Wednesday, January 19, 2005

Confronting Death with a human heart

This is the kind of physician we all would be honored to have...

I walked into the doctor's lounge the other day and suddenly felt like a pan-pipe tooter in the halls of Mount Olympus. Instead of the usual tableau of snoozing anesthesiologists in the corners and scrub nurses sneaking sodas from the refrigerator, all the giants of medicine were there. They draped themselves about the couches and chairs, chatting with fellow colleagues, or back-slapping each other with that hail-fellow-well-met ferocity found in the supremely confident.

I could see Cardiology slathering a bagel with ambrosia, while Obstetrics sat next to him reviewing last night's scores. Across the room was Pulmonary, yakking with Urology about some mutual patient; leaning idly against the counter, General Surgery nursed a quiet cup of nectar. Across the room the king of the gods - Cardiothoracic Surgery - was in his court, issuing maxims to the small crowd of admirers gathered around him.

How did it ever come to this, that I, Oncology, was fitted with a shepherd's rags? Was I not charged with a noble responsiblity - not pursuing the cause of say, diarrhea, but engaged in a mountaintop-worthy battle against a seemingly omnipotent foe? Do my patients not cry out in great numbers in the fields, or across the vast waves for merciful Oncology to save them from the sweeping fury of cancer?

Of course they do. It's just that as deities go, we oncologists are far from divine in our ability to answer the prayers of our suppliants. Our therapies don't work all the time - often not even half the time, compared to a surgeon given the task of amputating a limb - hard to imagine that not coming off all right, eh? Perhaps that is one reason why our fellow healers, when grabbed by the sleeve to hear us prattle about the latest improvements in the treatment of melanoma, give us the same look used to silence the family dog.

I suspect the other reason we get the glare is because of the drubbing we give our patients - the toxicities of chemotherapy. Who would not look askance at a doctor who eschewed the scalpel for a bag of poison? Is this anyway to be kind to people in need?

Until we come up with a bona fide cure for the cursed disease, we oncologists will always have a self-esteem problem. We may dream about sitting on the highest throne in the pantheon, but by Jove, some of our colleagues believe our place is by the ashes of the hearth.

Many strides of course have been made in the search for the cure for cancer, but in the world of the gods it is not enough to show progress. We must show a complete elimination of the disease, or perhaps a metamorphosis - changing breast cancer into a lowing calf, for example, would be a sublime myth to pass on to the generations. Until that day occurs, oncology has been hereby relegated to a minor constellation in the starry night.

I didn't always feel like this. In fact, when I started my training I was on cloud nine, running morning rounds with the team, seeing patients in the clinic, attending lectures purported to be fascinating. As I recall, it was only three months into my fellowship when innocence was shattered. I was musing at the nurses' station one afternoon when a sharp voice cried out over the hospital loudspeaker: "Dr. Hildreth report to the Emergency Room, STAT!"

I leaped from my chair like a wallaby in a thunderstorm and sped down the hall. As I rushed by, various helpful personnel hailed me with greetings like "Hey, don't you know they need you in the E.R.?" My mind raced with the possible scenarios that were unfolding there. What crisis awaited me, to broadcast such an alarm to the entire hospital? I pleaded for strength, wisdom, courage. It is always the oncologist who is asked to perform miracles, I thought, and began to recite the Serenity Prayer.

Blasting into the ward, I announced my presence and inquired as to the problem. A rather annoyed intern looked up from his chart and replied, "Oh, good - you're here. We need you to make the patient in room four a no-code. He has metastatic lung cancer and is going to be admitted."

Like Saul, the scales fell from my eyes and needless to say, the view from this formerly lofty perch was not inspiring. Since that day I have harbored a smallish but powerful nugget of skepticism about the prestige of the oncologist in the grand array of specialists.

Nevertheless our work, our search for the cure, will continue - even to the Gotterdammerung of medicine. The final outcome will not be revealed in my lifetime nor in the lifetime of my grandchildren, but when it does occur I will wager that the legions of oncologists who spent their lives toiling against cancer will be pleased to see their names finally added to the register of heroes.

We can all breathe a prayer of thanks and praise for this man. I have no idea who he is, but he writes like a caring professional. His blog is worth a look. He has been blogging since September. His first post is most revealing. I, for one, have no problem with the phrase "practice" of medicine.

The internet allows complete strangers to share their most important feelings and experiences. I always knew that there were many people who are articulate, sometimes great, writers. But I had no idea until the last few years how many there are. I am humbled to think about it.

The Anchoress lost her brother. Her typically incisive blogging has been punctuated from time to time with deeply personal glimpses into the sad, loving scenes she shared along the way. I have no idea what took him, but that is very much beside the point. Today's post is a memorial to her brother, as well as a testimony to her own remarkable strength. She shares practical advice about what to do and what to avoid when the time comes.

Do you know that when a brother dies, even though you expected it, you suddenly can't remember how to dial a phone? You attempt to call the funeral director who has been so incredibly helpful, but you can't manage all those crazy digits in that tiresome, necessary order. You can't remember your husband's number at work. The phone just stops making sense.

1 comment:

Dr. Craig Hildreth said...

Thanks for the nice words - I'm Dr. Craig Hildreth, a medical oncologist in St. Louis, Missouri, who writes as a way to appease his Erynie-like alter ego, The Cheerful Oncologist.