I Am Easily Charmed

There has been some confusion around the office due to the fact that my partner became suddenly ill, and it was important that the patients on treatment be seen once a week.  In addition to my own patients, I had seen all of his three weeks ago while he was on vacation, so I had a working knowledge of most of them, their cancers and the problems they were having during treatment.  Still, there were new patients to be seen, simulated and treated and it seemed that the most logical division of labor was for me to see the new patients, and the substitute doctor to see the old patients, many of whom were close to the end of their treatments.  It seemed that way anyway.

So when my partner’s nurse asked me to see a prostate cancer patient belonging to my partner this morning, I asked, “Didn’t Dr. Substitute see him yesterday, as she was supposed to?”  Our nurse answered, “She tried, but he wanted to see you.  He remembered you from three weeks ago. He is at the end of treatment.”  I said, “Okay, just this one time, but I will NOT see him in follow up.  He can return to his urologist for follow up as long as his PSA normalizes.”  A moment later, I was in with the patient, a kindly elderly man who described not his side effects and symptoms, but the fact that yesterday he went to the San Diego Fair with his two daughters, and what a delight it was that he got to spend time with his adult daughters alone without his wife.  Apparently this is a yearly ritual. We spoke about the art exhibits, the rose growing competition, and of course, the fried food.  I thought to myself, “Maybe Dad would like to go to the Fair.” I exited the room twenty minutes later, proclaiming to the nurse, “Okay, I will see him ONE time in follow up.  Just ONE TIME!”  She smiled.

At the end of the day there was another.  Just started on treatment, this prostate cancer patient had missed his on treatment visit yesterday because Dr. Substitute had to leave.  The nurse warned, “He’s a bit chatty.”  I entered the room, whereupon he declared, “No cancer patient is truly cured.  I just hope I outlive my cancer.”  This was a challenge indeed.  Despite the fact that I was quite certain my partner had already had this conversation with the patient, I felt the urge—no, the COMPULSION—to tell this patient of the multitude who indeed I had cured over a thirty year career.  It was a long conversation.  We both enjoyed it, heartily.  I added another patient to my roster.

What is it with these prostate cancer patients?  We have a mutual admiration society.  And I hear that the word on the golf course is, I give the best “finger wave” in the business.  Just sayin’…..

Weights and Measures

The sudden illness of a colleague is always a shocking surprise.  As physicians, we are trained from an early age to ignore our own infirmities in the service of others.  Apart from my three C-sections, I have been extremely fortunate in terms of my own health—I can count the number of sick days I’ve taken in the last thirty years on one hand and I am thankful every day for that blessing.  In my day to day world of caring for cancer patients, I know that in an instant, by accident or by sickness, everything can change.  I think that my colleague must have felt the same—that calling, that mission to care for the stricken that leads one to suppress the rising signs of illness in order to keep that black curtain of infirmity a little further to the edge of the window frame of life.

On Monday I learned that the man I have grown to respect for his insight, his dedication to his profession and his kindness would likely not be coming back to work, ever. My entire department was devastated, especially his nurse who has worked so closely with him for the eighteen months he has been with us, and also his patients, each of them with cancer,  who asked me one by one when they saw me for their weekly on treatment visit, “I am so sorry to hear that he is ill.  When is he coming back?”  As the realization of the gravity of his illness slowly came to all of us, since he had not shared the knowledge of his disease with any of us, the weight began to descend.  Our patient load is at its highest, our working hours are extended, there are patients waiting to be seen, planned and treated.  Who will step in to consult on these patients, to plan their radiation treatments, to oversee their side effects and work the extended hours?  Right now, we do not know.

I have always said that unlike my father, I do not want to “die with my boots on.”  I want to retire while I am still healthy enough to do the things that I’ve put off for so many years—to write, to paint, to take photographs, to teach English, to travel, to play with my dogs, and perhaps, just perhaps, get another horse—an older horse, a calm horse (we grow so brittle as we age that we break more easily!) who will carry me down the trails so that I can smell the orange and lemon blossoms on the trees, up close, as they bloom in late December here.  I said this to my husband last night, at the end of a very long week.  He said, “No one ever knows what they will do when faced with a terminal illness.”

This was a very busy week in the clinic, and I had a medical student rotating with me. In the chaos that surrounded us, I had to keep reminding myself, first things first. Yesterday, together we saw a man with a life threatening cancer.  I was running very late, and he was the last new patient of the week.  My student took the reins—he interviewed the patient, examined the patient, explained the treatment and seamlessly introduced me to the patient and his wife, who were quite pleased with the care and attention he had already received. We completed the consultation together, and as I left the room I suddenly felt a deep sense of satisfaction.

When the weight of illness suddenly descends on an individual, my colleague, and consequently, his patients, his co-workers and me, his partner, we can still take comfort in the small measures of success–the satisfaction that we, as a team, are doing things right.  Sometimes it’s the little things, the small gestures and kindnesses that count.  We dust ourselves off, and we go on.