Palliating the doctor

Posted by on Jul 11, 2016 in End of Life | 9 comments

Palliating the doctor

Being an oncologist can be an awfully hard job.  You give body, mind and soul, you love your patients.  Then, sometimes, the cancer takes over and those who have become your teachers and friends, die.  It can be hard to find balance. You have failed.  For some docs the practice of oncology wipes them out.  There is a secret to being able to join the fray, every day, month and year; Know that, whatever happens, there is always something you can do.

When I was first in practice, I took care of a young woman, a girl of 19, who had advanced colon cancer.  Surgery, repeat surgery, chemo after chemo, radiation, every treatment we tried, failed. She became weak. Her abdomen swelled. She became jaundiced. I remember gold tears on deep yellow tanned skin. Her pain and fear increased. I became frantic, anxious, even angry.  How could this pure child die?  I called every “expert.”   There seemed nothing I could do.

Then, late one evening, making rounds, I heard her crying down the hall.  I realized that while I was searching the medical world for a cure, I was failing to take care of her real need.  I could sooth her fear and control her pain.  A small amount of pain medicine and a slight sedative.  A hand held.  That evening she finally rested, quietly talking with her parents.  She laughed.  I realized, there was something I could do.  There would always be something I could do.

For oncologists who believe that their only role is to battle disease, to fight against death, to attack with treatment after treatment, there will always be failure.   Again and again, they experience deep loss.  They become shells with a burned out soul.

For oncologists that understand their role is to relieve suffering, whether by treating disease, relieving symptoms or just the compassion of a smile and a touch, there is balance. They will never fail their patients, never desert them, always have something to offer.

What is critical about this discovery, this approach to care, is that it is good not only for the patient and family, it is healing for the doctor.  It allows her to attack the disease, when that is the right thing to do, but always be ready to give comfort and sooth symptoms. To stand by each patient, no matter what happens.  There is balance in the knowledge that even if the disease explodes and life is coming to an end, the doctor has a role and purpose.  Closure not only for the patient, but for the physician.

Being an oncologist will always be an awfully hard job.  You love your patients, and some die. However, for me there is the comfort of knowing that whatever happens, I will be there.  My small place in the cycle of life.

 

 

9 Comments

  1. And that is why you are an outstanding doctor and human being!
    Thank you!

  2. Once again – Wow. Thank you, Jim for you.

  3. My hope is that every doctor would read your words and let them go somewhere deep inside them. Every patient deserves nothing less.

  4. I really don’t have an issue with my doctors, it’s the nurses. I am a low key complainer. Right now I’m saying—A hole is developing in my bone under the skin. It’s in the surgery site. It’s getting bigger. It hurts. It’s probably Gorlin Syndrome. Sure the oncologists probabley can’t do anything. They always told me to contact them if I had a problem. I have a problem, and I have contacted their offices. I’m not even asking for pain med. What contact I have is them rescheduling my appts. for a later date. That’s why I think that the nurses aren’t passing the messages on. Why did they bother flapping their lips?

  5. That is your LARGE part in the life cycle. As I said in my piece I sent you, the caring and attentiveness is everything, especially for the terminally ill. Thank you.

  6. Being all things to all people (An oncologist providing palliative care) is the makings of an “awfully hard job.” Palliative care has to be viewed as a team of healthcare providers that stand on the opposite side of the patient’s stretcher, offering patients alternatives to the medical intervention being proposed by oncologists, surgeons and radiation physicians in one-sided conversations. A balanced practice is rarely a solo undertaking and recognize’s one’s own limitations.

    • Amen. jcs

  7. Thank you, Jim, for your intuitive, compassionate and knowing words. Not abandoning our patients at this most tender of times is what matters. Your presence is the truest comfort and support – you make a great difference to your patients and their families.

  8. I wish this could be sent to ALL physicians. We are getting away from having a personal connection with our docs. Visits are hit and run, no one listens any more and misses the real reasons you are there. Thank you, Dr. Salwitz.

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