There will always be days in medicine that are hard to swallow. Today happened to be one of those days.
Back when I was on labor & delivery I saw a pregnant woman who was a little worried about several issues. I did a thorough history, physical, and review of symptoms. One of the things she brought up was that she’d had a breast mass for a significant amount of time. Other doctors had told her that it was no big deal, just a duct enlargement and it would resolve after pregnancy. I, never knowing what’s pertinent or not, presented this to the senior resident (along with twenty other findings) who told her she needed an ultrasound and biopsy. She left that night. Today the senior resident told me the pathology came back as triple negative invasive ductal carcionoma. It is one of the most difficult types to treat and has a high rate of spread and recurrence. While I’m glad we were able to finally listen to her and start treatment, it makes me sad so many other people failed to listen to her. She’s a young woman with kids, and a life, and now cancer.
I also have a patient with metastatic endometrial cancer. We had to tell her and her husband that the chemo is not working and that, in fact, the cancer has spread. We’ve discussed the idea of hospice care at this point. That is never an easy conversation to have with patients and their families. She had kids, grandkids, a husband, a life, and now cancer.
I think there are so many skills we learn as medical students. But one of the most important things I’ve learned has been this year and that’s how to talk to people and how to treat people. On the gynecology service there are some really amazing attendings and residents. And yes, they’ve taught me how to do a good pelvic and breast exam, elicit information about patient’s personal lives. But what they’ve really taught me, especially on the oncology service, is how to be a GOOD doctor. And the key there is listening to your patients, and treating them as you would want your own family members treated. It means taking the extra ten or twenty minutes with your patient (or even an hour if you need to) to explain things to them, to make sure they understand what’s happening. It means empowering patients to be their own advocates and to be active participants in their care. It means holding someone’s hand before surgery and giving them a hug when they’re cancer free. It’s not always about the medicine – it’s about being a decent human being.
Unfortunately today cancer is something that you’ll have to deal with no matter what specialty you enter into in medicine. And the best advice I’ve ever been given was by an attending who said “never treat cancer patients in any way that causes them to lose hope, because hope is often the greatest medicine we have”.
So, never ever give up hope.