Deep Breath

By Kelly Lien – Class of 2018

Deep breath. Nearly time to go.

Before heading downstairs to clinic, I remembered to ask about where I could borrow a white coat. It looks just like a lab coat, like the kind I would wear to teach organic chemistry labs at school. But, in the hospital clinic, it means that people might think you’re important.

Man, I hope no one asks me anything. I’m not even a med student. I know nothing.

My first shadowing experience ever leads me to finding my supervisor, a medical oncologist specializing in GI cancers, perusing his clinic schedule. He’s in a rush, like always. I’ve caught him between cases.

No wonder he’s always late to our meetings. His patient is 20 minutes late. And it’s not like he can just skip them.

A nurse comes in to tell us that the patient has arrived before he has a chance to tell me their history. Walking over to their room, he enters. I wait outside the open door, not knowing whether or not I’m allowed inside.

Shouldn’t he ask them if I’m allowed to observe? I guess he’s had so many students throughout the years that it’s normal to just enter.

He finally asks and relieves me of my awkwardness. Two women – one probably in her 60s and the other who looks to be 30, are inside.

Oh man, I really hope it’s not the younger one.

After some small talk, I breathe a sigh of a relief as he begins directing questions to the older lady. It’s a case that he’s been following up on for a while, since they’re comfortable with each other and waste no time on pleasantries.

“As you know, this is your third line of treatment – unfortunately, you progressed on the first two,” he says gently. The lady nods her understanding. “Looking at your lab results and from what you’ve told the nurse, it seems like you’re feeling worse. Is this true?” Again a nod.

“Do you still work? Who do you live with?”

“I take a half-hour bus ride to work at the grocery store most days. It’s getting more difficult though. I’m living on my own, but my daughter,” she gestures to the lady beside her, “lives in the next town and visits often.”

This lady has done multiple lines of chemotherapy and is still working? That’s insane. I wonder if she’s supporting herself, or if she just feels the need to continue on with her life, or both?

My train of thought is derailed with his next response.

“I’m afraid that at this point, there are no other treatment options available for your type of cancer. I think it might be time to start thinking of palliative measures and making plans for end-of-life care. It might be worthwhile to you to discuss a do not resuscitate order – DNR, for short.” All of this is said even more softly, as if to lessen the blow. It takes a second for what he has said to register in our minds.

Oh my god. What do I do? Crap, I can’t stop looking. Okay, stare at the floor instead. I hear a sniffle. Oh no… she’s crying. Nope, now it’s both of them. What do I do? My supervisor hands them tissues and places his hand on hers.

He continues to speak after a few moments of silence. Of course he has to. Someone has to keep the conversation going. I’m sure he’s had to give this talk for many, many years.

“I know that keeping busy with your work is important to you, so you don’t need to stop. But I will tell you to be careful. If you feel yourself getting weaker, please consider taking a break. In regards to your living situation, it’s important to start considering your options in terms of long-term care. Is your daughter here or anyone else you trust capable of having you stay with them?”

I’m not sure if either of them are absorbing his words at this point. They haven’t said anything – the only sounds they make are those of a woman coming to terms with exactly how fragile life can be.

I wonder what’s going through her mind. Has she had time to do all the things she’s wanted to? Is her daughter realising that she may be losing her mother soon? It’s only March – will she make it to the summer? Does she have grandkids? Will she be able to see them start school again?

I forget to look at the floor. She remembers I exist. Our eyes connect, mine trying to block out my weakness, hers tear-stained and wide open. She’s staring into my soul. In that moment, I know exactly how useless I am – unable to save her, unable to comfort her, only able to stand there and remain quiet.

Afterwards, in a brief moment of reprieve in the consultation room, my supervisor asks me if I’m doing okay. I tell him the truth – I’m not sure. Before going off to talk to the charge nurse, he says this.

“Before you get too deep into your training, understand sympathy and empathy. My definition of the two is that sympathy entails sharing feelings with a patient – their pain and sadness – whereas empathy is understanding their feelings, but not necessarily sharing them. It’s hard to separate the two, but I’ve learned that you must, or else you won’t be able to make it through the day. Those feelings will tear you up and limit your ability to help those that you can.”

I say thank you for taking the time to talk and for allowing me to observe. As I head upstairs, there is one thought on my mind.

I’ve always been good at compartmentalizing my feelings. But just this once, I want to embrace my sympathy. So that maybe one day, I’ll remember how I felt, and how I wouldn’t want anyone to feel the same way. My humanity will pave my way to becoming a professional.

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