‘Now I’m crying because you’re sitting there.”
“I’m sorry,” I say, preparing to jump up.
“No, please stay!”
This is our first meeting. “There” is at her feet, tucked to one side of her hospital bed to make room for me. She has been questioned and poked by all kinds of doctors. “From the moment I saw her, I knew she needed you,” the last of her specialists told me.
Oncologists like me are not flattered by such statements: when they are called to a patient at the end of a recording, it is to deliver the worst kind of bad news. Or rather, to compile the fragments of bad news into a compelling statement and confirm what everyone has been hinting at: the disease is serious and the prognosis is serious.
She’s a wife, a mother, and the kind of friendly person you can easily imagine delivering just-baked cookies to a friend or offering to babysit the neighbor’s baby.
After weeks of research into recurring cancer, she is despondent.
One surgeon places her on the operating list. A second, junior surgeon is not convinced, but keeps his mouth shut. A third surgeon, who was supposed to perform the operation, cancels it and I understand why: although an operation is technically feasible, the most predictable outcome would be a prolongation of the hospital stay, with the risk of wasting the precious time left of her life .
She has a clear understanding of her impossible situation, but still filling in the gaps feels punishing. I tell her that the surgeon was right to spare her the useless surgery.
We discuss that chemotherapy does not help. She asks how long and then adds that time is short. I touch her arm, swallow and nod.
And then she cries. Tears flow from her eyes and slide down her cheeks to the back of her sleeve. I look around for tissues; she tearfully jokes that we are in a public hospital.
But here’s the thing. She’s not crying because I just admired her unparalleled poise. She doesn’t even cry about her prognosis or the fact that she won’t see the grandchildren grow up.
She cries, she says, because kindness melts her.
There sat a surgeon, she says with a grimace, pointing to the windowsill. From his spot he spoke quickly and loudly, telling her that she was dying and apparently wanted the “whole world” to know. While he was talking, he took a phone call – she had found his cheerfulness unforgivable.
In contrast, she argues, the junior surgeon was professional And friendly. He had pulled up a chair and made eye contact. His honesty and warmth were so comforting that she memorized his name. Her eyes light up – just like mine, because she happens to be describing my friend.
I first met him when I tried to talk a dying patient out of surgery, but didn’t get far. At that moment he arrived and after waiting for me to finish, he gently took the man’s hand and said, “If you were my father, I wouldn’t want you to undergo surgery.” His gentle tone settled the matter and I remember thinking that if there was ever an example of a healing touch, this was it.
My patient is crying again, and she tells me that she is now crying at the memory of a single incident that will define her stay.
One morning a crowd of doctors stood by her bedside. As the boss rained bad news on her incessantly, everyone was speechless and she felt suffocated by fear. Then she saw a young man crying at the back of the crowd – “and suddenly I felt better.”
He returned to introduce himself as an intern and talked about how much the bad news had affected him. He sat down and talked to her about her health, her children, and her dashed hopes. Here was the person with the least agency taking the most time; according to her, he stood out as the best doctor of the bunch. (Later I’ll find the intern and tell him.)
I’m deeply moved, but part of me still can’t help but think that the surgeon who canceled the surgery deserves some credit. I indicate that he made the right medical decision, but that he may have felt anxious during a difficult conversation, but my explanation does not hold water. She was not privy to the decisions made behind the scenes, but only saw how she was treated.
Her account underlines an important attitude among patients that doctors often overlook. We like to think that patients judge us on our medical acumen, but in reality they observe the words we say, the empathy we show, and the kindness we offer. This is a lesson as abundantly available as it is difficult to absorb.
It illustrates the continuing disconnect between how doctors and patients view what really matters in medicine. Doctors are trained to think too much and feel too little. Our patients know that we think enough, but want us to feel more. While technology, machinery and bureaucracy overwhelm us, the essence of good medicine remains an open secret.
Days after we meet, the loose ends are tied up and the patient prepares to go home for the last time. She assures me that she leaves with a light heart, which seems impossible under the circumstances but is a testament to her character. She thinks that she will always remember the warmth that I and others showed her. How telling it is that we have come nowhere close to prolonging her life, and yet her overriding response is one of gratitude.
The ancient philosopher Seneca knew this when he said, “People pay the doctor for his troubles; for his kindness they are still in his debt.”