Everything Must Change
Don S. Dizon, MD, FACP
21 Jun 2012 11:13 AM
“Everything must change, nothing stays the same. Everyone will change, no one stays the same.”
Technology is amazing. I love to download random songs on my iPhone and listen to the songs that populate. On one bright early morning, Oleta Adams came on. The song was “Everything must change.” It’s a beautiful and haunting, somewhat sad but at the same time hopeful, song. It stirred up memories, and I found myself remembering a friend and ovarian cancer survivor until the very end.
My friend was in her 40s when we first met. She had been diagnosed with advanced ovarian cancer and following an optimal surgical reduction, was referred to me for adjuvant chemotherapy. We hit it off right away—we shared a love of art and travel and swapped stories of travel to the Pacific. Still, we weren’t there to become friends—she had cancer and it needed to be addressed. She embarked on adjuvant chemotherapy and at the conclusion of treatment, I happily declared her to be in remission. Unfortunately, just one year later, the cancer had returned. She again underwent surgery followed by second-line chemotherapy. A clinical remission followed, but it was relatively brief. I recommended a third-line therapy, and then a fourth. Through it all she remained resilient and healthy. She traveled between cycles, continued to paint and write, and withstood treatment with little side effects. I remember thinking to myself that she should be on a billboard—the new face of ovarian cancer, because she was alive and living. Proof that cancer was not a death sentence and could be treated as a chronic disease.
Then I did something to affect the status quo—I decided to leave my practice. My partner and I had our first child, Isabelle, and we had wanted to move back closer to family. As soon as I accepted a new position in another location, I informed my patients personally, including my friend.
When it came time for me to leave, I made sure we had a clear assessment of where she was—whether her chemotherapy was working or needed to be changed and what my expectations were for the immediate future, and then I coordinated her next appointment with the physician who would be taking over her care. She had handled the news of my departure well, expressing her happiness for me and my family.
At my last visit with her, we went through the plan for treatment and I assured her I was leaving her in the best of hands.
“Do you have any questions?” I asked.
“Only one,” she said as her eyes welled up. “You told me that if my time had come you would tell me. Is that still true?”
When we initially met, I had told her (as I do all new patients): “I approach cancer as a partner with a patient and believe in being as upfront as possible always. I will review all of the options and steer you to what I consider the best option, and will always respect the choices you make, now and in the future. If at some future point, I feel that treatment is not likely to help, that the cancer has become terminal, or I feel you are dying, I will tell you; I will be the one to say it.”
Looking at her, I realized that in oncology, the doctor-patient relationship is particularly special. In the face of a serious and life-threatening medical illness, a trusting relationship can make all the difference to patients. While I had assumed that by transferring her care to another physician, I would be transferring that trust to someone else, she did not share this view.
Ultimately, the message I left her with was a simple one: “Although I won’t be here anymore, I will always consider myself part of your treatment team and will always be here as your doctor. Should you need me, you have my contact information. I will never turn you away. You can come to see me at any time—no matter what the reason.”
Two years passed and by then I was firmly established in my new life. During one of my nonclinic days, my assistant came in to give me a message: an old patient of mine wanted to come see me. It was my friend.
I called her back and she had told me that things had not been going well. That chemotherapy did not seem to be working anymore and that she had recently been in the hospital with a bowel obstruction. She had been home for a few weeks but wasn’t able to eat.
“I think I should see you,” she said.
“You can come up any time,” I said. “Are you up for the trip?”
“Sure—it will be nice to get out of the city for a while.”
I contacted her current doctor to find out what he thought. He had recommended hospice, stopping chemotherapy. He had told her she had little time left.
I saw her later that week. She had changed significantly since I last saw her. Her abdomen was swollen, her face had thinned. But, her eyes were still as bright as I had remembered. We chatted, I examined her, reviewed her prior treatments, looked at her labs, and reviewed her most recent CT scans. Things did not look good.
“My doctors don’t sound optimistic. They didn’t want me to have any more chemotherapy...said something about hospice,” she said. “I didn’t quite understand it all, but I know it didn’t sound good.”
It suddenly dawned on me why she came to see me. She wanted someone to tell her, in the plainest of language, where things stood. And she wanted to hear it from me.
I gave her my complete attention and said, “I spoke to your doctors. They don’t think further chemotherapy will yield much benefit, but it will expose you to far more side effects”.
“Yes—that’s what they said,” she stated simply, all the while staring intently at me.
“And, I agree with them. I think it’s time.” I didn’t need to say anymore. She suddenly breathed out, and her posture became less rigid. “Okay.”
Ultimately, she moved from her city location to be closer to family and to live out the rest of her life by the beach. We initiated home hospice and she was able to stay at home until her pain prompted a move to the hospital where she passed away in peace, under my care.
This experience comes to me now as I reach another crossroads in my career and prepare to leave Providence for Boston. Once more, I am saying goodbye to colleagues, staff, and my patients. But, my experience with my friend, and with all the patients I have taken care of has taught me that patients and doctors remain connected, even though distance may prevent that primary relationship.
“There are not many things in life you can be sure of. Except rain comes from the clouds, sun lights up the sky, and hummingbirds do fly.”
And perhaps, that the relationships forged between doctors and physicians will continue, no matter what.