To cope with loss, oncologists simply forget. Perhaps, “forget” is not the right word. “Compartmentalize,” “separate” or simply “contain,” may be better. We put all those wonderful people who have died, all that suffering, all those lives, in a corner closet of our minds, close the door and lock them away.

Perhaps. However, all those memories remain; they are part of me. Quietly, they change how I practice medicine, what I feel and how I live. Sometimes, they come back in remarkable ways.

Almost three decades ago, when I finished training and went into practice, I took an intensive review course in Cancer Medicine, in Boston. I remember the excitement of the newest research, the brilliant ideas and the astonishing diversity of disease. Most of the illnesses we discussed I had read about and studied, but I had never seen. I was frightened, but thrilled, to be starting my career. I wondered what I would see and do.

This week, I returned to Boston, to take that same review course. I was feeling a little rusty around the edges and decided that 50 hours of focused lecture about the newest discoveries, given by the best minds in oncology, would do be good for my patients and me. I was not wrong. The course was exciting, revealing and cutting edge.

However, this time, 28 years later, there is a difference. Of course, the science of cancer medicine has advanced tremendously, with several hundred thousand articles published, thousands of new treatments and an understanding of disease barely dreamed in 1987. Now the core of advancing oncology is not biochemistry and x-rays, but immunology, computers and genetics. However, that is not the only vital, critical change. The big difference for me is the 25,000 patients I have seen since the first time I came to Boston.

As I sit in the lecture hall, and the speaker puts a PowerPoint slide on the screen, and he discusses a new therapy or particular disease breakthrough, I find that his words, the images on the screen, open, just a little, that place in my mind, in my soul, where I store all the hardest memories. I am forced to remember. The door opens up, just enough, to let out one or two patients who suffered from that particular cancer. In that moment, that patient, that person, that family, is with me again.

I remember the disease and what it did to that person, who, for a short while, depended on me. I remember the hopes, the prayers and the battle. I remember fear and suffering. I remember joy, celebration and love. I remember the treatments, in victory or defeat. Sometimes, in the most searing of moments, I remember the mistakes I made.

These are not mistakes in the “state-of-the-art” medicine I practiced. These are the things I did, which harmed or neglected, for which there was no better choice. They are the losses and errors which can be seen clearly now, looking back, through the advance of science and the perfection of hindsight. These people suffered and died because oncology did not known then, what we know now.

It is hard to hear the latest science, that most marvelous discovery, and not think of that young mother, that old man, that joyous artist, that vital leader or that smiling child, who could be saved today, but because they were sick 25, 15 or even 5 years ago, died. It rips my heart to hear discoveries, which indict my best efforts, my greatest gifts and hardest work. However, the regret rings hollow, when faced with overgrown headstones and all that remains of a life is ash in an urn.

I wonder if the changes, the advancements in medicine, in life itself, can clash so violently with the ghosts of the past, as to make one welcome failing memory, or seek pathologic distraction to reinforce denial. Perhaps. Nonetheless, in order to use the latest tools and fight for today’s patients, I will gently close the closet door, once again. However, wisps of memory, of those lives, will always remain. Every cure is built on the dreams and graves of those that have come before.



  • Such a poetic post. I have a child who has many medical needs, and have spent a fair amount of time with multiple specialists over the last 16 years. Thank you for sharing your perspective. I have watched a number of people, from a distance, deal with cancer. From where I stand, it all seems more unpredictable and difficult than I like. I image that must be frustrating on your side of things. I think the smartest thing a doctor ever said to me was, "We're just not smart enough yet to understand why this happens." That came to mind again when you shared how difficult it can be to see the advancements in cancer treatments. My experiences have taught me how to live with the dichotomy between doing everything possible to ensure quality of life and yet knowing somethings aren't meant to be cured. Having to live with that reality is one thing, choosing a profession where that's the norm is quite another. Thanks for doing what you do.
  • jill mckenzie
    My sister- in- law died this morning of lung cancer...had not seen a doctor in 28 years. 67 I think. My younger brother and his wife found out their 36 year old nephew, married and with a new baby, has lung cancer. I found out that after a 1991 stage 1 intraductal carcinoma with focal invasion...I have grade 2 stage 4 intraductal carcinoma. I saw so many doctors over the years...thought I had DCIS..pre stage 1. I had a baby. I was diagnosed with a herniated disc, fibromyalgia, mono, migraine, lyme maybe....I had physical therapy twice, one biopsy, (breast), a pain injection to my spine..many scans and bloodwork..regular mammos till the last one...too much pain..arm blew up...what happened.
  • You knowledge as well as your sensitivity to your patient' well- being is what makes you a great doctor and human being. Perhaps the memories of those lost gives you the courage and aptitude to go on with the quest to cure cancer and bring good results to the all those patients and the lives of all those they touch. Thank you for all you are and all you.
  • Thank you for this meaningful essay, so more people understand. I wrote about clinicians' grief in Mourning Report : With respect and hope, Wendy

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