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‘You’ll be a better doctor for this one day’
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In the spring of last year I experienced a difficult personal loss. As I sat on a couch in a hospital room, an attending physician looked at me squarely and said to me knowingly, as a peer as much as a physician, “You’ll be a better doctor for this one day.” I thought that intuitively he must be right, but all I could feel at the time was a deep and lonely ache and a very personal connection to human suffering.
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Back at work, things seemed a little, but maybe not dramatically, different than they were before. I lingered longer over conversations during clinic visits, asking more questions than I used to about my patients’ friends, families and hobbies at home.
A few months later, one of my patients was admitted to the hospital for chemotherapy in preparation for a curative transplant. I’d known this 29-year-old young man throughout my entire first year of fellowship, and had come to love his humble and understated approach to life, his devoted and supportive wife, his beautiful two-year-old daughter who proudly showed me her artistic skills with colored pencils. Things went well at first. I came to visit him many days, and he pleasantly told me that his experience was “easy” and “much better than he thought it would be.” Even when he eventually developed neutropenic fevers, he continued to eat and drink, to walk around, to smile and to look well. I wasn’t sure how to help; I wasn’t on the inpatient team, though I was around a lot, and worried that I was hovering and pestering my colleagues.
One day a chest X-ray showed a clear abnormality, and a CT scan uncovered a necrotizing lobar pneumonia. The patient became tachycardic and mildly dyspneic. He was transferred to a step-down unit, and I grew increasingly anxious. Nonetheless, after a few days he appeared to start turning around. I left for a conference for the weekend.
On arrival back home late on that Sunday night, I called my wife to tell her that I had safely landed. She worriedly told me that someone from the hospital had just paged me and said it was important. My patient had been transferred to the intensive care unit, where he was intubated, on pressor support and was actively dying.
I didn’t think long and hard about what to do. I rushed home, changed into a dress shirt and slacks and arrived at the hospital a little after midnight. I looked in on my critically ill patient and led his terrified mother and brother into a small family conference room. I tried to interpret for them what was going on even as I tried to understand it myself. As I answered their questions, I realized that sometimes I was thinking aloud. After embraces and promises to return soon, I returned home and crawled into bed in the early morning.
Dinner conversations with my wife over the next few nights revolved around that day’s clinical events and my visits to the ICU, the status of my patient, and my conversations with his family. Sometimes during my visits I’d perseverate with the inpatient critical care team over my thoughts and suggestions about his medical management. I pored through the chart, compulsively followed labs and vital signs, phoned consultants, talked with my transplant attending, performed multiple literature searches, and looked for answers. Sometimes I’d just spend time by the bedside, rubbing a shoulder, holding a hand, sharing a prayer.
A few days later, I was paged during clinic that he died. I felt an overwhelming and familiar deep and lonely ache. My heart felt especially heavy as I walked across the street and found his family in the hospital lobby on their way to leave the building for a last time. I hugged my patient’s mother and wife and gently touched his little daughter’s head, saying over and over that I was so sorry.
As I write this, I think back to my own experience last spring. Not long afterwards, I’d spent an early evening with a palliative care geriatrician who was one of my mentors in medical school. He told me then that having experienced suffering, I would learn to understand it better for my patients and families who would experience it too.
Now, I look forward to my own future. In the immediate aftermath of my patient’s death, I thought that I wasn’t cut out to be an oncologist after all. Later that night and the next morning, I felt exhausted but started to feel at the same time stronger and more complete as a doctor and as a person for having so passionately fought the good fight and for having experienced human empathy on the deepest possible level.
In honor of my loss, of my patient’s death and of his family’s suffering, maybe I have become a better doctor after all.
Bill Wood, MD, is a second year Hematology/Oncology Fellow at the University of North Carolina Chapel Hill and is a member of the HemOnc Today Editorial Board.