Tuesday, August 4, 2009

"I don't know how you do your job"

Most days, I love what I do.

Today was not one of those days.

Today I sat down with a 13 year old girl that I take care of, along with her parents, and we reviewed the results of her most recent scans. The news was not good. A month ago she had no evidence of disease. Today, there is a large mass on one side of her skull, a smaller mass on the other side, a dozen nodules in her lungs, and cancer throughout her pelvis, in both thighs, and in her arm. A mass near her left hip has caused what we call a "pathologic fracture," which means the tumor has broken the bone, causing a lot of pain.

Needless to say, I made her cry. Her parents, too. They all know what this means. She told me she doesn't want to die -- she only wants to live. I wish I could help her achieve that goal, but I know I can't.

So many things can come out of days like this. Today I was impressed by the capacity of the human soul for compassion. After I told the patient what was going on, her father looked at me and he said, "I don't know how you do your job." Despite what I had just told him, he was concerned about me!

Later in the day, I went back to check on the family. I caught the patient's mother in the hall and we talked. We spoke about palliative care ... about making the most of the time her daughter has left ... and I asked if she thought the patient wanted to see me again. I was surprised by her answer.

She told me that I should go in and talk to her daughter. Partly because her daughter likes me and is always cheered up by my presence. But... she also said, "I think it will be good for you, too. I saw the tears in your eyes. It might be good for you to see her looking happy."

Wow. This morning, she found out her child had months to live, and this afternoon she was concerned about me. She was trying to comfort me!

The human spirit is amazing sometimes.

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rlbates said...

Yes, it is. Glad you are still around.

Craig said...

At the age of 31, I'm going back to school this fall for medicine. I've told friends and family that I've been considering pediatric oncology, and everybody reacts the same way. "I don't know how anybody can do that. It seems so depressing." My response has always been that cancer is there whether I'm around it or not, and if I can help those afflicted with this horrible disease, then even though it may be hard, I want to do it.

Thank you so much for sharing this story. And thank you for what you do.

Dr. Smak said...

Many of us don't want to need you, but we do.

Mary said...


Morah Mary said...

Because you care for and about people (not just their illness and health) people care for and about you.

You make a difference and we all need people in our lives who make a difference.

Anonymous said...

Thank you for your compassion. It brought great comfort to our family.

Doctor David said...

Thank you all for your kind words. I almost didn't post this because I was afraid of seeming self-serving. I hope I didn't... writing about it was very therapeutic.

Anonymous said...

this is an awesome story...thank you for sharing.

Bruce said...
This comment has been removed by the author.
ลงประกาศฟรี said...


Susan said...

Thanks once again for showing us how Doctors feel and how deeply they care.

This patient and her parents were just trying to give back to you, what you've given to them.

Praying for this precious family tonight.

Dr Vikram said...

Resp David,
you are very kind hearted doctor, i came to know through this post, resp sir i have uploaded video of neonatal resuscitation on my blog just see that and tell me how you like that or any improvement needed in video...see link here http://wacky5.com/how-to-resuscitate-new-born-watch-video.html
dr vikram

Dr Vikram said...

Resp David,
you are very kind hearted doctor, i came to know through this post, resp sir i have uploaded video of neonatal resuscitation on my blog just see that and tell me how you like that or any improvement needed in video...see link here http://wacky5.com/how-to-resuscitate-new-born-watch-video.html

Bruce said...

Well said. I never know how to respond when people, particularly medical people, wonder how we keep coming back for more. It is what we do.

Thanks for letting us all stand at your side for an important moment.

Disability Insurance Quote said...

Wow, what are sadly disheartening story. A day like that would set me back for a week. It just shows how volatile and fragile life can be and that we should always be wary of protecting ourselves and our families from experiences like this.

Nick said...

This is a beautiful post, and thank you for sharing it. The sort of incredibly difficult and terrifically necessary conversation that some people call the 'death panel' -- which is actually the moment when a trained doctor talks to a patient about an imminent or unavoidable death -- is one of the most valuable and expensive gifts a doctor can give his or her patient. No matter what decision the parents/children of the patient make, you did such a good thing for them by talking to them honestly and listening to their questions.

Gberger said...

I will always remember this conversation with our daughter's oncologist. We had many bad days due to adrenocortical carcinoma, but that day was one of the absolute worst.

I have wondered many times since how (or if) doctors are taught "self-care" in medical school. The answer is not apparent to me, though I have asked some doctor friends. Somehow, you have learned to take care of your patients first, and then yourself. I suspect part of the purpose of your blog is that essential self-care. If you don't do it, you will be likely to burn out, and what a loss that would be to your patients!

Three and a half years after Katie's passing, I am working on creating tools to teach doctors how it feels to the patient and family to go through all of these cancer-related experiences, from diagnosis through hospice. It is my hope that this information will help doctors take better care of themselves AND their patients and families.

Laurie, Kat's mom said...

I'm so glad I found your blog ~ through another cancer mom on facebook. Our family has a pediatric oncologist at CHOA who we feel much the same about as the 13 year old girl's family that you describe. Since entering the pediatric cancer world 3 years ago - my daughter has GBM- we have come in contact with many physicians and doctors like you are rare. Thank you!

Unknown said...

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