In the opening line of his famous book "Anna Karenina," Tolstoy wrote, "All happy families are alike; each unhappy family is unhappy in its own way." To paraphrase him, I have also observed that each family deals with cancer in its own way.
Doctors, especially oncologists, learn how to keep an emotional distance from their patients. By doing so, they can make critical decisions with objectivity and avoid early burnout. This approach is frequently, and incorrectly, viewed by patients and their families as a sign of lack of empathy.
During hospital rounds, doctors need to carefully regulate empathy and continuously adjust their own emotions to properly respond to patients' fear, happiness, pain, anger, sadness and hope, without losing focus on resolving complicated medical problems.
While doing so, doctors also have the opportunity to observe the lives of others during their most vulnerable moments. Some of these "snap shots" can be profound in reminding us of the basics of our humanity.
After six years of fighting cancer, the patient progressively developed multi-organ failure, generalized swelling, shortness of breath and pain. He had already received ten treatment regimens, including stem cell transplant and experimental therapies. While his body was getting weaker, his tumor was getting stronger.
He was admitted to my service, where I met him and his wife for the first time. He was in his mid-sixties. He was tired, breathing heavily and somewhat drowsy from the pain medicine that he was given. His wife also looked tired from the long days and hours she spent caring for him.
Deep inside, she knew that they had lost the battle. She wanted him to die in the comfort of their home. She asked for help with arrangements for home hospice care.
On the morning of the planned discharge, I entered the patient's room to make my final visit. As I opened the door, his wife rushed to meet me. I could see him comfortably lying in bed, not aware of his surroundings. Looking over his wife's shoulder, I saw for the first time an old, wrinkled, fragile woman with thin white hair, sitting in a chair next to his bed. She must have been in her nineties. She was gazing at him with love and extreme tenderness. Realizing who she might be, I walked towards her to introduce myself. She immediately stood up, hugged me and started weeping like a child. With a choked voice, she said "I am his mother."
As I moved to the next room, the nurse was joking with a 40-something-year old patient, who was getting ready to be discharged to go home. She has completed six cycles of chemotherapy and was happy to be in remission. She was bold, already dressed up, complete with a beautiful necklace and lipstick. I walked into her room smiling, shook her hand and congratulated her for this milestone.
She did not know about the tragedy next door, but we all did.