Running With IV Poles

I wish I could show you a picture of this young couple huddled over the side of a crib. Their faces were clouded with deep concern. Their baby had spent the greater part of 4 or 5 years in various hospitals, for treatment of a multitude of problems. His endocrine problem, which brought us into the treatment team, was the least of these. Even though we were only monitoring one lab value, we came by to check on this little patient every day. Every single time, we walked into this same scene with his devoted parents huddled over his crib.

I wish I could show you a picture of this child. Like so many Pediatric Endocrine patients, he was tiny for his age. He lay floppy in his bed, barely able to move his claw-like limbs. And he had these fascinating buggy eyes that seemed to stare in opposite directions.

Parenting is complicated, of course. There are many tremendous tasks associated with caring for a child, and despite excellent efforts, children don’t always turn out as one hopes or predicts.  But, seriously, no one could have been prepared for this! And yet, I have never seen any parents who loved their kid more than these brave people loved this poor child.

Pediatrics can be a tragic, heartbreaking field to work in, especially at a tertiary care center like UCSF (where I’m currently visiting). Every patient has several big problems. Too many will die shortly. Families have to split time between the hospital and the life they want. Parents put off their education, their careers, their relationships, their other children. They drag on in these horribly straining circumstances for months, years, indefinitely—until their trials end abruptly in the death of the little one. So many times a day I wonder how all these families make it through such times.

The beauty of Pediatrics is getting to be a part of these stories, to see example after example of courage and resilience, and to help bear these huge burdens in some small way. It’s the little head poking around the IV pole, shouting, “Excuse me, Doctor, I can’t see the TV!” It’s the five-year-old grinning when asked about his new diabetes, then running over to bite his brother’s head. It’s the sigh and nod of a tired mother writing down the dosages of yet another new medication regimen. It’s the gorgeous young couple huddling over the crib of their severely-deformed son.

The beauty of Medicine in general is seeing people in the most unimaginably horrific circumstances, and realizing, they are just people. They are not a list of diagnoses. They are not limited in their ability to be happy.

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To Fight

Have you ever had a doctor break down and cry with you as you received bad news? Sometimes I have to work really hard not to be that doctor.

Each day in Oncology clinic, I see all the stages of grief. Everyone battles cancer completely differently, and I get to experience it all as one giant roller coaster.

One minute an old woman comes in after her last round of chemo left her hospitalized. She absolutely insists on taking another round. Her doctors hesitate to give her more chemo and radiation than she could tolerate, yet she refuses to go to the grave without having pulled out all the guns. The defiance in her eyes is contagious. I want to shout, “Yeah!! Go get ’em!”

Next thing we see a young man whose cancer had no business interrupting the course of a well-plotted life. He’s already nauseated just worrying over how the treatments will affect his family. He and his wife raise a slew of questions, exploring every crevice of every possibility. Our uncertainty makes them visibly uneasy: Curing cancer is a numbers game, from our perspective. But for each individual patient, we either achieve a cure or we do not—and the side effects are definitely not worth it for a not-cure. I wonder if he might talk himself out of getting any treatment at all.

Then we get a happily oblivious patient, a guy with brain tumors so far gone that he no longer has the capacity to understand his own plight. We try to explain that he needs to take his chemo pills diligently. He smiles pleasantly and agrees, indicating that he clearly won’t do anything of the sort. While this is truly terrifying to me, part of me also thinks that perhaps, for a cancer patient, he is in the best of all worlds.

The tearful patient really gets to me. Someone had given her false hopes about her prognosis, so then it became our job to set the record straight. The doctor apologizes profusely. The patient retreats into heaves and sobs as she begins to mourn her own death all over again. In her mind, we have just killed her. I hand her a box of tissues—inadequate for the gravity of the situation. Yet she smiles briefly as she takes the box from me. We continue the conversation as she empties the box. Pagers ring, and we silence them without answering. Occasionally I stare at the ceiling so the tears won’t crash down.

Where in my medical training was I supposed to learn how to let a patient die? How do I tell the dark news, and then, how do I react? Do I grieve the disease, or do I fight it? What does the patient need to hear? Is it inappropriate to laugh with them? To cry? Is it unprofessional to admit that the cancer, in beating the patient, is also beating the doctors?

What is a good doctor?