Editor's note, August 6, 2019: The following post by Dr. Stephanie Graff was recognized with a 2019 APEX Award for Publication Excellence in the category of Social Media - Best Single Blog Post. Congratulations, Dr. Graff!
By Stephanie Graff, MD
I am a medical oncologist specializing in breast cancer. I often try to conceal what I do for a living when I meet people for the first time as it always leads down a particular road. “Is that so depressing? I don’t know how to deal with that all day, every day.” But in truth, it is not depressing. My work is very rewarding. I feel that the most valuable lessons I have learned in life, I have learned in the practice of oncology.
- Labels hurt. In a world of ever-growing diversity, labels extend to the oncology clinic. While perhaps less publicly discussed than other forms of bias and discrimination, the labels can be just as damning. I have patients with incurable metastatic cancer who proudly wear the label “survivor”—they are, after all, surviving. But I have an equal proportion who abhor the societal survivor movement because the word doesn’t describe their experience. They will die of cancer—and pretending that represents survival is hurtful to them. Even patients with curable disease struggle with labels. They don’t identify with phrases like survivor, or cancer warrior, or brave, or heroic. They just want to be seen for who they are. They want to be more than their disease. We all do. And the world of medical labels extends to life—black, white, rich, poor, gay, straight, saint, sinner. The power of any individual is greater than a single word—let’s not use such restrictive language to describe or define.
- There is power in bearing witness to the pain and fear of another. A cancer diagnosis is serious, scary stuff. It is a pivotal moment in the lives of many. Often, when alone in the private space of my clinic, my patients confide in me their fears. Their pain. They are afraid their cancer will come back. (It might.) Afraid that being afraid will make their cancer come back. (It won’t.) Afraid of when or how they will die. Afraid of treatment and side effects. Afraid to let their family and friends see any of that fear. They are trying to be brave out of duty, they are trying not to burden those they love any more than the diagnosis already has. We all just need a safe space to share our fears. We all need a safe place to say what is hurting us. If you can be a person who bears witness to that side of another’s life—whether cancer or infidelity or miscarriage or any feeling of failure—do it. Create that safe space. Bear witness.
- Remember the little things. Life is made of the little things. One of my early career mentors told me that to be an expert consultant you only had to know one thing: the names of everyone’s children. “Everything else you can look up!” he exclaimed. I remember rounding with him on weekends and he’d ask other physicians or support staff about their toddler’s potty training or their daughter’s college essay. But he also knew those facts about his patients. While I certainly know a lot about my area of expertise, I always try to know a little about my patient’s lives, about the little things that inspire them and excite them. And that advice easily transcends to my friendships and relationships. A quick text to ask how a presentation went, a card on the anniversary of their mother’s death, a babysitter recommendation to a new mom—a little thing, but it feels very big.
- We all want to know why. I have three children under the age of 10. I answer “why” questions exactly 3,872 times a day. But curiosity doesn’t end in childhood. Helping those around you have a foundational understanding of why—why this chemotherapy regimen was chosen, why they got cancer in the first place—brings us comfort, satisfies our curiosity, helps us be invested partners in the decision. Discussing why strengthens all relationships. I talk with my husband and friends about why I loved a restaurant or a book or a TED talk. And I ask them whys, which helps expand my understanding of their world.
- A warm greeting is always a great start. No one—and I mean no one—wants to be in my office. But when I walk in the room I smile. I shake hands. I introduce myself. I learn everyone’s preferred names and relationships. I sit down. And I watch the tension and worry diffuse. Regardless of whether I’m meeting a new patient or a new friend, a warm greeting is an important first step in helping the relationship start. So, smile at the next person you meet and reach out your hand.
- Teams united around a common goal are the strongest. I go to work every day in an office with the singular mission of helping people affected by cancer. My nurses, front office staff, financial counselor, nutritionist, and endless other team members know exactly what we are trying to accomplish. My patient and their family and I form another team with the same mission. The clinical trials I lead or participate in are all united around the same mission. Day by day, milestone by milestone, we reach our goals. Doing it together brings us all joy and pride and satisfaction. I’ve experienced the power of united teams while engaging parents at my child’s school, serving on mission work with my church, or on my own high school sports teams. Every team needs to have an established goal and needs to work together towards it. This is how we create positive change and influence on the world. Find your team. Make your goals.
- No one ever regrets choosing family. A part of my oncology practice is dealing with death and dying. Talking about end-of-life goals, bucket lists, and priorities. Not once has a single patient told me that they wished they had worked harder, made more money, spent more time at the office, or devoted less time to their family. I have heard repeated wishes to have more time with spouses, parents, children, and grandchildren. I have heard patients regret missing reunions and vacations, regret not apologizing earlier, or not fighting harder for a relationship. In the end, nearly all of my patients wish for love and human connection. It is, hands down, the best part of my job. Every day I am reminded exactly what is important in life.
- Ask for help. Cancer opens up a lot of vulnerability and need for my patients. They need help with rides to treatment, meals, sorting through bills, understanding medications. They certainly need expert care from specialty-trained physicians and other health care team members. The patients that are the best at asking for help have the best outcome. In a society that values independence and personal achievement, I think we are sometimes afraid to ask or delayed in asking for help. But overcoming obstacles or new experiences is always easier when you ask for help. Whether a marriage counselor, a veteran mom with advice, a personal trainer, a career mentor, or a financial advisor—the times in our life where outside help can smooth the road are endless. Ask. Help is always there.
- Admit mistakes. Cancer is hard. Medicine is hard. I have said the wrong thing, missed a test result, seen the wrong medicine given. And every time it haunts me. I wake up worrying about the mistake, about whether I have done it before or will do it again, and struggling with the reality that none of us are defined by a single mistake. I have found tremendous grace and forgiveness by openly and honestly saying, “I was wrong. Here is what happened. Here is how I am going to fix it. I am sorry.” And not just at work. With my husband and children and friends. Mistakes admitted openly create opportunities for growth and grace. And I can think of nothing I want more.
- Take care of yourself physically, mentally, and emotionally. I meet patients who have never seen a primary care physician, who have never learned what it means to eat healthy, who have never exercised. I meet patients who deny their depression and anxiety and stress to the point of illness. And I know physicians who are the same—not regularly getting medical care or engaging in healthy behaviors. The body of evidence for mindfulness practice enhancing our overall health and wellness continues to grow. None of us should be so busy taking care of others—our families, our employees—that we neglect ourselves. Life is short. Don’t neglect yourself.
Dr. Graff is the director of the Breast Cancer Program at Sarah Cannon Cancer Institute at HCA Midwest Health. Follow her on Twitter @DrSGraff.
Dennis Morgan, MD
Aug, 31 2018 10:24 PM
I applaud your whole commentary, and especially so the ninth lesson.
As a retired oncologist, I can assure every reader that the only retired oncologist who thinks they have never made a serious mistake (at least once), simply didn't recognize it when it happened.
There is bravery in oncology, but not because we expose ourselves to the miseries of cancer.
It is because we expose our egos to the brutal consequences of sometimes being wrong, and yet carry on, because—somebody has to.