Saturday, May 10, 2008

The Surreal Life

It’s been a crazy 48 hours.

In my blog’s first post, I wrote about what happens when people ask what I do for a living. I’ve been thinking more and more about the answer to that question. What DO I do for a living? How should I describe it?

Over the past 2 days I:
1) worked in our outpatient clinic and saw patients I have been treating for years, monitoring them now not for disease recurrence but for late effects of our treatments,
2) went to the OR (operating room) and watched an endoscopic biopsy of a sinus tumor in a 19 year old patient of mine (we also collected some of his tumor to study in the lab),
3) met a new patient, this one a young man who just graduated from college and has a tumor that should be very aggressive but is behaving in a much more indolent manner than we expect,
4) had an informed consent discussion with the mother of a totally adorable girl with a relapsed brain cancer who now needs a bone marrow transplant,
5) reviewed data from my lab,
6) worked on a grant application, and
7) managed the final 36 hours of a 14 year old girl’s life.

As you might imagine, this last thing was the hardest of all.

I blogged about her once before, talking about how cool it was that as she was recovering from surgery, she was texting her friends, and that’s how we knew she was OK. Well, as it turns out, she was unfortunately only OK for a short while. We tried to get her enrolled in a clinical trial, but she didn’t meet the criteria. Her tumors began to grow, and her pain got worse. We admitted her to the hospital and got her pain under control, but she didn’t want to go home. She was discharged for about 12 hours last weekend to attend a fundraiser for her family, but came right back. She said she felt safe with us. We spent the week keeping her out of pain, trying to keep her from being scared, and preparing her for the most dignified death we could provide for her.

She died yesterday afternoon afternoon.

Two hours later, I had to give the residents at Hopkins a lecture about sarcomas. And when I returned to my office, I found an email from the Maryland Stem Cell Research Fund informing me that they are going to fund my grant application to study Ewing’s sarcoma stem cells.

How do I describe what I do? Am I a scientist? Am I a doctor? Who has days like this? What kind of job requires a person to give a lecture 2 hours after a child dies?

My patient died from Ewing’s sarcoma… the very disease I got a grant to study today.

My life is surreal.

Related Posts:
When My Patients Die
The Human Spirit
A Day in the Life of a Pediatric Oncologist


Obsessedwithlife said...

Thanks for sharing. I will keep that family in my prayers and all of us patients REALLY appreciate all that you, as doctors, do for us!!


Jaime said...

hey there....I know this isn't much help now, but people have always told me things happen for a reason. You got that grant because you worked hard, are passionate about what you do, and are GOOD at what you do. Maybe it's a sign to keep fighting the good fight, and one day, kick Ewing's sarcoma's butt.

Dr. Smak said...

Heavy days, Dr. D. Heavy days. Give yourself some time to heal.

Doctor David said...

Thanks, guys! It's great to be a part of a supportive community like this.

Margaret Polaneczky, MD (aka TBTAM) said...

I remember days that were so filled with emotional events that there was no time to process because I had to move on to something else. Somewhere we have to find the time to process the emotions associated with what we do or we end up shutting down.

Surreal, indeed.

Doctor David said...

TBTAM, you are so right. I take solace in knowing that I still feel it when these things happen. The day I stop feeling it is the day I'll walk away.

Anonymous said...

Dr David,

I know you through my daughter. I know of your sensitivity and attention as she makes decisions r/t my grandson's brain cancer.

You are a great support and advisor without making judgement or even giving your opinion. You are perfect for what you do. You don't pretend to know the answers.

At the peak of my career I was an oncology nurse. There was no strength to be gained like that of my patients.

Thank you for what you do.

Heather said...

I don't know where you find the time to blog about this, or from where you gather the strength...

Anonymous said...

Thank you so much for what you do, especially for caring so much about the people who need you.

DeeDee said...

Wow. All I can say is just Wow. You have to have amazing strength and courage to do what you do and I admire you for it. I really do understand why you would blog about your life. Who could keep all of that bottled up?

In case you didn’t know, I found your blog through DadGoneMad. I've posted a complete list of everyone who left their blog link on his Big Big Stars post a while back in a post of my own in April called Blog Rolling With My Homies over on my blog, so if you want to see it come on over and sit a spell. It's a good place to forget about your stress and read about mine.

If you did know just overlook this and pretend I said something funny since my brain feels like mush from trying to comment on all 217 on the list because somebody had the bright idea to challenge me to it!!

Doctor David said...

Dear Mary, Heather, DeeDee, and my anonymous commenter,

Thank you so much for your words and wishes. Writing posts like that is always therapeutic for me. It helps to know that someone else is reading and hopefully enjoying what they read. Honestly, the real strength is in the families and the patients, like Dr. Smak and Rachel and Mary. They are my heroes. Heather asked where I get the strength... it's from them.

Anonymous said...


It is a very nice and great post and I like it.

Anonymous said...

I lost my 14 yr old son AJ to childhood cancer. It was an 8 month battle with Burkitts at TX Children's One of the only times this guy cried through the whole ordeal, was saying good-bye to his fav docs as we left for home the last time. So hang in there man, like AJ always said, you get what you give.

student doctor said...
This comment has been removed by the author.
student doctor said...

Thank you for sharing this with us. I appreciate your perspective immensely. If you have time will you post on how recoop from these types of days? I'm just curious b/c I think we all have our own ways of coping. Ya know?

Bruce said... spent a day as a true academic physican-scientist, as a clinician-educator, and, finally, as a palliative care physician. Somehow, I don't think that will fit on your business card.

There IS no other profession that expects you to be able to go on as though nothing has happened even though you have just had a profoundly inexplicable experience. Rachel Naomi Remen writes about how we are taught to understand the grief of patients and their families, yet we are barely prepared to deal with our own. Hope you are doing okay.

You really struck a chord here. Thanks.

Doctor David said...

KY, I hope to post something about the recovery process soon. I just need to recover first ;)

Bruce, thanks for dropping by. I've petitioned my administrative manager for bigger business cards, to fit all of those titles, but alas, to no avail. Rachel Naomi Remen sounds like someone I should be reading. Thankfully, the summer is upon us, my grant writing will be taking a pause in 2 weeks, and I'll have time for some pleasure reading.