Saying goodbye to my cancer patients is the best part of my job
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Version 0 of 1. Saying goodbye to you is the happiest part of my job. Saying goodbye because you won’t need to see me again. You don’t need to see me again because the cancer that you came to me for is gone. It is now a line in your past medical history, and will not be a part of your future. Do you remember when we first met? A colleague had phoned me to inform me of your imminent arrival from a rural part of the country. They told me you were coming in the early part of the evening, and that you were anxious about what was about to happen to you. It was around 3am in a London hospital when you arrived. I had to meddle with the creaky light above you to see how you were doing. You weren’t asleep, you had a pile of damp tissues by your side. You needed chemotherapy, a cocktail of drugs concocted decades before your admission. As your oncologist, I had to initiate you in the ways of our world. I was sorry you were going through this. I was going to reassure you and introduce you to the others who had been here and recovered – others that were of a similar age to you. It’s understandable that you were afraid given you were only in your 20s. We started to talk about what had happened. You had taken a pregnancy test which was positive and you had celebrated with your partner, you had thought about expecting your first child. You had thought about maternity leave and the colours for the spare bedroom that would have a new purpose. At the scan at eight weeks you had talked about your heavy bleeding with your doctor – it was concerning he had said. Rather than a heartbeat, the scan had showed something abnormal, something that looked like a bunch of grapes. It turned out that the pregnancy test you had celebrated was not accurate. It was a molar pregnancy you were told. The words became a part of your lexicon, a search term you entered online. You learned about molar pregnancies, that they could happen in one in 1,000 pregnancies and in 80% of cases it was benign and treatable with a procedure to evacuate the tumour. You went through a procedure to take out the tumour. You joined a message board to exchange notes with others who had gone through this. You expressed your devastation; they consoled you with emoticons. The bleeding started again a few days after the procedure, interrupting your plans to get some respite. Your doctor said it was likely cancerous and had invaded a part of the uterine wall – this happens in 20% of cases. You will need chemotherapy, you will have to head to the city, he said. You didn’t hear anything but the word “cancer”. On the drive you worried about being away from home, and why this was happening to you. “Is it cancer?” you asked me. “It behaves like one if we don’t treat it, but we’ll get this sorted for you”, I said. You looked for any evidence that this was your fault. I reassured you that it was not. We looked at your scans together, I circled my fingers around the abnormal tissue and blood vessels on the images – the culprit of your symptoms. You would start chemotherapy that evening. I held your hand as I explained that it was likely you would lose your hair. You asked whether you would be able to have a normal pregnancy, and I provided you with the statistics. I was hopeful that this would merely be a blip in your life. You struggled through the side effects and we tried to keep you going like the cheerleaders we aspire to be. When you started to lose your hair, we talked about the options. When you came to clinic with your wig, you joked about your longstanding wish to be a blonde. On some days you were stoical, and on other afternoons you hated us. You wanted it to be over and wished to be anywhere else than with us on the chemotherapy unit. I understood when you said you were fed up. We rejoiced when we conquered your symptoms of nausea. You were ecstatic when I told you that you had three sessions left. The countdown was quick and then you came back to see me six weeks later. Your laboratory tests were pristine. Your scans were normal, almost like it had never happened. We talked about precautions, the holidays you would take to recover. You promised you would continue sending us samples to keep an eye on you from a distance. You thanked us. “You don’t need to see me again, I hope you never have to. I mean that in the best sense”, I said as I led you to the door. A wonderful phrase for an oncologist to say. The patient is a composite of this oncologist’s experiences of patient care If you would like to contribute to our Blood, sweat and tears series about memorable moments in a healthcare career, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com. Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views. |