perspective

i've had the privilege / dubious honour of spending four weeks on an oncology ward, and this week on oncology outpatients and at a hospice. oncology is relatively unrepresented in our curriculum so i'm fortunate to have this bonus time in a discipline that really interests me. sat in on clinics this week and was pleasantly surprised to have one-on-one teaching from consultants. glad to be at a medical school that takes teaching very seriously, and to have consultants who take the time to explain things during a very busy clinic. having spent the last five weeks with patients at varying stages of cancer, i leave hospital every day supremely grateful that my family and i are in good health. i hate to think of it as schaudenfr but i make an extra effort to walk home because i can. and i'm constantly reminded that there are so many people out there who aren't. i've seen familial ties and social isolation, sheer relief at rare misdiagnosis (CT showed brain mets, conclusive MRI didn't) and grief and resignation at a terminal diagnosis. there have been so many memorable patients, wonderful people who selflessly relive the nightmare of their diagnosis to tell me about their cancer journey. they're looking death in the face, and yet still think to ask me about the tiny allergy i'd last week.

it also forces me to reflect and prioritise because there's a certain clarity when one's thinking in terms of weeks and months. i've seen people show such grace and dignity when broaching their own mortality, and i've watched bad news being broken ever so gently. i don't think you ever get used to telling someone "it's not looking good" and there's something to be said about just being present, and letting the patient lead the agenda. emotionally i found it hard to leave my patients in their wards, and almost every night i'd be telling the mister yet another heart-breaking story about patients going before their time. one common thread is their concern for the loved ones they leave behind, for unfinished business and unrealised dreams. which makes me wonder whether humanly,we are ever satisfied. because if it's a life worth living, it'll never be enough.

reading around and outside medicine was helpful, in particular david brooks' "the art of presence"

–Don’t compare, ever. Don’t say, “I understand what it’s like to lose a child. My dog died, and that was hard, too.” Even if the comparison seems more germane, don’t make it. Each trauma should be respected in its uniqueness. Each story should be heard attentively as its own thing. 

–Do not say “you’ll get over it.” “There is no such thing as ‘getting over it,’ " Catherine writes, “A major disruption leaves a new normal in its wake. There is no ‘back to the old me.’ ”

 

also found this opinion piece particularly poignant, articulating what many patients were trying to express regarding coming to terms with inevitable parting.

The path forward would seem obvious, if only I knew how many months or years I had left. Tell me three months, I’d just spend time with family. Tell me one year, I’d have a plan (write that book). Give me 10 years, I’d get back to treating diseases. The pedestrian truth that you live one day at a time didn’t help: What was I supposed to do with that day? My oncologist would say only: “I can’t tell you a time. You’ve got to find what matters most to you.”

i met the loveliest old gent yesterday who's found out last week that he's got months to live. his first thought was for his wife of 59 years and who'd look after her when he was gone. when i congratulated him on being married for 59 years, he looked at me with bemusement and said, "it's not a race, flower. it's been pure pleasure and i wouldn't have it any other way."