Follow Up

My new resident started working today.  He is the first radiation oncology resident to come to work in our facility, since the residency director felt that being out in the community was more like “real life”—I don’t have the luxury of treating only one or two types of cancer—out here in the suburbs I have to treat them all.  So it seemed like a good idea that the residents get a few years of experience under their belts before venturing outside of the white tower of academia.  Our residency training program is relatively new, and so we are feeling our way through this thing to make sure he has a valuable learning experience.

The issue came up as to whether or not my new resident would see follow up patients with me.  My own residency was like an apprenticeship—at the World’s Greatest Hospital, we residents would spend three months with each attending physician, every one of which was a professor at the World’s Greatest Medical School.  Three months of prostate cancer, then three months of head and neck cancer, then three months of lymphoma, and so on—we learned from each maestro in turn.  Since we moved on every three months, we never got to see the patients we planned and treated in follow up.  I think it was sometime during my lung cancer rotation that it occurred to me to read the obituaries.  I mean, how else was I going to find out what happened to those patients?  I kept the names of each new patient I saw in a little black book.  And over the next few years, I put a little red check mark next to the name in my book as it appeared in the Globe, usually with an old photograph that I did not recognize as the person I had treated.  Lung cancer, especially when inoperable or metastatic, is a terrible disease. At the end of my lung cancer rotation, I had a list of 120 names.  At the end of my residency training, 10 were left unchecked.

I learned a lot about those patients by reading those obituaries.  The unassuming elderly woman with her arthritic hands had once been a famous sculptor.  The still dignified but stooped over old man had led a battalion at the Battle of the Bulge. The forty year old man who smoked two packs a day despite the fact that he had watched his own father die of lung cancer left three grieving children behind, and contributions could be sent to his local church.  And I discovered that I wasn’t the only one reading the obituaries.   Years later, my secretary at my new job in California and I were talking about reading those brief little bylines that so neatly summarized lifetimes of love, joy, milestones and tragedy.  She said to me “I thought that I was the only one who reads the obituaries!”  Then she whispered conspiratorially, “and I know this is REALLY bad, but when a day passes that I don’t see someone I know, I feel like I’ve missed seeing an old friend!  I’m a little disappointed.”   It turns out that a LOT of cancer doctors read the obituaries.  The lives imaged, and imagined are the ones we never got to see.

So when asked if it’s worthwhile for my new resident to see my follow ups—patients that he did not treat—I say, no, I don’t think so.  But when it comes to me, many times these follow ups are the highlight of my week.  I get to see the fears gone, the new lives started, the transformation of priorities brought on by conquering a life threatening illness. Sometimes I even get to see the new husbands, the new wives, and the new babies.  Occasionally though, I’ll get a cranky one—someone who says, “You think I look great, but I still have this, and THIS, and THIS….” reciting a litany of side effects.   And then I get to quote one of my old professors, a great man, who when confronted with such a patient would draw himself up to his full height, puff out his chest, and say, “You’re still ALIVE?  I must be better than I thought!”