Monday, January 09, 2006

Melancholy Monday: Treating People

This past week, I was having dinner with my family when my cell phone rang from the kitchen counter. I excused myself from dinner, but quickly returned when I didn’t recognize the number on the caller ID. I thought that it must have been a bill collector looking for a payment on my student loans whom I have managed to duck and dodge successfully for the past month.

I didn’t check my voicemail until the following day, and was surprised to hear not the monotone, automated, voice of a collection agency, but rather the sullen tones of a women whom I have come to know well over the past few months. Her daughter “Sarah” was my patient, she was calling to tell me that she passed away on Christmas Eve.

Sarah was diagnosed with a rare form of childhood cancer when she was 14, an age which is almost unheard of. While I cannot divulge into the specifics of her case, let’s suffice to say that the list of potentially fatal complications that she developed filled volumes of medical files. She has been given her last rights 6 times over the past few years, her mother has made the painstaking phone calls to inform family members of the gravity of her condition just as many, and each an every time Sarah somehow managed to bounce back.

I wrote about the day when this young woman entered a new hospital to receive a stem cell transplant at the end of October. The transplant was considered a palliative option, for doctors were quite certain that Sarah’s worn out body could never handle the high dose chemotherapy that the transplant entailed.

And yet, given her history, I was certain that if anyone could survive it, she could. Sarah had cheated death so many times, that I (and I know I’m not alone in this thought) had convinced myself that she would live no matter what and was therefore unprepared for hearing the primal screams of her mother as she received condolences from friends, family, and medical professionals who had made such an investment in her life.

And as I stood there watching her mother, all I could think was that every parent whom I have met must convince themselves that their child can live through everything that cancer can throw at them, for to think otherwise, to exhibit any kind of doubt would cause them to fall apart. When given a mathematical probability of mortality, the only somewhat adaptive thing to do is think that your child will fall into that 1% braket. At least that's all I've been able to come up with.

But it was such a mentality that left me wholly unprepared to face the drunken expression of Sarah's mother during her only child's "death services". Her gaze was fixed upon a point on the ceiling so as to avoid eye contact with the line of mourners which extended for what seemed like miles outside the funeral home.

When it was my turn to express my condolences to the family, I gave her mother a hug but couldn't grasp any words except the obvious "I'm so sorry." At this weak expression of sorrow on my part, she looked at me for just a moment and uttered with such desperation: "what am I supposed to do tomorrow?"

This woman had quit her job when her daughter was diagnosed. She's spent the past 4 years in and out of the hospital. She has come to define her role as a person as that of a caregiver of another. So what happens now that the one she's cared for isn't there tomorrow?

During the viewing I met Sarah’s brother, her father, her best friend, people whom I had never met during her hospitalizations. I began to piece together the many facets of her person that had nothing to do with her role as “patient”. And I came to the realization that I don’t treat “patients”, I treat daughters and sons, sisters, brother, nieces and nephews. And it is this realization that makes losing so many of them so difficult to bear.
I think that in the medical profession, patients tend to known by a series of numbers. Doctors tend to remember patinents based upon the number of times the relapsed, the number of days they spent in isolation after transplant, the number of rounds of chemotherapy. I have to admit that at times I’m guilty of the same. Sometimes I think we’re so focused on treating an illness, we forget that we’re treating people.