2019 Physician Writing Contest: Caring along life’s journey

My step-children roll their eyes and laugh at me when I say, “Life is a journey,” because I say it so often. What I hope to convey to them is that life is long and complex, and that for all of us, experiences along the way continue to shape who we are, how we live, and how we view the world.

As a person, and as a physician, I am proof of that. I am older and wiser, and I am also a better physician than I was 30 years ago. And I know it is the totality of my life journey, and the interactions I have had with the patients I have been privileged to care for over many years, that have shaped me and made me a better doctor.

These days, as I proudly watch my daughter grind through medical school, all-consumed with studying and doing well on exams, I try to give her advice and perspective, but not surprisingly it often falls on deaf ears. What I know is that I was not a dissimilar student. Life balance is always hard as a medical student. I remember at that stage of my career, as a future internist, it was all about knowing everything. I wanted to be a great internist, and I believed “book smarts” was the answer. Only with time have I come to realize that being a great internist requires so much more.

One of my early growth moments came from my mother-as they often do. I was seven months pregnant with my second child when I diagnosed my mom with stage 4 adenocarcinoma of the lung. She had a large pericardial effusion at diagnosis and as an internist’s daughter, I knew the prognosis.

I was devastated and I began to grieve immediately. She moved in with us to receive her care in Cincinnati. The day I brought my son home from the hospital, she celebrated his birth as “the circle of life,” and we both cried with joy and sadness.

The next day I accompanied her on her first cycle of chemotherapy. As her disease progressed, I felt it was important to talk to her directly about her prognosis, often saying that it was likely she had only weeks or months left, thinking that information would allow her to prepare and would allow us to have all the conversations we needed to have. In hindsight, I was trying to prepare myself for her death in some way and to control the uncontrollable. But I now understand my approach was wrong.

What she said to me in the days before she died profoundly changed the way I practice medicine. She told me that as a cancer patient approaching death, the only thing one has left is hope. And although she knew my intentions were good, and I was trying to help her with factually correct information, it took away her hope.

Since her death, I have cared for my cancer patients in a completely different and, I believe, better way. Even at the end, when they are in hospice, I am cautious to allow them hope, and to follow their own journey to making peace.

Another patient, this one much younger, also changed my life. In his early twenties he had a seizure while playing tennis with his family and was diagnosed with a large brain tumor. Following surgery to remove it, he was hemiparetic, bedridden and completely unable to care for himself.

Visiting him in the hospital and then in the rehab facility was one of the most significant patient interactions of my career. Sitting with him ten days’ post-op, as he needed help to go to the bathroom, with a very uncertain future, he remained hopeful, positive, kind, and connected to his friends and family.

I treasure the handwritten note he sent me thanking me for my care and support. With hard work over time, and an unwavering positive attitude, he largely neurologically recovered. Within months he was walking and returned to his job in Chicago.

Three years later he fell in love with a woman who was also a cancer survivor and they married. Unfortunately, at the same time they learned they were expecting, his cancer returned. I saw him in the months prior to his death, and his grace and strength were incredible. He died just a few weeks before his son was born. During his final months, he remained hopeful and joyful, and he never complained. The way he lived his life taught me how to live, a gift without a price tag.

What my patients, including my mother and the young man with cancer, have taught me over the years has impacted who I am as a person, and how I practice. That’s what makes caring for them such a gift.

Witnessing the devotion of children to aging ill parents, the love shared by elderly couples as they become frail and sick, the strength patients show with a terrible diagnosis, the generosity of people when others are in need, and the courage they show as they approach death-all of that has taught me an immense amount about life and love. It has also helped me share what I’ve learned with other patients. That’s why caring for them along their journey is a tremendous privilege.

Then there’s my own breast cancer diagnosis at age 49, which taught me more than I ever thought possible, and has further impacted the care I give my patients. As a women’s health internist, my focus has been on caring for women at midlife-through menopause, changes in sexual health and breast cancer survivorship. Now, when I lecture in the community, I can share that I am living with exactly what many of my patients experience-chemotherapy-induced menopause, sexual dysfunction, radiation fibrosis and more. In the exam room, I can be empathic in a way I could not have been without my experience.

But the most powerful gift of my cancer diagnosis was learning in the most profound way the value of close, connected relationships. My family, friends, patients, and community supported me in ways I did not know were possible. I never felt more loved than I did during my treatment.

Experiencing that love, and the gratitude I now have for my life and my profession is impossible to put into words.

Simply put, it has made me a better person. And, yes, a better doctor, too.