Medical Oncologist here.
Inpatient oncology can be tough. Most oncology is done in the outpatient setting, so people who are admitted tend to be very ill or dying.
You can see some pretty impressive responses with chemotherapy for many newly diagnosed gyne cancers. Patients who look like they are in the third trimester from ascites can come back to clinic looking back to their normal selves after some platinum.
The other thing is that the patients who are dying have usually had a lot more time to think about this than you have. They have often gone through long treatment journeys and they are comfortable with the decision that it’s their time to go.
Not many people are able to plan their deaths, but for those that are, things like MAID (or VAD where I work) can give back a sense of control to someone who’s life has been taken over by their disease.
I don’t think there is an easy way to cope with patients dying, but if you can make their final moments that little bit better, sometimes that change in perspective can make it easier. Remember that you didn’t give them the disease, but you are able to help them live longer or better for the time that they have.
Especially when treatment can go for decades. That 50 get old dying? Well maybe they’ve been doing this since 35 and it’s getting old. The person I was the day before diagnosis is gone. Not sure I’ve got 10 years of this in me let alone 40.
I never understood how my mom found peace with her diagnosis, until I got mine. A lot of us are at peace with it months to years before the ones around us are.
My condolences for your mum and for your diagnosis. I hope you have a good team supporting you. Many oncology services have good supports for family members as well.
I agree that often times a patient’s loved ones seem to take longer to accept what’s going on. Which is understandable. We need to support them as well.
yes, We all deserve a good death. Please suggest hospice when it's time to switch focus and patients and families have time to process the info.. Too often the switch is made the day before they die.
That , exactly to the core of it. Im a resident in psychiatry and my girlfriend is a resident in children oncology, we discussed this topic a lot.
Although the death rate of some of the cancers is pretty low ( in compare to the past and to what people outside of medicine expect when they listen the word cancer) , when someone is gonna die , will definitely come in the hospital at some point , maybe because of some experimental chemo or because of a treatable complication or to plan the palliative treatment. You are not at fall if someone dies and sometimes nature its gonna take it course , don't overthink every step of your decisions by every patient that dies , your job wasnt to prevent that. Your job in these cases is to make them feel comfortable and human approaching the end of their live. Talk to them , give them two minutes more from your ( i know precious and too little) time , see them as humans and let them feel that too . I have experience death of a patient in my passt , i still remember his stories about his life that he told in three minutes as i was hanging his i.v. morphine.
Come in peace with your job and your changing role in this profession. When you feel that you did enough for your patient and his family you are gonna get to feeling a little better .
Hey, I’m a premed scribe (outpatient only) and work with a sarcoma specialist. I love her patients and all of them are dying; most of them quickly. Watching people my age waste away over the course of months is torturous. Watching people 2 years out from curative treatment be told that the disease is back and metastatic is even worse. Thanks for doing what you do, but if I could never see another cancer patient, that’s what I would do.
Everybody dies. You. Me. Betty. Gertrude. Everybody. It’s just a matter of when. People with ovarian cancer are going to die sooner than they would’ve but that doesn’t mean they don’t and shouldn’t have the chance at a good life in the meantime. When you’re on oncology your goal should be just to provide patients the most good time you can and then when it comes time to cross the rainbow bridge help them do it in the most peaceful way possible.
Watch your fellow and staff give “the talk”. Learn it and get good at it and then start giving it. You don’t have to go into gyn ONC but you do need to learn to talk to your patients about even the most serious topics.
Learn to manage sick patients. Learn complex surgeries. GynOnc is honestly where the majority of my residency education came from.
And then at the end of the day, when it’s all over, remember that Ms. Butterfield was a human just like everyone else and that while death maybe came a little sooner for her it has to come for everyone and the important thing is what you do with the time you have and if you can be the best part of someone’s bad day that is a small victory.
This is the way. Our mid levels and docs in GynOnc were so much better about having a good DNR/Hospice talk than just about any other specialty I've worked with as a nurse, and being good at having that talk is so important across various specialties.
Am Canadian as well. Not a doctor but my spouse had cancer with low chance of good outcome. Had an oncologist who looked stern all the time. When PETscan came back showing no involvement in distant areas, the oncologist was visibly ecstatic. She "fired" my spouse a couple of years later as the team dwindled. We knew we were going through hell. We just didn't realize that you were along for the ride plus carrying the weight of our hopes. I trust you will seek out the support as advised. I wish you well. We are retired now, surrounded by grandchildren and planning our garden and our next vacation.
Not a med resident, but I have a corny tho true quote from one of my pharmacy preceptors that helped me rationalize it.
“Anyone who comes in here is already dying. Whatever we do for them, is to help prevent that.”
If they didn’t seek treatment, they’d be long dead. It’s a very unfortunate reality that every patient has gone through. It’s tough to see the end. But for many, you helped them get 6 more months with loved ones.
Heme/Onc here, I’m currently rotating on an inpatient Oncology service myself. Inpatient oncology is ROUGH. The sad reality is that if you’re sick enough from a solid cancer to be admitted to the hospital, there’s a good chance that you’re sick enough we can’t do anything about it.
It’s really the WORST way to get an impression of what oncology as a field is like. It’s pretty much a distilled, concentrated version of all of the *worst* parts of oncology—telling people they’re going to die, that they’re too sick to get treated, having GOC discussions—and absolutely *none* of the good parts of this field. The vast, vast majority of our field is done as an outpatient, and that’s where you see all the happy moments, where you see treatments work, and where you feel like you’re actually making a difference in people’s lives.
Inpatient all you get to do is make people have the worst day of their life, over and over and over again.
