On Medicine and Mourning - The Post I Meant to Write for Father's Day

"The good thing is, it'll make you a better doctor."

This was the response that I got from an attending after I told her about my father's newly diagnosed melanoma.  I wanted to hit her.  There couldn't possibly be a "good thing" to the fact that my dad, the man who had been there for me since I was born, had been given a life expectancy of six to twelve months.  Or to the fact that my fourth year of medical school, which was supposed to be filled with the excitement of away electives and applying for residency, was instead going to be filled with the uncertainty of when and how my dad was going to die.

Besides, it absolutely wasn't true.  If anything, watching my father die was making me a worse doctor.  It was making me distracted, barely able to focus on what was being said at morning rounds because my head was filled with the results of my dad's latest CT scan or a mental image of the lymph node on his neck that was becoming increasingly swollen with metastatic cells.  It was also making me angry - like the time a patient on my Plastic Surgery rotation complained about how many surgeries he had been through to remove basal cell carcinomas (relatively benign skin tumours) from his face.  "Oh yeah?" I thought bitterly.  "I'm sure my dad would trade his deadly skin cancer for the inconvenience of your stupid little basal cell tumours."  Being a dutiful medical student, I remember choking down my bitterness and muttering encouraging words through clenched teeth before ushering the patient out of my examining room.

And it was causing me so much pain.  Going to work some days was like going out into the world with no skin, vulnerable to every insult, immune to nothing.  While on my emergency rotation, I was assigned a patient with melanoma who had the same doctor as my dad.  As she told me her story - from unexpected diagnosis, to surgery, to one clinical trial and then another - I felt like I couldn't breathe.  Here was my dad's story, so closely mirrored in someone else, and just like with my dad, medicine had nothing to offer.  We could palliate, relieve her physical pain, but there was absolutely nothing we could do to keep her alive or to ease the real suffering of her or her family.

For more than a year - through the seven months before my dad's death and the long months that came after - I hurt for every patient I treated.  Diagnosing a young man, younger than myself, with a terminal brain tumour left me walking around for days raging at the unfairness of it all.  I would show his scan to classmates and attendings, tell them his story, hoping that someone would give me an explanation for how screwed up God must be to make tumours grow in young men's heads.  Months later, in oncology clinic, I felt like vomiting while examining a fungating mass on the breast of a woman born in the same year as I was.  It was all so bloody unfair, and I couldn't let it go.

Fortunately, the mind has strong instincts for self preservation, and it will only allow a person to torture him- or herself for so long.  I vividly remember the moment I started to surface, to come up for air from the bottom of the deep sea of grief that I had been suffocating in for far too long.  I was faced with another sad story - a previously healthy man whose bone marrow was now packed with leukemic cells, a death sentence for someone his age.  If statistics held true, he would have even less time remaining in his life than my dad did at the time of his diagnosis.  Speaking with him and his wife, hearing him ask the question "Why me?" that my dad had asked so many times, I could feel the usual tears welling in my eyes and the lump in my throat growing bigger.  And then, in my head, my own voice, clear as day, said "This isn't about you."

The grief that they're feeling isn't yours; it's theirs.  The shock isn't yours; it's theirs.  This isn't your dad's story, played out one more time; it's their story.  And your role isn't to cry, or to shake your fists at the sky in anger; it's to be a doctor.  

"This isn't about you."  Four words that saved me.  Four words that somehow allowed me to put aside the pain, put aside the grief, and go to work each day and be a doctor.

And now, despite my anger at what the attending said to me in the beginning, her words are beginning to come true.  Having been through what I have, having born witness to my father's suffering, is indeed starting to make me a better doctor.  A few weeks ago, I sat in the same emergency room where I had trained as a medical student, now a first-year resident sitting across from a patient with terminal lung cancer who was mere days away from death.  Where others would've admitted the patient quickly and then left the room, justifying their haste to themselves by thinking of all the other things they had to do before the night on call was over, I was able to sit with him for a few minutes and offer comfort.  Because I had seen how afraid my father was of death, and how alone he was in that fear, I knew to stay with this man and to address his fears as best I could.  It wasn't as good as offering a cure, but it was something.

Edited to add:  This post was recently selected for inclusion in the latest edition of Grand Rounds at Fizzy's Cartoon Guide to Becoming a Doctor.  If you're visiting the blog for the first time, I'd love it if you'd leave a comment so I know who's reading.  Welcome!