By Jon Steinmetz, DO
A few months ago, at the start of my second year as a hematology oncology fellow, I attempted to take stock of the most valuable lessons I had learned in my first year. Among the pathology conferences, difficult family conversations, and many tedious smear reviews, one series of patient interactions struck me as the most powerful.
Early in my training, I saw a patient, Ms. H., who had been recently referred to our clinic for a new diagnosis of non-small cell lung cancer. Her primary care physician had ordered a biopsy and initial staging scans; we were meeting her and reviewing these tests with her for the first time. When I entered the room, I sat across from a stylish middle-aged woman who appeared surprisingly relaxed. She expected to hear the words lung cancer, it seemed—those words resonated with her. The term metastatic, though, did not. She had not anticipated hearing phrases such as control of disease, palliative and not curative.
At that point in the conversation, she shut down.
It was slow at first. I continued to talk but could sense I was losing her. When I began discussing the treatment options we had to offer her, her eyes were no longer pointed directly towards mine; they were drifting. As I spoke, her gaze veered down to the ground.
When I paused to check in with her and see what questions she had thus far, her eyes were glued to my feet, stuck on the space between my shoes and the hem of my pants. Right through my socks, dark green with sailboats all across.
She was memorizing them. It was as if she had taken off in one of those sailboats in her head, and was heading down the coast to a faraway land where she never met me.
I soon began seeing Ms. H. every three weeks after she was started on treatment. I would ask her about any toxicities or side effects she may have had from the last cycle. I would pry and prod and go through a laundry list of potential adverse effects. From A to Z, abdominal pain to zits.
But she didn’t want to talk about her chemotherapy. Her husband, a caring and oft-frustrated partner, would try to fill in the parts of the week she would purposely leave out, wishing to not relive them.
When he would say, “She had diarrhea on days 4 through 7 and it was definitely more frequent than last cycle,” I would look to her for confirmation, for elaboration—really, for anything.
She would just look up briefly and in a sullen voice agree, “Lousy, I feel lousy.”
At the third appointment, when again I found myself with a quiet and dispirited Ms. H., she answered little and spent much of the visit looking down, unengaged. Until a quizzical look came upon her face. “Are those pink socks with turtles?!” she exclaimed. She seemed both shocked and delighted. They were unusual, no doubt, a gift from my mother-in-law that always seemed to intrigue my more observant patients. Today, Ms. H was no different, and they took her mind off the reason for this visit, even if only briefly.
At her next appointment, she stopped me as soon as I walked in.
“Let’s see the socks," she said with a devilish grin. “Blue socks with racoons?! I need those for my son,” she chuckled. And then, quite unexpectedly, she offered me the full breakdown of her recent weeks, no questions asked.
After that, an assessment of the socks was always the first order of business during her visits. A brief respite before we could move on.
“How do you always have something different?” she would often ask.
I shared with her that my mother-in-law had bought me fifteen pairs of socks for my thirtieth birthday—30 socks for 30 years. I wasn’t going to run out anytime soon.
We both seemed to take enormous comfort from this. There was going to be a constant here; the boats she was once sailing away in could be anchored, at least for a while.
Weeks went by and she completed the chemotherapy portion of her treatment. She was now on immunotherapy alone, and she began to look and feel more like herself. I could once again recognize the woman—chic, relaxed—I had met just for the first few moments of her initial visit.
I was told that a small gift bag was left at my desk. In it, a pair of crisp blue socks with smiling faces all around.
I decided to pursue a career in oncology because of the constant interactions between remarkable pathology and advances in treatment and because of the ever-changing landscape of cancer management.
I’m sticking with it for the socks.
Dr. Steinmetz is a current second year hematology-oncology fellow at the University of Connecticut. An ASCO member since 2019, he developed his interests in improving health care literacy and communication while completing his internal medicine residency at University of Connecticut. Disclosure.