By Jane Lowe Meisel, MD
I was at a birthday party with my 4-year-old son last weekend, and found myself standing by the snack table talking with the other mothers as the children roamed around the indoor playground where the party was taking place. I watched out of the corner of my eye as Jack and a classmate jumped, giggling and holding hands, off of a foam diving board into a pit of plastic balls. They came up laughing hysterically and ran to repeat the trick. It was a beautiful thing, the unfettered joy of children at play.
“So, you work during the week, right? What do you do?” asked the mother standing next to me.
I always hesitate a little to talk about my work at birthday parties or other such activities, even when asked directly, because it seems to somber the mood. Saying you are an oncologist when chatting amidst balloons and cake is very different than saying you are in advertising, or a teacher, or even a different type of physician, like a pediatrician or an ENT. But you can’t not answer the question. “I'm an oncologist," I told her. Jack and his friend jumped again, squealing with glee. “Really? Cancer?” Her eyes widened. I nodded. "I see patients with breast and gynecologic cancers, and run clinical trials of new drugs, mostly in breast and ovarian cancer."
"Oh wow," the other mother said, looking at me with a mix of awe and fear. "That must be so hard and so depressing. How do you do that all day and then come home to the boys?"
A great question. I love so much about my job: teaching fellows and residents, running clinical trials at my institution and attending national committee meetings to determine what direction new research should take; but most of all, I love being there for my patients at their greatest times of emotional need. This could mean sitting with a young mother with a new diagnosis of breast cancer and spending an hour discussing how to get through neoadjuvant chemotherapy and maintain her family life; talking with a nurse with a first recurrence of ovarian cancer who doesn't feel sick, but fully understands the implications of the cancer’s return; or telling a patient whom I have come to know deeply that no more treatment options are available and that the transition to hospice needs to be made.
Each of these situations, and many variations, can come up in a busy 30-patient clinic, something that schedulers and administrators cannot possibly account for. How does one get through the day, let alone get home and put dinner on the table? These moments stay with you long after you leave the room. I still remember where I was sitting—on the floor of our kitchen at 5 AM—when I found out about the death of one of the first new patients I saw when I made the transition from fellow to faculty. Even though she was elderly and had aggressive metastatic disease, and the death was not surprising, for the rest of that week the sadness consumed me.
It doesn't necessarily get easier as time goes on, either. I get to know my patients well as a rule, because I like to and because I need to—I think that to really care well for people, we as providers need to understand their families, their professions, their values. I think it is also important to understand what scares a patient about treatment, recurrence, or death so that we can use our medical knowledge and our empathic skills to best address those fears.
However, as I became more established in my current position and my clinics became busier and busier, I came to understand that maintaining some emotional distance from each situation was critical. This was not just for myself and my family life, but also to enable me to leave one clinic room after an intense encounter and then, composed, be ready to fully address the needs of the patient behind the next door. In each room, I try my best to be fully present, to answer every question and address even the unstated concerns. Then at the end of the day, when I have seen all my patients, returned all my calls, communicated with all of my patients’ providers and family members, and made my list of things to follow up on for the next day, I head home to my husband and my 4-year-old and 1-year-old sons—a totally different kind of chaos.
As I often tell friends, or anyone else who asks, I love what I do and could never do anything else. I live for those powerful moments in clinic and at the bedside, and find that it is one of the greatest honors in life to be able to be there for patients at a time of such extreme vulnerability. Juggling all of this while raising two sons can be complicated, to say the least, but for me the few hours at night of running, playing, reading, and snuggling with my sons is how I regain my emotional strength. Somehow, because life with them is so all-consuming in a completely different way, it fills me up again, giving me the emotional reserve I need to help sustain others.
Back at the party, Jack and his friend come running over to the table, interrupting our conversation. I shrug apologetically at the other mother, who understands implicitly that I have to shift focus. Jack’s smile fills his whole face; he is all energy. “Mommy! Mommy, I want you to see this!” he says excitedly, pulling me over to the diving board.
As he and his friend run and leap again, I think to myself, it isn’t how I do what I do all day and then come home to this—it is how thankful I am that I have this to come home to.
Dr. Meisel is an assistant professor of hematology and oncology at the Winship Cancer Institute and the Emory University School of Medicine whose focus is on breast and gynecologic cancers. She conducts clinical trials in these areas and enjoys teaching residents, fellows, and students in the clinics and as part of their formal curriculum.