“Doctor, the funeral home is requesting you to sign the death certificate for your patient who passed away.”
For most walks of life, this quote would stop someone in their tracks. For an oncologist this is too common an occurrence. Breakthroughs are occurring each day that extend patients’ lives. The length of time patients with cancer are living with metastatic disease is unparalleled. No matter how many new treatments prolong life, the majority of patients with advanced disease whom I treat will succumb to their cancer. We spend close to 6 years after medical school training to become oncologists to learn how to diagnose, treat, and counsel our patients along their cancer journey. We are taught to blend science and humanism to help fight cancer and hold our emotions at bay for our patient’s sake. Yet we are never truly taught what to do when we lose our patients to cancer. This is not a course one can enroll for unless it happens to you. I thought I would reflect on this topic by honoring the courage and strength of my patients.
I will never forget the first patient I lost as an attending. Yes, I know that is cliché, but first-time experiences always resonate in our minds. The patient was young, with widespread masses in the lungs, brain, liver, and bones. The local hospital was struggling with the diagnosis and the patient was transferred to our hospital for further work-up. The doctors at the previous hospital had pretty much prepared the family for the worst and recommended hospice. In addition to diagnosing and treating the patient, the transfer was also a way to provide a new perspective and hope for the family. The cancer had destroyed multiple organs and ravished the body. We were able to determine the diagnosis, but the only options in controlling the masses in the brain were radiation, followed by chemotherapy. The goals of treatment were to improve quality of life and prolong his life. A cure was not on the table for this patient. I sat in his room late at night with his family after clinic and we talked about his goals. He held my hand and said, “Doc, my daughter graduates in June, and I need to be there no matter how tough the treatment.” I paused and reflected. It was November and there were more than 6 months until the graduation. I looked at him and his family and said, “Then we will make that happen.”
I was naïve and fresh out of training. What did I know? What promises had I just made? He first completed radiation therapy and then we started on chemotherapy. He progressed through multiple lines and the cancer continued to grow throughout his body. I mustered my efforts to never show any fear or lose sight of his goal to attend his daughter’s graduation, yet I was running out of options. I discussed with experts and was able to find a clinical trial for him, testing a new approach. It was a last-ditch effort and we transferred his care to another hospital. The family moved with him to that city to provide for his care. My life continued, his life continued, and although he was always on my mind, he was in now in someone else’s hands.
Months went by and new patients came into my life, with new challenges and battles to be fought. I didn’t hear from that patient and as May approached, I couldn’t help thinking about him and his family. I had intentions to reach out to the family, but long days led to excuses and time lapsed. One day at the end of May, my nurse pulled me out of a room and was reading the local obituary (a sad habit for those of us in oncology) and saw my patient’s name. He had passed away and never met the goal of being by his daughter’s side at her graduation. Devastated and in shock, I tried to muster the strength to continue clinic that day. What had I promised? Did I fail the patient and his daughter? How many more patients will I face this predicament with? Why did I choose oncology? All these questions raced through my mind and I wanted to reach out to the patient’s family. I wanted to let them know I was thinking of them, him, but didn’t know what was acceptable protocol.
I looked up his medical record and picked up the phone. I called his wife’s number expecting to leave a message. She picked up and said, “I was waiting for your call, Doctor.” It turned out she saved our office phone number in her contacts. We talked and comforted each other for a little bit. She said he was in hospice at the end and died in peace with all his family members. The school had performed a small graduation ceremony for his daughter early so her dad could be in attendance. We ended the conversation with me sending my condolences and prayers to the family. Sure enough, 2 weeks later I received a card from the family thanking me for all that I did and a photograph of the patient and his daughter on her graduation.
What is the lesson from this story? Is there a lesson at all? I don’t know exactly what I learned, yet it did shape my future practice. Try to connect with your patients as much as you can. With computer charts and emails, we lose that personal touch. Write letters, pick up the phone, and connect with your patients. They appreciate it more than you will ever know. Write a card of condolences and have all the caregivers who touched that patient’s life sign it. This is a habit I need to practice more. As much as I hope to cure all my patients, the reality is I will not and I need to prepare to deal with death. Inevitably, with some patients, the connection may not be as good, you get busy with life, or the family may not want to hear from you. Always try to reach out and know that you are there in their corner. And who knows, it may comfort you also.
Originally published on Cancer Doc in Evolution; reprinted with permission.