Monday, January 28, 2008

salt water wells up

the rooms were full. i was moving through the patients as fast as i could. then it was her turn. she had presented the previous week with a 7cm mass in her breast. she worked in the medical field, so she must have at least suspected it couldn't be good. but sometimes we all hope bad things will just go away. they seldom do.

i had told her it looks suspicious of a cancer but we had to wait for histological confirmation. and now i had it. as i walked her to the room, i glanced at the report. it was cancer.

as a surgeon, i treat many people simultaneously, seeing each one for a short time. i therefore must be able to jump between thinking about someone with mild abdominal pain and someone who is facing death and back many times each day. the trivial and the grave alternate through a typical day. this was grave. i consciously slowed down.

i went through her previous examination with her. i repeated that clinically i had been suspicious of cancer. and then i told her the news, as gently as i could. this is never fun, but i think i do it better than most and i'm always encouraged that it is better for her to hear it from me than from someone with little or no empathy.

she asked questions about treatment options. as i answered i could see her mind wandering off. she was probably thinking about her family and the grandchildren whom she would not be able to see grow up. she was being human and i understood. she asked the same questions numerous times and i patiently repeated the answers.

as she sat there with a far off gaze, trying to hear what i was saying and failing dismally, her eyes slowly filled with tears. she was being brave and my heart was breaking for her. i slowed down even more, giving her time, repeating once again how we were going to fight this thing, trying to give her hope.

finally we decided on a course of action and she left. i took a short moment to get my mind back to the day's tasks and moved on.

i moved on, having seen one more breast cancer patient and broken the news once more, but for her, she had just experienced possibly the single most devastating moment in her life.

sometimes our work is very sad.


rlbates said...

Yes, sometimes it is very sad. Thank God for the times when it is not.

TeacherLady said...

I have always felt that the saddest experience is the moment when bad news is shared and someone goes from a state of naivety, happiness, and blissful ignorance to that horrible state of knowing. It's that instant of loss and realization that is so crushing.
I'm sorry to have to be a part of that more than most.

Sid Schwab said...

well said. both in reference to the sadness, and the fact that we must dance from one scene to another as if nothing had happened.

Bongi said...

sid, the idea of juggling between multiple small parts of dealing with many conditions simultaneously was part of what i was trying to address. the way we are taught (meaning going through a complete condition from beginning to end) and the way we practice (diagnosis one day and treatment on another with many snippets of other patients in between) are in sharp contrast.
and yes sometimes when you are discussing an ingrown toenail with a patient it is difficult to shake the thoughts of the patient who died in icu last night from your mind.

as they say, in theory there is no difference between theory and practice, but in practice, there is.

Bongi said...

teacher, yes, but knowledge is power. to have a cancer and not to know is far worse than to have a cancer and to know, thereby being able to at least take action. i actually empower patients by informing them. that doesn't make it easy, though.

ness said...

Your pictures are awesome and your stories are captivating. I like your weblog.

Anonymous said...

Well blogged. But forgive me if I say that based on the few times I have been a patient, I would rather have someone other than the doctors I have had, be there with me. Something about the not enough time. And I have had relatively little of importance to deal with. So thank you for taking some time in a busy day to deal with someone and acknowledging that might have had one of the most important messages ever that day.

Can't get this thing to accept the message.

-borneo breezes

Dizzy Dee said...

This is such a sad disease. I find it absolutely devastating to just read this story. I also read a book (fiction) about a Mom who had breast cancer, and eventually died. Its a very sad journey, which sometimes has a tiny ray of hope shining through, but just as soon as you find the courage to believe again, it hits you back even harder.

My empathy to all the women (and men) who have been affected by this horrible disease. And I pray that it doesn't affect someone who is close to me. Or myself.

Greg P said...

I saw a man today, that I am reasonably certain will be sometime soon telling him he has ALS -- amyotrophic lateral sclerosis. And thus, I will be telling him what he is going to die of, no maybe about it. And will watch his reaction, his wife's reaction, and we will spend time together until they both look a bit less stunned.
Then I will see him back several times, watching his muscles slowly melt away, while I order speech therapy, and swallow evaluations, and various pieces of equipment as he needs them, until he needs nothing ever again.

Anonymous said...

Those of us that get diagnosed with these various things, appreciate the doctors like you, that slow it down and can understand the impact this is going to have. We know we are not the only patient you will have in your day, but the way in which we are told will stay with us. We may not remember every word, but we will remember the manner in which the news was delivered, and the compassion shown to us. I hope you never lose that empathy.

Anonymous said...

As a patient who recently received a need for surgery/possibly cancer diagnosis, I just want to second what others have said: that your empathy and your patience will always be remembered. Obviously it won't stop the tears, the straying thoughts, the barely-bottled panic. But your gentleness will be as well remembered as the diagnosis itself.

Amy said...

Interesting post. The ENT who broke the news to me was more uncomfortable than I was! I had researched lymphoma before my biopsy, and was pretty sure I had it. The DLBCL it showd wasn't the worst case scenario to my mind, but the doctor was obviously waaay out of his comfort zone.

BTW, today is World Cancer Day. Funny, to many of us, every day is cancer day... Check out my blog for more.

Anonymous said...

I think doctors often underestimate how powerful listening and compassion are. Especially in a situation where cure is not possible and drugs can't make the bad stuff go away - there is still the possibility of a healing of the mind and the spirit.

I believe you helped your patient on many levels.

Jeffrey Parks MD FACS said...

Knowing when to slow down and listen is a big part of a physician's development. Good post.

Lisa said...

You get it. You absolutely get it, and that is probably what makes you better than most at breaking that kind of sad new.

Maureen Hayes said...

Repeating what has already been stated, but how you delivered the news will be remembered as long as the news itself. Thank God for good doctors like yourself, who take the time to slow down and realize this is a person, not a number or a chart, and lead with compassion.

I am sorry for the sadness of your job, but grateful for the humility in which you perform it!