I’ve heard it said that knowledge is power, and that to be forewarned is to be forearmed. I still remember getting a text from my mother when I was on my OB/GYN rotation, during the first window of time I had gotten to use the bathroom all day.I remember her texting me a picture of a CT scan of my grandfather’s lungs with the words: “What does this mean?” And just like that, my grandfather was reduced to a standardized test question stem: An 80-year-old man with a 30 pack-year smoking history presenting with a spiculated lung mass on CT.
Everything ceased to exist except for the picture on my phone, the chill stealing its way through my veins and a vague buzzing in my ears. I tried to warm my blood with a few fortifying breaths that caught in my chest and didn’t seem to be making their way into my lungs. I blotted my suddenly clammy hands on my scrubs and tried to go back to work as if nothing had happened.
My family in India is usually daunted by crisis and plagued by indecision. Once the doctors in India confirmed the diagnosis of lung cancer, things progressed at the speed of light. My grandfather, a typically proud man who made decisions with his heart and did what he felt was right, told his children to make whatever medical decision they thought was best. He was scheduled for a lobectomy. My mother immediately flew to India to help care for him.
I’ve heard it said that knowledge is power. But sometimes, knowledge is the torture of knowing exactly what can happen and realizing that you are powerless to change the outcome. I couldn’t help but think of the many hours I had spent over the past two years studying the different types of lung cancers: how to treat them, which type caused hypercalcemia, which type caused hypercortisolism. How tawdry this paltry litany of facts felt now, useful only for blind regurgitation onto test papers, as my grandfather lay in a hospital bed on the other side of the world. To hold on to any semblance of control of the situation, I called my mother every day, sometimes multiple times a day. Beyond the few developments she was able to give me, we mostly spent our time on the phone in empty reassurances and silence, because that was preferable to hanging up and being left alone with my own thoughts.
Call it faith or desperation, but the heart’s ability to cling to any available shred of hope is infinitely more powerful than any knowledge obtained from books. I always thought I would be better equipped to handle death after spending two years in a classroom learning primarily how to intellectualize illness. But when my mother called me that afternoon to tell me that my grandfather had passed away due to post-surgical complications, I sat frozen and uncomprehending on my couch, feeling no less lost than the first time I had encountered death. Until that moment, I hadn’t realized just how much I had invested in the slim chance that he would make it. Never mind everything I had learned about respiratory distress; never mind the fact that every time I visited him, I had been watching the laughter lines fade from his face and the light dwindle from his eyes over the past ten years, replaced by a desperate desire to be somewhere else. All I could wrap my brain around was the fact that my grandfather, the cornerstone of my spirituality — the impossibly tall man who would steal my toys from me when I was a child and wave them merrily out of my reach until I was exasperated to tears — was not only fallible, but gone forever.
As physicians, the burden of knowledge is one that is not only placed on us, but one that we shoulder with eagerness. We are bred in a culture where it is imperative to know everything and to fix everything. Understanding this fact, it is even more important to recognize that our knowledge does not replace our innate need for humanism and compassion. Our relationship with death is perplexing; it is a constant see-saw between being paralyzed by our fear of failure to the point of forgetting our patients’ emotions and numbing ourselves by accepting that death and old age come hand-in-hand. Ultimately, our knowledge does not protect us from the ironclad truth that we are not infallible and that, even after we study our hardest, an element of the outcome is beyond us. The surgeon who performed my grandfather’s surgery was so shaken by his death. It reminded me that, while doing less than our best is not an option, our illusion of having total control is fragile and evanescent.
My grandfather’s death also challenged me to look at patients in a different way. He was a deeply spiritual man, more concerned with the soul and transcendence than the physical body and materialistic trappings of a world for which he no longer cared. He always told me that he hated seeing his doctors because he never felt respected as a person. It always brings a pang of pain to my heart to think of how much he must have resented the fact that the end of his life was marked by the final ignominy of visiting doctors who reduced him to a bundle of flesh and fascia, muscle and matter, with their poking and prodding. Remembering how his personality seemed to vanish piece by piece before his death, I challenged myself to see elderly patients for the people they were before they came to the hospital — for their stubbornness, their curiosity, their fierce independence, their aspirations. I resolved to remember that all of them had once been filled with the same passion and dewy-eyed excitement for life’s possibilities that I have today. No one feels the pain of losing that vitality as acutely as the patient.
Whenever my grandfather and I talked on the phone, he would always make fun of me and call me a “half-baked doctor” because I hadn’t graduated yet. I know that he was proud of me before he died. With his blessing, I hope to spend the rest of my life in the knowledge that I am working in the shadow of something bigger than myself, and I hope to always treat my patients with knowledge, humility and compassion … in other words, to become a full-baked doctor.