Mr. G was a patient I met while on the surgical oncology service. He was in his early 50s, a loving husband and the father of two children. He was the middle sibling with two brothers. He also battled metastatic cancer.
He was in pain when I first visited on Monday but was quite strong and talkative; yet in just three days, he had become so jaundiced and weak. He could barely get out of bed and struggled to even maintain enough concentration to follow conversations with his family. It was my first month in the hospital, and I felt concerned but also powerless. It seemed like everything we tried to do to medically support him was to no avail. I went to bed every night wishing he would recover only to come in the next day and find his condition continuing to decline. The man I had joked around with on Monday was slowly withering away. On his fourth night, Mr. G requested a chaplain and a prayer for him and his family. He had concluded that in his current state of suffering “[he] would rather die than live,” but he also worried about how to break this news to his family. He felt guilty for thinking this way, thinking that he was letting them down.
A goals of care meeting was quickly organized the following morning between the family and representatives from medical oncology, surgical oncology, palliative care and social work. As we walked into Mr. G’s room to greet him and his family, all heads turned toward us. It felt as though the air had thickened. It was clear that the family already had an idea of why we were there before we had finished introductions. Together, we discussed Mr. G’s declining health, prognosis and remaining treatment options. It seemed as if everyone in the room was hanging on to every syllable with the utmost concentration. His wife and brothers were teary-eyed but kept their composure. I struggled to make eye contact with the family when I wasn’t actively speaking. My eyes would frequently wander to the family collage by the window. It was surreal seeing those smiling faces in the photos now filled with sadness. I could barely recognize Mr. G in the photos; he was so full of life and barely recognizable as the frail, defeated man that now lay in the center of the room.
At this point, Mr. G had weakened to the point where he struggled to keep his eyes open. His lips puffed out as he gasped for air with every breath. His slurred speech was only a little louder than a whisper. Yet, he mustered all the remaining energy that was left in his reserves to sit up and look directly at his family. For just a brief minute, Mr. G was the most lucid I had seen him in days. He turned towards his wife and paused for what felt like an eternity. My heart felt like it was pounding out of my chest and my legs felt numb because I knew what he was about to reveal. He stared into her eyes with a look of guilt — but also of conviction:
“Honey … I’m tired … I can’t go on like this.”
The room fell quiet as he gasped for more air to finish his thoughts.
“I don’t want to live anymore.”
Mr. G, having expressed his wishes, sunk back in his bed. To his relief, Mr. G’s family supported his decision fully, though tears ran freely down several of their faces. His oldest brother gave a comforting rub to Mr. G’s wife as they both tried their best to stay strong in front of him. I walked across the room to the family and offered them tissues, but my hands were shaky, and I could barely keep the tears out of my own eyes. I was a needle’s edge away from losing all composure.
Our discussions on transitioning to comfort care and pain control were punctuated with silences. Each felt long and heavy but also necessary.
After exiting the room, we all exhaled and shared a moment of silence to process the discussion. The tension made me forget what it was like to take a fresh breath. I couldn’t help but put myself in the shoes of Mr. G’s children. I could feel tears welling and my throat tightening as I realized that they were around my age. I felt a throbbing pain in my chest imagining the raw grief they must be experiencing. As I came out of my daze, our group debriefed the conversation together and then went back to work on our respective services. In my case, this meant resuming afternoon rounds.
I could still feel the weight of the conversation in my mind as we entered the next patient’s room. This patient was recovering from surgery and coincidentally had the same type of tumor as Mr. G. He and his wife were nervously waiting on lab results to find out if the cancer had spread to his lymph nodes. They looked up at us expectantly, holding hands as they awaited our news. Earlier that day, the pathology report came back negative. When we delivered the news, he and his wife immediately beamed with joy. The heavy burden of metastatic cancer had instantly dissipated off their shoulders. His wife jumped to her feet and embraced him in a deep hug. As they parted, I noticed subtle tears of relief glistening from her eyes. They thanked the team incessantly for our care. The couple radiated happiness throughout the room; yet, this joy failed to penetrate through the layer of grief that still encircled me. I did my best to embrace the joy and celebrate with everyone, but I still felt empty.
I marveled at the juxtaposition between these two patients. These patients had very similar types of cancer, yet the conversations we had with them were polar opposites. Tears were shed in both rooms, though with different emotions tied to them.
The hospital is such a strange place. From the outside, it appears relatively homogeneous — every room is equipped with the same basic amenities with almost identical floorplans. However, this day taught me that each room could not be more unique. Each houses a different world. Each patient has their own unique story, ambitions, loved ones and medical conditions. As physicians, we have the privilege to observe these worlds and travel between them. As we travel, we will inevitably come across patients who will leave an emotional impact on us, little souvenirs from the worlds we encounter. However, as physicians, we also are tasked with leaving these souvenirs on our spaceship, preventing them from entering the next world. Each patient we encounter deserves our undivided attention. Bringing previous emotions into the next patient’s room may impede our ability to connect with a patient or even cloud our clinical judgment.
I learned that day how hard it may be to compartmentalize our emotions and leave those souvenirs behind as we move from one world to the next. It can feel unnatural and cold. Even more so, when we get to the end of our shift and head home to our own planets, what do we make of the souvenirs we have collected? How do we honor our patients while also attending to our own personal lives? I worry about one day becoming desensitized to my patients and their stories. However, I worry equally about being buried by the emotional toll of empathizing with patients. I want to continue connecting with my patients because that is what brought me to medicine in the first place. But there are times when I’ve already felt overwhelmed by the souvenirs I’ve collected, and I now understand why such a high rate of burnout exists in medicine. Being only a couple of months into my clinical training, I still am looking for answers — I’m striving to find my balance for deeply caring for my patients while also prioritizing my own well-being. So far, my best answer has been to journal and write about my patients so that their impact on me is not forgotten.
I found out that Mr. G passed away later that weekend, and I imagined the massive shift that was occurring in the lives of his loved ones. His death shook me; yet, the only noticeable change I could point to was the extra blank space on our patient list. I gave myself an extra couple of seconds to process this emptiness. I took a deep breath and got up to start checking in on my other patients.
Author’s note: The names and personal details of the patients discussed in this piece have been modified to preserve their privacy.