October 1999

Premature Holiday Column

By Michael J. Katin, MD

Those who have been faithfully awaiting the conclusion of the May, 1999, column about surveys will have an early holiday gift--the gift of anticipation, since it will now appear in November rather than October. This was done in order that we can prepare for the holidays by remembering that regardless of whether you think you consistently help people with ionizing radiation or get discouraged that we can't cure everybody, at least you can assure yourself that you did whatever you could to make your interaction with that person as supportive as possible. We are assisted in this, and often surpassed in this, by the therapists and nurses with whom we work, and one of the great things about most departments is that those who are too rough or impersonal with their patients often are winnowed out of the group by their peers. This is accomplished either with subtle but persistent pressure or simply by placing that person's film badge under the beam for a few treatments.

Keeping ourselves reminded of the importance of kindness and consideration is critical but lapses can occur. I hope that the following letter will keep us aware of how our actions and attitudes can be perceived. Barry Friedman is a professional writer and comedian whose mother went through a traumatic and ultimately fatal course with breast cancer. Mr. Friedman wrote this letter to her medical oncologist:

Dear Doctor,

I am writing this before my mother dies because I don't want my judgment, or your assessment of it, to be clouded by my grief. I won't send it until she dies.

Your treatment of her has been professional, competent, and timely. You minimized her pain and discomfort, especially now, at the end, and, in retrospect, your decision not to start her on a full regimen of chemotherapy (with all its debilitating side effects) saved her from months of agony. For that, I thank you.

I write, then, about the nebulous topic of doctor/patient/family relations.

There's no good way to say this: your bedside manner was as sensitive as an auto mechanic's working on a recalled Chevrolet; you were perfunctory, bordering on rude, and experienced.

In the eighteen months you treated my mother, you never once called to check on her. When she came in for her monthly Aredia treatments--and granted this was not her actual appointment (a distinction lost on her, I promise you), you never asked what you could do to make her life easier, never took the time to see how she was coping psychologically, and never tried to allay any of her fears. During the last appointment she had with you, you let her know the only reason you set aside time for questions was because your nurse asked you to. Did it never occur to you that it might be a good idea?

When she cracked her ribs early last year, you told my parents it was no surprise to you that might happen. It was to them.

Once, when my father called you, you called him back...collect. You weren't on vacation, not at a conference, but in another part of the state.

We recently had to cancel an appointment because my mother literally couldn't get out of bed. Again, no one from your office called to inquire about her condition.

As to the matter of our family, your reluctance to talk to anyone but my father was expedient but irresponsible. My brother, sister, and I know you're busy; we know you can't tell the same story three times, but when my brother called to ask for clarification on some part of her treatment, your nurse asked him in all seriousness who the family spokesman was. What are we...the Kennedy's? Are you really too busy, and is it really a breach of medical ethics, to give the sons and daughters of one of your patients five minutes of your time twice a year? And it is on that note, I have the most difficulty. My father, obviously, had trouble dealing with her prognosis. Who wouldn't? I assume you did your best to fill him in on all that would happen in the months to follow (and I know my father can be maddeningly repetitive), but couldn't you see he was unable, or unwilling, to understand the seriousness? I was in your office with them that last visit and I could tell from his questions about saunas, heating pads, and rubdowns that he was not dealing with her condition. Didn't you see that? Didn't you ever consider taking someone else in the family aside and making sure one of us got the full story?

My brother, sister, and I got more information from the Hospice nurse in fifteen minutes this morning than we got from you in the past two years.

I can imagine the bombardment of questions and requests you and your office get. My family tried to be respectful of that, but your staff never missed an opportunity to miss an opportunity to be kind or helpful--even when it came to releasing my mother's records. We were told she would have to physically come in and sign a release. At this point, she couldn't get out of bed to urinate; still, your office wouldn't fax us a blank release form.

To me, doctor, you thought of my mother as a vessel of carcinogens. And the rest of us as people who got in your way. We're not, obviously, just that. And I'm surprised you didn't see the anger and resignation in a 69-year-old woman's eyes when told her breast cancer of twenty-five years ago had returned, didn't understand the fear of a man watching his wife wither away, and didn't feel the sadness in children who wondered what they would tell their kids at grandma's funeral.

You didn't give my mother cancer; you didn't have to be sorry. It is our responsibility to sit at the foot of her bed and wonder what her moans and spasms mean, not yours. Your job, really, is done. The irony is I never expected you to save my mother's life; I expected so much less.

I'm sure doctors have to keep a healthy distance from the death staring at them from across the examining room table. Often to do your job, any job, one has to be dispassionate. But that's a crutch too often leaned upon, don't you think? It doesn't take that much energy to care; it doesn't corrupt one's medical expertise to hold a hand or return a phone call. Medicine, I'm sure, would be wonderful were it not for the patients. But unless you decide to sit in a research lab, cutting up mice, and looking at isolated viral samples, the scared, frustrated and frustrating patients and relatives reading 6-month-old Times and Newsweeks in your waiting room should be why you do this.

It would have been nice had we seen some understanding of that in your eyes during the last two years. Much more important, it would have been nice had my mother seen it as well.

Barry Friedman

(My mother died the evening after this was written. Her doctor called the following morning and offered his condolences. He never responded to this letter.)

email: mkatin@radiotherapy.com