I have discovered that being in medicine has sucked the creative energy right out of me. Part of the reason is that it’s so time consuming, so intellectually stimulating, and so emotionally exhausting, that by the end of the day, week, or month, I can no longer find that inspired voice inside my head.
But I have regained a thread of inspiration, after spending a week in sunny Southern California with two girlfriends basking in the sun, soaking in a hot tub, and cleansing myself in the salty spray of the ocean. And instead of reading journal articles or textbook chapters while on the plane ride home, I impulsively picked up a great novel in the airport bookstore on the way home. It was “All You Could Ask For” by Mike Greenberg and it filled me with hope, inspiration, and a renewed sense of commitment to my writing.
While sitting in the hot tub under a full moon and sipping white wine from a water bottle, my girlfriends and I shared stories. We talked of our families, our struggles with our relationships, and our work. It reminded me how much I love stories, and why I have chosen not only medicine, but the field of physical medicine and rehabilitation. I could never have been an ER doctor as there isn’t enough time to hear the patient’s story. On our inpatient rehab floors, where patients are healing from strokes, traumatic brain injuries, spinal cord injuries, or just plain old deconditioning from being so sick, I am able to take the time, over many days and weeks, to hear people’s stories. How they got ill, how they are (or more likely are not) adjusting to their new disabilities, how their families are coping, where they have been in life, and where they’d like to go in the future. I am reminded that no matter how much paperwork or computer work or fighting with the insurance companies or billing issues threatens to kill my love of medicine, it can ever take away the magic that I feel when I am in a room with a patient listening to their stories.
While in that hot tub I also realized that I have experienced a lot of trauma in my training, and in my personal life, that I don’t think I have had time yet to process or heal. There is the woman with end stage lung cancer who died overnight during my intern year, in part because I erroneously listed her wishes in the computer as comfort measures only rather than do not resuscitate and do not intubate. There is the woman with end stage esophageal cancer who died in minutes after hemorrhaging up blood on the morning I was trying to get her home on hospice. There was the 20 year old with end stage sarcoma requiring a complete amputation of his right leg and hemi-pelvis trying to adjust to what he knew was soon to come.
I started reading a book many months ago called “The Emperor of All Maladies, A Biography of Cancer” by Siddhartha Mukherjee which is a fascinating story of the history of cancer and it’s treatments. It humbles me to learn of all the trials and tribulations many patients have undergone in the history of physicians and researchers trying to understand and treat cancer. While I read of a story of a man’s progression from asbestos exposure to a lung cancer that kills him many many years later, I can’t but help think of my dad. When did his cancer start? What if we had caught it earlier? Would he have survived chemotherapy? Radiation? Surgery? Why did he have to smoke? And many other unanswered questions.
The truth is that my dad died of cancer the exact way he lived: with passion and intensity. He went in for a MRI for back pain on a Friday afternoon; 10 days later he was dead. He knew smoking was bad for him, but he got such pleasure out if it, he didn’t care to stop. He also thought he was invincible, which in the end, he learned he was not. I remember seeing him the hospital, where he had the night before gone completely bezerk, requiring guards and anti-psychotics. I don’t know if it was delirium from being in the hospital, or from the cancer that had metastasized to his brain. Either way, he looked crazy when I first saw him, sitting up in bed with an ice pack on his head. My physician instincts took over and I sat at his bedside and asked him where he was. He thought he had been kidnapped with 500 other people and he was in a building where they were doing experiments. He just wanted to go home he told me. I gently explained to him where he was, and why he was there. That he had cancer that was not treatable. That we would go home as soon as possible, where we would make him comfortable.
I sent my step-mother home that night, so that she could get a break and I could take care of him. He asked me over and over and over: “So I have cancer?” “How did I get it?” “So I am going to die?” It was a heart wrenching night. But the next day we went home, and because he knew what was coming, he was able to call all of his old friends up in Vermont and tell them goodbye. Four of his closest golf buddies had promised him that they would spread his ashes in a particular spot, and he called to remind them of their promise. One friend he found to his dismay had passed away from cancer 2 weeks prior. Another was currently in the hospital with cancer. The other two could not stay on the phone long, as they couldn’t stop crying after he told them he did not have much time left.
The day after my dad finally peacefully passed, we called to let his friends know. When we called the son of the golf buddy who had also been in the hospital we found to our surprise that he had also passed the previous night. We held our breaths while asking Greg what time his dad died. When he said “7:10 pm” we all started crying in disbelief, as that was the exact moment that my dad also died. We joked at his memorial service that they probably had a tee time to catch, so they could play another round of golf together.
I tell this story because I realize, like that patients that tell me their stories, it is needed in order to heal. I look forward to all the future stories that I will hear from my patients, and for the stories of my own life that I will create. Miss you dad!