Tell me, what should I have done differently?
Doesn’t everything finally die, and too quickly?
Tell me, what are you planning to do?
with your one wild and precious life?
The writer in me marvels at how Mary Oliver, the Pulitzer Prize-winning poet, so accurately expresses the question at the heart of so many of my conversations with my patients. Young and old, curable and incurable, in remission and on the brink of death; Each form of cancer is as different as its treatment. But of course what lies just beneath the complicated medical discussions is a search for meaning.
Spoken or not, every patient comes to terms with big questions. What does this diagnosis mean for me? How should I think about the rest of my life? What is important?
December is a somewhat anxious month for me. As the year draws to a close and the lights and baubles come out, I pray that my healthy patients will stay healthy, that the sick will survive the holiday, and that my actively dying patients will avoid dying around Christmas and New Year’s. Regardless of whether people mark the occasion, there’s something more unfair about losing someone when most of the world is on a break.
Patients also worry that their caregivers may be on leave – although sometimes I can’t help thinking that despite our best efforts, the body tends to follow its own rhythm.
Once upon a time, hospitals held an end-of-year memorial service for the deceased. On my first shift, I was afraid I would be the “face” of failure. But as family members mingled with caregivers and reminisced, I felt embraced by a common humanity. It was perhaps the kindest thing we did to ease our grief; Unfortunately, when healthcare becomes a business, such events become history.
If you work in any hospital, especially in a cancer service, every year is an opportunity to take stock of your own life.
Here are three things my patients have taught me this year.
In forgiveness there is peace
Earlier this year I lost a patient prematurely. The demands of the disease put a strain on her faltering marriage, and she subsequently had to juggle death and divorce. When I saw how she arranged the hundred practical matters, I often felt cheated on her behalf. But even within the privacy of our consultations, she didn’t have a bad word for others. When I called her effort superhuman, she smiled and said she was doing herself a favor. In forgiveness lies peace – I will try to keep this advice in mind.
Fortitude is achievable
My patients undergo countless tests and scans, sometimes several times a day. They are faced with unexpected postponements, cancellations and continued uncertainty. A patient’s wife cried as she said that despite all the advances in medicine, the words they heard most often were “let’s just wait and see.”
Fortitude is defined as courage shown over a long period of difficulty. I think this is the hallmark of being a cancer patient, and it shows even in those who think they are incapable of doing it. Among my patients I see the worst poverty, disadvantage and need. And yet they show up and keep going.
Bearing witness to their attitude puts your life into perspective.
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Show grace under pressure
No cancer patient remains unaffected by treatment. From problems with appearance and stamina to the personal suffering caused by sexual dysfunction, incontinence and mental tension, cancer patients have a lot to be ungrateful for. So it is always humbling to see the well of grace that comes from my patients. They carry themselves with an innate dignity and poise that, frankly, is not always evident in others who are more fortunate.
Yes, sometimes they lose their patience, abuse suppliers, make questionable decisions and give new force to the term ‘heartbreaking patientBut overall they are in the minority. I have always experienced cancer centers as places of humility and humanity. If you look closely, inspiration is not hard to find.
Finally, a word for family members, for whom sadness may resurface during this time.
As I was writing this column, I received a call from the husband of a dear patient who said she had breathed her last just as he was going out with their friends.
I remembered her qualities and commented on his dedication. To this he said what everyone says: “Doctor, I only did my part.”
But it would be a mistake to forget the love, dedication and sheer heroism of the family members who become caregivers. Too often, we medical providers fail to acknowledge you – or worse, we ignore your input. We can do better.