With one eyebrow arched and his thin lips pressed together in a smirk, Vic Davis’ face was in a perpetual state of bemusement. The twinkle in his eyes belied his own protracted health struggles. A diagnosis of prostate cancer had truncated a successful business career, and signs of wear were beginning to show. His hair had fallen out and his eyes were sunken in. His speech was encumbered by a slight stutter and he was a little unsteady on his feet — scars from a recent and unrelated stroke. All this, and yet Mr. Davis was only in his fifties.
His upbeat persona contrasted sharply with that of his wife’s, who broke down almost immediately. “I can’t do this anymore,” her voice shaking, with shreds of tissues clenched in her hand. She dabbed at the rivulets of mascara streaking down her face. “He gets dizzy when he walks around the house — last week he almost fell in our kitchen! What if he hits his head?”
“I just can’t take it much longer.”
We watched Mr. Davis’ gait in the hallway to assess his balance. He seemed determined to prove his wife wrong, but he wavered ever so slightly when he re-entered the exam room. The physician assistant explained how chemotherapy drugs often cause neuropathy, and that the stroke probably didn’t help matters much either.
As Mr. Davis eased himself back onto the exam table, his wife rummaged in her handbag for her phone: “I want to show you a picture of his legs.”
“Oh c’mon, honey, don’t,” Mr. Davis protested, rolling his eyes. But the picture had been pulled up, and the physician assistant stared at an image of his swollen and distended legs. Peripheral edema was, like neuropathy, a side effect of his chemotherapy. Mr. Davis stared grimly at the floor.
“He’s a wonderful man, and he doesn’t complain,” his wife whispered. “He comes in here, and he puts on a brave face, and he pretends like everything’s just fine — but it’s not. It’s getting worse. I just don’t know what we’re going to do.”
Mr. Davis kept staring at the floor.
We had to lean in close to hear what Paul Curtis was saying. In his early eighties, he had a raspy voice reminiscent of that of Marlon Brando in The Godfather. A recent diagnosis of kidney cancer led to a nephrectomy; today’s visit was to begin planning for radiation and chemotherapy.
Mr. Curtis was staying at a rehabilitation facility after his surgery, but he would soon be discharged to his home, a two hour drive from the cancer center. And, with no relatives nearby and nobody to look in on him, a more local caregiver needed to be found. As the doctor went to make arrangements, we stayed behind to keep him company.
“I’m allergic to only one thing: alcohol. It makes me break out in handcuffs,” he said, holding out his wrists, his eyes wide. I thought he was joking at first, until he explained how his drinking had brought an end to each of his two marriages. By the time he gave it up — “cold turkey,” he proudly stated — it was too late. He had lost his family. Now, they lived over a thousand miles away in the Midwest, and he had virtually no relationship with them. Except for the rehabilitation center’s nurse who had accompanied him to the clinic, Mr. Curtis was alone.
We spent some more time with him, chatting about weather, cars, baseball and his surprisingly progressive views on marijuana legalization. The doctor returned, and the plan was settled. Mr. Curtis would receive treatment from a physician in his community.
The visit was over. I held the door open as his nurse oriented his wheelchair toward the corridor.
“Thanks for listening.” Mr. Curtis said. Then he wheeled down the hallway.
Author’s note: All patient names are pseudonyms and have been changed to protect patient privacy.
Numerous studies have documented that medical students lose empathy during clinical years, becoming jaded and pessimistic. This has been linked not only to diminished enjoyment of our work, but also to worse patient outcomes. My goal is to sustain the humanistic values that drive so many of us to medicine, so that, instead of being quelled by cynicism, our idealism can be refined by wisdom.