Inside the clinic hours
later, I am running back and forth between two rooms, seeing patients as fast as
I can. I sit down in one room and ask Maria how she is doing. Immediately, she
bursts into tears. She lost her apartment this week because she has been unable
to work. Her landlord wouldn’t even let her back in to get her clothes. Her
nephew was kind enough to take her in, but her chemotherapy schedule has made
it impossible for her to get a new job. We discuss how she has been through
multiple lines of chemotherapy already, and options are limited. There is no
cure and I can’t guarantee that what we are doing now will help. She nods
acceptingly. Maria asks only one question: do I have a cell phone charger for
her flip phone? The battery died, and her ride’s number is in there. We get
lucky in the waiting room and find another patient who has a compatible charger
with her. Maria is happy for the small victory.
I see Gloria next. It’s an
easy visit. She has completed her treatment. When I enter the room, her husband
has his arm around her shoulders, and her sister is holding her hand. They look
at me with anxiety and anticipation. I cut to the chase. “I have good news. We
don’t see any cancer on the CT scan.” I am pulled into a group hug. “You saved
my life!” Gloria exclaims. Her sister cries, and the husband leans back in his
chair with relief. I give my spiel about close monitoring. They ask if she can go
to the Philippines for vacation. I joke, “Only if you take me with you!”
Everyone laughs, as months of blood tests, side effects, and fear momentarily
melt away.
I close out my day with Lily
and her husband, quiet people who have been coming to the clinic for years; her
disease is stable. Her husband tells me that on my recommendation, they bought
a new bed. Not only has Lily’s back pain improved, he is also sleeping better.
Lily’s wig is askew, and she looks distracted. She shares that her daughter is
having a baby soon. I congratulate her and ask her when she is going to visit.
She points to her percutaneous nephrostomy, a drain that empties urine from her
kidney, and says she doesn’t think she can be around a newborn with that “dirty
tube.” I see from her recent imaging tests that the kidney has minimal function,
and I propose we remove the tube. Lily laments that it takes weeks to get an
appointment with the interventional radiologist. I step out of the room to call;
the radiologist confirms that it would take weeks for him to see her, and I ask
for instructions to remove the tube myself. When I cut the hidden sutures and
the tube smoothly slips out of Lily’s back, she stiffens for a moment, then
relaxes. “Ok, I want to see the baby pictures,” I tell the couple. Lily smiles
for the first time that day, “You are a good doctor.” Her husband beams at me.
When I chose to
sub-specialize in gynecologic oncology, I thought my days would be filled with
operating, concocting chemotherapy regimens, and staying up to date on clinical
trials. What I found out very quickly was that being a gynecologic oncologist
often has more to do with managing the fall-out
of cancer, rather than the cancer itself. Patients come wanting you to make the
cancer go away, because they think you have the secret to making their lives
normal again. Over and over, my patients tell me they will do anything I say. They
bring in soaps, fabrics, recipes, and herbs for my approval before use. They
want my permission to take day trips. Betrayed by their bodies, they no longer
trust themselves to know what’s safe.
The humbling reality is that
there is no cure for most cancers right now. We can do everything right and cause
harm to the patient; we can do everything wrong and the patient thrives. My job
focuses instead on empowering the patients to regain each precious moment of their
lives, despite the cancer. I try to convince them that cancer is an aspect, not
the totality of their existence. And in the final moments when there is no
earthly solution for the suffering, I try to help the families make peace with
what can’t be controlled.
In this way, I am comforted
that my work serves some good, even though it is far from perfect. In the
trenches of the War on Cancer, the small daily battles matter just as much,
because so many unique lives hang in the balance.
