind when he visits a patient for the last time?
No matter how sympathetic he is, someone in my profession who constantly views the face of the dying must eventually become inured from heartbreak, or otherwise risk losing the ablility to carry on with his duty. I too have learned to fashion a mask of impassiveness, molded from years of exposure to patients lost, to be worn at the hour of greatest sorrow. I dare not walk into a hospital room without it for fear of embarassing myself with a maudlin display of emotion, which could be interpreted by the family as a sign of irresolution or frailty. It is better to play the role of the "professional" at all times.
Surely therefore I pride myself on my ability to stand far away from grief - all the better to not be harried by it as I attempt to continue on with my busy day.
Surely I can minister to the dying without fear of breaking down this facade of calm concern.
Yes, surely I can - but the price paid is horrendous.
My face may appear composed, but let me share with you the truth: trapped within it are the tears of a thousand deaths. No oncologist can call himself a true professional who does not weep for the loss of life wreaked by this curse.
I weep for my patient who lies helplessly in a room he didn't ask to live in.
I weep for the person who sits by the side of the bed, stunned by the awful transformation of a spouse, parent, or child.
I weep for pain of not being able to do anything further to save a life.
Sometimes my breath is taken away by the awesome power of this disease to spirit off a good soul - away from a life no longer whole.
At the final goodbye, if the patient is conscious I will speak to him or her, ensuring that pain is under control. What should be said to the family is said: thanks for all their loving care, reflections on the life of the patient and on the relief soon to come. It is an emotional meeting and I find myself pausing, waiting for the ability to continue with composure - loyal to the code of the unflappable doctor. It is a time for a hand on the shoulder or a handshake, or a hug.
Inside I feel as if a part of me was left behind in that room...as if cancer has exacted its price also on the doctor who dares to defy it. If this were true, the day would soon come when there were no more oncologists, for after scores of goodbyes we all would eventually drain away, sealed forever within the memories of those we served.
Fortunately oncologists draw our strength from an inexhaustible well, for day by day as we give of ourselves to our patients, from them are we replenished.