Sunday, December 26, 2004

Saying Goodbye

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 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.


At 9:52 PM, Blogger Dot Bar said...

Thank you for that touching and insightful entry. I don't think I will ever look at doctors in the same way again.

At 11:46 AM, Blogger Orac said...

I, too, have been torn up on a few occasions by this very experience. One in particular was very painful and happened only a couple of months ago. I don't have to deal with this as much as a medical oncologist does, but surgeons do occasionally have to deal with it. It may be worse for us, because we tend to deal with cancers that can be "cured" surgically.

At 4:45 AM, Blogger Nurse Mia said...

I think it's okay for doctors to show grief. As a nurse, I have had tears fill my eyes during certain conversations with family members. I think it shows that we care. As long as we do not fall apart and start bawling, so that they must comfort us, of course. :-)

At 6:14 AM, Blogger Internal Medicine Doctor said...

"tears of a thousand deaths"

You do an amazing job. horrible, emotionally taxing and unbelievably difficult.

having said that, beautiful post. thank you ofr writing it.

At 10:33 AM, Anonymous Anonymous said...

I am not sure how to phrase what I am asking, but, how does your faith affect how you speak and cousel your patients during these times. Like your post earlier about the gentleman who "expected to be healed", I imagine it must be hard to counsel and console patients whoose belief systems are different from your own...

As an example, I once helped care for a patient who often proclaimed herself "a devout atheiest" at the very end of her life. Two extremely religious nurses were quite bothered by that, and went too far (in my opinion) in trying to "convert" her before her death, moving from trying to comfort, to badgering. How do you keep a check on your own beliefs (if that question makes any sense at all) when dealing with a dying patient?

At 10:37 AM, Blogger Dr. Craig Hildreth said...

To DisappearingJohn:

I'll leave the converting of souls to the proper religious personnel. My mission is to serve all - believers and non-believers - with equal respect.

At 3:39 PM, Blogger Sally said...

I have been the patient doctors and nurses visit knowing possibly it is the last time they may see you. Nurses especially are more emotional, they see the patient for 20 hours or more. Doctors are a little more distant because the patient is seen in the abstract. But, they both put on a cheerful costum, not meaning to give false hope but to give the patient and their family cheer or comfort. I have seen them outside my room gather to gain the...courage to enter my room without tears.

At 9:08 AM, Blogger angela marie said...

I had more to my comment on the 'Angry Husband', but it didn't post for some reason.

I wanted to also say that I really like your blog (I work in oncology also) and I am glad I came across it.

May I add you to my Blogroll?

At 7:58 PM, Blogger Alicia said...

Thank you for this insightful look into the mind of doctors. I am a 10 year cancer survivor and wouldn't trade ANYTHING for my illness and things I learned during it. I have always wanted to know what the men and women on the other side think of cancer and death, always afraid to ask. Please keep sharing, it will help the world remeber that doctors do struggle with us.

At 12:41 AM, Blogger Beth said...

Ditto to everything Alicia said! (I'm a cancer survivor too.) Very touching.

Thanks for letting us know that you don't get completely hardened to the things you see every day; it means a lot to know that despite the professional demeanor, you really do care about the patients.

At 9:13 AM, Anonymous Julia said...

I just found this site. 3 years ago I was the one sitting next to that bed. And there were his onc and social worker giggling about whose pager just went off.
Thank you.


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