Earlier this week, I walked into the exam room and introduced myself to a 48-year-old male. As I generally do, I sat in front of him and asked “how can I help you today?” We talked about bleeding that started one month ago, discussed his concerns about only having a bowel movement every other day and his mother’s bout with colon cancer in her 60’s. We proceeded to the physical exam. During the digital rectal exam, I felt a large, firm, and fixed rectal mass that told me his life was about to change. Now it was my job to tell him how.
I appreciate just how tough it is to be a patient. Fortunately, for most, good health has been their norm, taken for granted while going through life without ever seeing a doctor. Perhaps they suddenly begin having problems they had never experienced (seeing blood on the toilet paper, feeling abnormally tired after a daily walk, or a gnawing abdominal pain they can no longer ignore); symptoms, which eventually prompt a visit to a doctor. For others, an abnormality is discovered during a routine exam (i.e. colonoscopy, mammogram, an EKG). With diagnoses such as colorectal and breast cancer, patients must adapt to a new normal that includes frequent office visits, periods of hospitalization, and in some cases, suddenly facing life-altering treatments and even their mortality.
A friend and colleague bravely shared with me her early writings as she begins to process her experience of being diagnosed with breast cancer at the exact time she had hoped to start a family. With a single diagnosis, her future was forever altered. A surgeon who operates on patients with lung cancer, she found herself looking at the operating room lights from a different angle as she underwent bilateral mastectomies with reconstruction. Having always sported a thick mane of curls, her hair loss following chemotherapy is a powerful symbol of her new reality. She was anxious to return to work with a scrub cap thinly veiling her bald scalp. As she described her fears, “I am bald. I can’t hide it anymore and I am terrified of everyone’s reaction. I was and I am scared of the fact that my cancer can come back and kill me, that I may never be able to have children, that the future that I have carved so carefully for myself is so uncertain because my own body betrayed me.”
It is common for patients to feel this sense of betrayal: sometimes from their body. Sometimes from God. Patients have cried, become silent, or even angry when I have given results indicating a diagnosis of cancer. Unable to fix everything in that moment, I sit with their silence. Hand them a tissue and wait. Most patients want answers and a cure. While I generally enter these patient encounters with the goal of finding a cure and full recovery of whatever ailment may be present, there are times I am often forced to care for the patients in other ways, usually with the goal of alleviating suffering. With time, most patients process and reframe their future and transition to an active member of their treatment team.
We are all just one diagnosis away from a different reality. My interactions with patients, and now the diagnosis of a close friend and colleague compel me to consider my own reaction if faced with similar circumstances. How would I respond to a life-changing diagnosis? Above all else, I would want my physician to possess compassion–to listen, care, and remain empathetic. May I always strive to enter each patient encounter with sincerity, compassion, and gratitude for the opportunity to serve.