would be when she was dead.
Albeit this patient passed away from other complications (in other words, her cancer did not sneak up and grab her suddenly in the middle of the night), the case for me serves as a metaphor for how unpredictable cancer is. More literally, it served as a wake-up call. As terrible as it may sound, this case is what it took for to me to register in my mind what these patients are really up against.
A couple weeks earlier, I sat down for a chat with my mentor. It was one of our meetings together that particularly stands out. She described the difficulty of not taking the "baggage" out of the room--in other words, not feeling personally responsible for the fact that most of (certainly not all, as we like to believe that miracles can and do happen) these patients will ultimately die as a result of their disease.
In fact, I was having the opposite problem. I had no feeling of baggage as I left the room, nor was I emotional (unless the patient was emotional; I guess I suffer from sympathy pains). While some may argue that aloofness is an important trait for a future doctor, I was disturbed. Am I heartless? Why can't I bring myself to understand that these people are dying?
But when the above patient passed away, all of the naïveté that I brought with me to the job disappeared. I guess I never really believed that these people would actually die--at least not within the ten short weeks I was there. Like a little girl holding on to her beliefs in the existence of the tooth fairy, the notion that everyone is a good person, and the fairytale that the world is a fair place, I held on to my hopes that these people would not die. I built a wall between myself and the fact that they would die so I would not have to acknowledge it. But my wall came crumbling down pretty hard.
I guess I've gone on a major tangent, but maybe it's not so big. A day in the life...well, to be honest, there's no one day that describes all days. We're up against something different everyday. As my mentor pointed out, two lung cancer patients could be the same age and stage, and yet their stories are likely completely different.
So on the days that I'm in clinic (Mondays and Wednesdays; the other days I work on my data collection project described in the first post--which is also very fulfilling), it's impossible for me to tell how the day will go. Every patient is different, and every family is different. Some take bad news better than others. On the other hand, some need to be told to be "thrilled" at good news.
As I watch my mentor in the room with patients, I am amazed at how calmly she lets emotions flow. This goes back to another one of our meetings together when she described to me how she has learned, over the years, to let this emotion flow. To paraphrase her, it's important to let patients and family feel what they need to feel. The anger, raised voices, tears, and yes, sometimes, name-calling cannot be taken personally, because they are not meant to be. Everyone has different coping methods. In the case of bad news, it's a hard thing to do, to sit with a white coat on and face, with wide eyes, the patient and family who often have a subconscious perception of you as the "angel in the white coat." But doctors don't have angelic powers; they're just people.