I am sick of the pink. This is not pink. Pink is not breast cancer. Look at me. This is what breast cancer is.
I stood there and did my best to explain what we felt was going on, our impression of the possible causes, and our investigations around them, some of which simply could not be done tonight.
The family was not satisfied. “We want answers. Now.” From there came the questions. “Why must it happen later? Why is this test being done? Why will you not take our complaints seriously?”
I reassured everyone that we were checking every avenue, that there was a method and reason behind the tests and explained as plainly and thoroughly as I could. More importantly, I tried to address their concerns up front and with honesty.
Nothing could appease my audience. I could feel the growing dissatisfaction in their tone, the tension that my presence brought to an obviously well meaning and concerned family.
However, standing there, the focus of every pair of eyes in the room, I began to feel the churning of my stomach, the pounding nudge in my chest, and the burning flush of my face. I had become an enemy in the room, an obstacle between the vocal family who wished to be heard and heard by none other but the doctor himself. It was time I excused myself.
I returned quickly to my attending and explained the situation: I had attempted my best to alleviate their anxiety and answer their questions but I had failed. I needed help.
When he arrived, even then the discussion presented challenges. It took a lot of work to come to an agreement and understanding.
The communication channel is open both ways. The solution to defusing a situation like this is always to make people feel that they have been acknowledged, that their concerns have been understood, that they are not an afterthought in this already complicated system of care. Even with that in mind, the discussion can be challenging. It really takes a lot of patience, perseverance, and thick skin to build up the rapport needed in difficult situations.
Perhaps with time and experience, I can find a way to finally manage this myself. For now: please do not shoot the messenger.
Were you ever involved in a confrontation? How did you deal with it?
“Tom, come take a look at this,” the attending beckons excitedly. I get up from the charting station and walk over to his computer.
A CT scan fills his screen with a very large, obvious abnormality. “This is one of the biggest I have seen in my career,” he says. The patient had developed not only a large mass but a rare one, causing all sorts of systemic anomalies. Given the extent, it would be inoperable.
As we proceed to the patient’s room, the doctor explains the clinical presentation of mass effect on the body. His eyes are wide and flicker with a fiery excitement. He can barely control the rate of his words as he gushes about the various pieces of the unique clinical puzzle in front of him.
“Are you excited?” he asks after he finishes. I reply that it is “interesting,” much to his displeasure. “How could you not be excited? You might not see this ever again in your life.”
But all I could think about was how this mass, this zebra on a CT scan would soon bring our patient to their untimely death.
Within, I watched the attending as he spoke to the patient and their family about the situation. He explained things with such professionalism, clarity and assurance that I could see no better way it could have gone.
Yet it continued to disturb me, his excitement in it all.
Joseph Addison, a poet said: “Everything that is new or uncommon raises a pleasure in the imagination, because it fills the soul with an agreeable surprise, gratifies its curiosity, and gives it an idea of which it was not before possessed.”
For my attending, who may have seen thousands upon thousands of patients with very similar presentations, this zebra case must have stirred up a renewed sense of adventure, a break from an otherwise regular routine of patients.
Perhaps, it is that hot flush of novelty, that infectious high of our peers that perpetuate our own behaviour.
Too often our fascinations show outwardly as our primary intent. In the process, we forget that the patient has a name, has a right to be treated with dignity, has an illness that still needs to be treated. In the process, we forget that the condition does not define the patient any more than he defines the condition.
It is a strange situation we find ourselves in, to be excited and captivated by our morbid curiosity; on some level, we must in order to learn and improve as clinicians; at the end of the day however, it must come at the expense of someone else’s health. For that, I must always consider the fine line that separates respectful and disrespectful learning.
“Pretty neat findings, eh?” He nudges me. I take a look back at the patient’s room. I watch as the family huddle in an emotional embrace as they come to terms with our news.
“Yeah. It is really interesting,” I mutter bleakly.
The way I see it, the standards and recommendations of practice change from year to year, decade to decade. What does not change is the art of medicine, the ability to build a relationship with your patients.
If you can take away that from your training, you will do fine. The rest you can look up and read.
Recently, I had the great pleasure of working with a specialist. While I found him to be an excellent doctor and teacher of his field, he impressed me more with his mastery of the art of medicine.
Watching him work reminded me of the heart it takes to work with patients.
After spending a morning with him, I can honestly say without hesitation: I have never been more inspired about medicine.
There was nothing complicated or mysterious about his interactions with patients. There was no parlour tricks or unnatural question structure. It was just him, his patient, and the problem. His language was simple, his examples relevant, and his explanations honest.
We often talk about empathy as a tool to help us connect to a patient. In my hands, it is an embarrassingly clunky, yet unrefined hammer of “it must be frustrating,” or that “I see you are upset.” His was the precision cut scalpel that sliced to the core issues and emotions.
Patients simply opened up to and connected with him. And I, sitting in my seat, even felt the transference of emotions at times as well. It was a powerful and beautiful display of the art of medicine at work.
To his patients, it was an overwhelming sense of feeling human in the eyes of a stranger, to not feel like a bag of meat at the mercy of a probe and a blade. To him, it was just the way medicine had always been and would continue to be.
For me, it was the revelation of what it is to truly practice great medicine.