I do apologize for what seem like persistent pessimistic rants; true, my obsession with Death and the dying does reach depressing extremes. It doesn't behoove me, to try and laugh it off; and saying that Death and Disease are all around, like a perverse version of the Wet Wet Wet song playing on repeat, has me coming across a lesser person than anything else. I can very well attribute my somber tone to the fact that I've now started my Oncology rotation, perhaps, also, to the book I just finished reading - "The Emperor of All Maladies" - Siddhartha Mukherjee's cancer biopic.
It's hard to try and put into words just how significant a role cancer plays in our lives. To some, cancer might still be just a statistic. Whether it's 1.6 million new cases in the US of A alone, or whether it's the 3rd leading cause of death, it's to be taken as a statistic, and stored at the back of their brains, or discarded as yet another "somewhat interesting" but ultimately useless fact. But,to a lot more, Cancer is real. Ever present. Honestly, if I asked the few dozens who I hope read this, everyone would know someone - friend or relative, living with or having had cancer.
But, I believe I'm sidetracking. What really got me thinking about the big D this time was an interaction with a patient. I had to tell someone that we had "done all we could". That I believe, is one of the most testing conversations a doctor will ever have, that about giving up. Testing for the patient, and the doctor. I can never say I understand how it must feel to be in the patient's shoes, because I can't; and I'd rather have a life where I'd never have to. How do you react when you're told there's not a lot to do? How do you react to a timer placed on your life - a premium on the time left? How do you, basically, come to terms with the fact that you will die. "Soon". Testing for the doctor, because you will never be sure how exactly to play it( pardon me for my choice of words). How do you go in, knowing that what you say matters, but not as much as how you say it. How do you get the person on the other side to understand, at the same time sparing him/her from what could prove to most disastrous now - false hope. And how, and this is hard for me, do you not get affected? A stray conversation I can understand, but when you're in a profession where this might be, unfortunately, a not too infrequent occurrence - how do you detach yourself emotionally and yet manage to come across as someone the patient can trust in?
And I did go and have the conversation. My first. One that I'll always remember. I was with my attending, true. He did most of the talking, but I felt that this hit hard somewhere. It's so easy when you study stuff. 5 stages of Grief, they say. When you do have to practice it, the "shit gets real". There I was, getting overwhelmed, trying to hold back, constantly thinking that I could never imagine having to repeat this conversation for the rest of my life; and then feeling guilty that I was being petty about a conversation when the person in front of me was having his life's notice being served.
It's funny the things you notice when you actually pay attention. I went in expecting to see a man defeated. Someone who would break down at the news. Overreact. Be inconsolable. (Maybe it's just the "naive movie fan" talking). The little things touched me. the wife squeezing his hand ever tighter as my attending discussed the prognosis. The daughter trying hard not to break down for her father. And the smiles got to me. You know the kinds you put on to show that you might be ok, while you're really falling to pieces. What struck me was the calm in the room. The feeling that the eventuality that had been put before them would be dealt with, just like anything else. The sense that, despite everything that was happening, the father tried to stay in control. And the fact that he thanked us. Thanked Us, the messengers. What I'll take away from this, is the fact that I met a man who refused to let something as big as the looming eventuality of Death change who he was, and how he'd behave. Someone who would accept. Someone who would face death on his own terms. Go out being himself.
That to me is perhaps the take-home message for me from the number of people that I encountered at Yale, and Siddhartha Mukherjee's book. Yes, Cancer (and death) is a dark and often unforgiving adversary, but what matters is how you choose to face it. The book, to me, is not so much about the history of Cancer, as it is about the personal struggles of the men and women who faced up to it. The survivors who soldiered through, and those who didn't. But chose to accept it. Go out doing what they always did.People like Susan Sontag. And that is what it's about, isn't it? Why do we remain so afraid of Death? Is it the pain, is it the loss that'll be, or is just the fear of the dark all over again, afraid of what we don't know. Which brings me back to the doubts I had before. What do you do, when you're faced with such an eventuality? I know there isn't a right answer, but learning to accept it seems a brave choice. To me, it's most of the battle won. When you can't "win" over death in the traditional sense, not letting it change you is a victory. Being yourself is a victory. Acceptance is a victory. To me, that is the closest you get to "conquering" Death.
As John Donne put it, " And Death shall be no more. Death, thou shalt die"
