It has already been 12 years now, but the memory is still as vivid as if it just happened yesterday. I met 8-year-old Abdo as my first assigned patient in my first clinical rotation as a medical student in Jordan. He was lying in a hospital bed with refractory metastatic Ewing’s sarcoma that rendered him blind, bed-ridden with massive ascites and craniomegaly. Abdo had failed all conventional therapy and was kept in the hospital for palliative care due to a social situation that prevented his family from taking him home. He used to ask me every day: “When will I be able to see and play with my friends again?” I never figured out the right thing to say. I used to tell him that we needed to get him stronger first. His mother would listen to our conversation with silent tears running down her cheeks. I always wondered how you can tell an 8-year-old kid that he was dying and that all we could do was to make it as painless as possible.
But I also had a newbie medical student’s unconfessed illogical hope that one day I would come to his room and find him miraculously cured. He used to wait eagerly for me to come to his room, as I found out he loved Snickers bars and would bring one with me each time I visited him. One day I came to his room with his favorite candy bar in hand, but his bed was empty. The cold truth struck me, the miracle had not happened and Abdo had died the night before. That night I realized that curing cancer would be my life calling.
Twelve years passed quickly, and I joined the hematology/ oncology fellowship program at Johns Hopkins in Baltimore. Approximately 8 pm in a cold winter night, I was finally getting ready to go home after another long, exhausting day in the busy leukemia ward. Just as I was about to leave, I was paged by a nurse saying that one of the leukemia patients was crying, and the nurse wondered whether I would talk to the patient or whether she should call the on-call doctor. I was surprised because the patient had been always very cheerful and upspirited during the 3 weeks I knew her in the ward. She was a 21-year-old college student on an experimental protocol for acute myeloid leukemia that was refractory to 3 different induction regimens. I always admired her bravery, as she smiled and joked with us all the time, despite being very well aware of her dismal prognosis. I went to check on her and found her in tears. Being confined in the hospital for such a long period in an isolation room, missing being out with her friends in New York City, and the reality of her disease had all caught up with her. I sat down and we began chatting. I only remember a few of the things we talked about, including her leukemia, the TV show “Friends,” skydiving, and many other things. By the time I left her room at about 11 pm, she was back in her cheerful mood; and I do not think I’d ever felt more energized or refreshed in my life. Soon after that night, she was discharged to undergo a stem-cell transplant in her home city. Two months later, her father called to thank those who took care of his daughter and to inform us that she had passed away peacefully from complications of her disease.
Many oncology fellows encounter such heartbreaking situations on a regular basis. Despite all the defensive mechanisms we develop subconsciously to prevent ourselves from getting too emotionally involved in these situations, they do not seem to get any easier. I’m sure we’re all asked the common questions, by friends and relatives and from colleagues in other subspecialties: “How can you deal with dying patients on a daily basis without feeling defeated? Don’t you worry that you have failed them by not being able to offer them anything?” Now I know the answer to these questions. I do not need to be giving chemotherapy, experimental agents, and painkillers all the time to be a good oncologist. It turns out that simple things, such as a candy bar and chatting about skydiving, can go a long way to help my patients feel better. As my young patient with leukemia said in the card she sent me before she died: “It was so reassuring for me to know that someone was genuinely concerned with seeing me through this, and giving me the strength to keep going. Someone that would always support me on my good days, and respond to my concerns on my bad days.” Now I really know why it is so gratifying to be an oncologist. Not only because we get to help cure many patients, but also because we are so fortunate to have the ability to help ease the journey of those who are not cured.
Amer Zeidan, MD is a clinical hematology/oncology fellow at the Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Hospital in Baltimore, MD.