By Pesona Grace Lucksom, MBBS, MS
I rushed out of the patient’s room and sat on a chair. I hurriedly covered my face with the palm of my hands as I did not want anyone to see me cry. I desperately ordered my tears not to roll down my cheeks but they didn't listen to the thoughts in my head, only to the pain that deeply pierced my heart. I started sobbing and said to myself, "Oncology is not meant for the fainthearted.” It takes courage to see people whom you have treated lose their lives when the disease takes the upper hand.
When I joined as a first-year resident in gynaecology oncology, I was an enthusiastic learner. I wanted to learn new ways of treating patients, both surgically and medically. I had completed my masters in obstetrics and gynaecology and had worked as a general gynecologist and an obstetrician for 5 years. Working as an obstetrician and a general gynecologist I had a very cheerful time. Though untoward incidents do happen, most of the time this profession helps bring new lives into this world and introduce happiness into families.
My desire to learn more led me to join as a fellow in gynecology oncology at Tata Medical Center, Kolkata, India. On my first day as a fellow, I sat in the OPD with a smile extending from one ear to the other. I was elated and curious as I waited to be enlightened with fresh knowledge. However, when the clinic started, I felt everything was different. Everyone was sad; the patients and the family members who entered the clinic were sad, the doctors were sad, and the nurses didn’t look happy as well. It was a very gloomy environment and it made me feel suffocated.
The first patient who entered the room that day had come for her first follow-up after the completion of treatment, so I thought she must be anxious and this anxiety would vanish once I told her that she was fine. As she lay on the examination table, she started loudly chanting prayers, which was new to me. I conveyed to her that she was disease-free and expected to see her smile, but I noticed that though there was a feeling of relief, there was no outpouring happiness as she knew the disease could come back any time. I felt I was a monster rather than a doctor.
The situation became worse when we had to convey to a different patient that the disease had recurred. A woman, who had undergone multiple surgeries for leiomyosarcoma, had come with a large recurrent pelvic mass. The multidisciplinary team decided that no further surgery should be done and that she should be given palliative care. We, as fellows, were to convey this decision to the patient and her husband, who were waiting eagerly outside our clinic. As soon as the patient learnt of the team’s decision, she grabbed my senior attending's hand and begged to prolong her life for few more years. She cried, "Doctors, I beg of you to please help me survive for 2 more years, as my eldest daughter would be of marriageable age and I want to see her off into a new family." She wanted to take sweets home for her younger daughter as she had come from a neighboring country. She cried, saying that her younger daughter didn’t even know that her mother has cancer and had asked her to bring sweets as she came back home. We found ourselves as helpless humans in white coats who could only console her. After she left the room, we, the helpless bunch, started crying too.
When a month had passed, I noticed that joy had completely abandoned me and I had forgotten to smile. I could no longer hold on to my cascade of tears, so I went home after work and cried my heart out. I cried so much that I started having a headache. I had to console myself, as the salty drops from my eyes wouldn't stop flowing.
My view about an oncologist changed that day when I lay in a pool of my own tears. I realized that it is my choice to see the glass either half full or half empty. People suffer from cancer and if we don't train ourselves, this disease will continue taking lives. I could start seeing the glass as half full and help those suffering. Three years of my training life then became more bearable. Painful situations kept occurring, but I carried on, and life taught me more than what I had expected to learn. It taught me about passion for work and compassion towards other human beings.
That day when I ran out of the patient’s room, I had gone with my consultant to discuss end-of-life care with her. She had been treated a month prior with surgery for ovarian cancer and I had taken care of her during her stormy post-operative period. Even during her difficult days she never stopped thinking positively. She was admitted with recurrence and the disease had taken a toll on her. When I saw her that day, she was a different person physically, and emotionally she was drained. She couldn't even speak a sentence clearly. As we stood by the side of her bed, she spoke in a frail tone and asked for forgiveness to the nurse for having to clean her up. She told the nurse in Bengali, “Sadinata, ke na bhalobashe?!” (“Who doesn’t like being free and independent?!”) but today she didn't have the strength. She had accepted that her frail body could no longer fight the battle.
The words she spoke still echo in my ears: "I am not afraid of death, but I am scared of dying." That is the moment I ran out of her room and started sobbing.
She passed away that night and I realized oncology is not for the fainthearted. We are not God to bestow life on others, but if you are willing to be an oncologist you need to see the glass half full rather than half empty. Only then can we make a difference in our lives and in the lives of our patients who become our families.
Dr. Lucksom is a professor in obstetrics and gynaecology and a gynae-oncologist at Sikkim Manipal Institute of Medical Sciences, in India. Disclosure.