Rainy Day, Wednesday: How an Oncologist Deals With the Death of a Cancer Patient
I've been silent on my blog for a while - many busy weekends on call, many other professional commitments. Not much personal or family time, I might add, but I will start writing faithfully again and will try not to take any hiatus in the future.
Today it's raining in the Bay Area. As I drove into work the rain beat down, and I was listening to "Dusty in Memphis" as I drove. And I felt sad; at first with no particular thought behind it. The music made the sadness a little better, I suppose.
Then my thoughts drifted to some patients who had passed away. First was a man who passed away this week - a young and wonderful man - fighting until the very end. And then I thought about a patient from my former practice in Annapolis, a woman with breast cancer.
This woman was a favorite of the practice; she had been on Herceptin for seven years and came in weekly for treatment. I was her third oncologist in the group. Her first left practice to teach high school chemistry, and she left her second oncologist for me, for whatever reason had struck her. She was a beautiful woman, kind, cheerful, spirited and courageous. I found out she had passed from an email sent by my former nurse.
Before I took my hiatus from writing SharePosts, there was an article I was supposed to review. The article reported that physicians dealt with patient death badly, quoting some horror stories of insensitive physicians and saying there was a need for training. As for physicians lacking kindness and a bedside manner, I think they're the exception, based on what I've seen. As for the latter - that there is a need for more training in how to deal with death and dying, I agree. Two things could be taught better: how to deal with the dying patient, and how to personally deal with death and dying.
My medical school was forward-thinking in incorporating a humanistic approach, and this article implied that the "old school" approach didn't require dignity in patient dealings.
During fellowship I once asked an attending to let me watch as he told a young man his prognosis (which was dismal). The doctor skirted the issue, and I didn't learn much. And I was dismayed that this particular attending didn't have it in him to be honest with the patient. He was not one I learned much from about dealing with death and dying.
When I was a resident, my mentor had a wonderful bedside manner, and I tried to mirror him and explore how he dealt with death and dying as an oncologist. He was literate and thoughtful and has been a solace for me. I still am in touch with him, and when I see him at a conference, his wit and sparkle always makes me feel good again about my career choice.
I've been fortunate in that all the doctors I've worked with in practice have been kind, and we all feel deeply, deeply sad when a patient passes away. It's always hard, and harder the closer one is to a patient. But that doesn't mean doctors need be emotionally detached and again - I've been fortunate in that all my partners have been able to strike that balance of emotional attachment, but still being objective in their care.
It is very hard when a patient passes away. It is balanced out by the patients who are cured, but it always affects me. Lately it's affected me much more than it used to - and I'm not sure why. And, it's still raining outside.