By Shadia I. Jalal, MD
I have been taking care of patients with thoracic cancers for a while now. I no doubt have become more experienced at tackling difficult sensitive topics with my patients, such as life, death, bucket lists, goals, religious beliefs, etc. In spite of this experience, I continue to suffer emotional pain as part of my occupation and at times definitely feel burned out.
January this year was especially draining. I lost a number of patients who had lived longer than usually expected with cancer around the holidays. One in particular comes to mind. For almost 5 years I cared for a young engineer who had metastatic esophageal cancer. He had quite a good quality of life throughout his illness and worked until 2 months prior to passing away. His cancer responded to almost every therapy I gave and over the years he went through all standard care options and two clinical trials. He died with dignity at home surrounded by family members after going on his last family trip. In every respect as an oncologist, my care for him and the results achieved should give me some degree of satisfaction. Yet it doesn't. I feel a twinge in my throat and heaviness in my chest every time I think about him. He was rough around the edges and at times would have been described as a “challenging patient” but I had gained his trust. He was one of the reasons I took only 5 weeks off during my maternity leave. His wife had asked, through an email to my nurse coordinator, "Is Dr. Jalal really back? He needs to see her. He trusts her."
It's hard to see anybody suffer. It's really hard to see people turn into shadows of themselves due to cancer. It is grueling to see them age due to illness. My engineer went from a fully functioning man on his laptop, at times annoyed by the wait before I entered the room, to a frail cachectic person hunched in a wheelchair with no awareness of time. He could barely breathe or communicate during his last clinic visit but still managed to squeeze my hand and whisper a thank you.
I have many things in my life that keep me going and control the burnout. My young children are my first line of defense. My husband who never gets tired of listening to my sad stories plays a major role in maintaining my emotional wellness! Hallway conversations with my colleagues that allow me to get things off my chest are crucial. My 5 AM exercise class boosts my energy, especially on clinic days. My 5-minute dose of The Tonight Show before I go to bed ensures I laugh at least once a day. My faith that God always takes care of people and never asks me, my patients, or their loved ones to carry a burden we can't handle comforts me.
That is how I get up the next day and do it all over again.
Dr. Jalal is an assistant professor of medicine at Indiana University. She specializes in the treatment of lung and esophageal cancers. In addition, she serves as the medical director of the Clinical Trials Office at Indiana University Melvin and Bren Simon Cancer Center.