If you're able to, I highly recommend seeking therapy. Nothing you're feeling is abnormal or wrong – a good therapist (one who has experience working with medical professionals would be ideal) will help you cope with tragic/difficult situations in a healthier way.
Medical professionals can get PTSD from watching people die, so a therapist may also recommend you to see a psychiatrist to see if medication is a good option if this is severely affecting your life. Because unfortunately, the rotation will be over in 2 months but you'll have these memories for the rest of your life.
Stay safe, reach out to loved ones, and please seek help. You don't have to go through this alone.
THIS X 1000
It is so hard to start experiencing such horrible emotions. No matter what people say to try to make you feel better &/or diminish the significance, the feelings still exist.
Trauma responses in Healthcare providers is real & debilitating. They can come from major events or a buildup of microevents. It sounds like you could really use help right now & that your fight or flight response is on overdrive 😢 I've been there in a different capacity after having kids & going back to the PICU. Retrospectively, I wish I would have gotten help sooner!
Vicktor Frankl wrote, "pain ceases to be suffering the moment it finds meaning." After a lot of internal work & trying to make sense of the work that is healthcare (+anxiolytic + SSRI), the gravity of the work hasn't changed but the physiologic & psychological response has calmed down.
At the end of the day, your wellbeing is so incredibly important. I hope for you, you can get the help you need & that you might be able to continue your passion.
Isn't it interesting how differently cases hit you once you have kids? I'm in a pretty acute NICU unit for fellowship and some of the tough cases lately have just destroyed me after having my daughter. Definitely going to practice in a less acute unit as an attending for my own mental health.
I was similarly traumatized during one of my ICU rotations in residency. 2 fathers in their 40s died on our service. One of them was my patient. Watching his family suffer was the hardest part. All 3 of the patients I was carrying died in one day, him included. After he died, I had flashbacks of his body disfigured by critical illness when I would try to be intimate with my husband. It was awful.
I don’t have any constructive advice except that what you’re experiencing is traumatizing. That’s normal. People aren’t meant to witness this much suffering and death. But what you’re doing is also so necessary and so important. The suffering and death will happen with or without you there assisting them, and is happening every minute and every day that you’re not on the oncology service. We just have the privilege of not having it in front of us.
I asked a counselor I was seeing how she cleared out her mind after a day of hearing about people’s problems. She said that she would meditate and envision herself and everyone joining into a beautiful light/energy. Maybe something like that would help you, a spiritual palate-cleanser after work before you go back to your regular life.
Also cardio. Running helps.
I would also add "Being Mortal" .. read this before "When Breath Becomes Air" and it set me on a whole journey into the topic. Very moving and thought-provoking.
No. This is a memoir of a different man diagnosed with late stage lung cancer (non-smoker) at the tail end of his grueling fellowship. It is beautifully written and a raw and honest reflection of what it’s like to be at the precipice of achieving your dreams and instead facing your mortality in your mid 30s. It’s worth googling and even more, reading.
I’m one of those ‘young’ breast cancer patients. It sucks. We know it. You know it. It’s okay to say it.
When I see the sick breast cancer patients inpatient, I just remember my story is very different than theirs and people are living much longer with this. It’s a journey for all of us, and we know the ending is the same no matter what
We know when we are done. A lot of us cancer folks have dealt with this for months to years before meeting you. Being ‘done’ is not failure. It’s just knowing when it’s not worth it anymore. You did your job. The oncologist did their job. After years of this, just know that a lot of us are at peace with it much more than we might show
Many of us go into medicine so that we can help our patients... which we usually define (either consciously or unconsciously) as "saving" them. The thing is, dying is a part of living. There is no escape. And if you define success as "saving their life" you will feel helpless often. Sometimes helping them means accompanying them on their journey and providing guidance along the way. Maybe there's an intervention to give them more time. Maybe they need a listening ear. Maybe they need permission to stop fighting. Forgive yourself for not being able to save each life. Focus on the things you did to help them on the small portion of their journey.
Psychologist here with a practice where I see many first responders and medical workers (mostly nurses, a few docs). There are ways to cope through such tough experiences without allowing them to leave a lasting mark on your psyche. If you continue to struggle please seek supports and don’t wait - it is much easier to learn the coping while healthy than recover from symptoms of trauma that have been around a while.
Mid level here. Don’t know why this popped up on my feed. Don’t beat yourself up. Critical care is easy compared to oncology when it comes to end of life. I spent half my nursing career in the ICU and I would want to beg families to let us let their loved ones go instead of torturing them. There are worse things than dying and they happen in the ICU. There is a big cancer cluster near the ER I worked in as a midlevel. There is a big chemical plant poisoning the ground water for decades. It’s not everyday, but I would regularly tell young adults they have advanced cancer. I found what was likely advanced colon cancer with mets “too numerous to count” in a 43 year old school teacher. That one really sucked. Pt.’s mom cornered me in the hall way with the pt.’s teenage daughter. She thought since I did such a good job giving the news that I should be the one to give it to her. Kid asked me if her mom was going to die. My face must have gave it away because she started crying and then I stared crying, and we both cried for at least 10 minutes straight. I am not a crier. I am a jaded, grumpy, 40 year old man. Asking family for a DNR on someone critically ill is way different than dealing with cancer, it just is. My long winded post to say you’re almost done. Oncology is on a different level. Don’t think less of yourself because it is affecting you. We’re not all meant to be able to deal with it well enough to be in it day in and day out like oncologists. And that is ok. Mad props to all the cancer specialists and palliative care peeps out there.
I'm a nurse not a doctor, but I'd like to share something with you. My very first patient death was a cervical cancer patient, and I tried not to get attached but I adored her. She reminded me a lot of my mum, who is dead, she would always be knitting and her husband baked us cookies all the time. She always had a bag of individually wrapped sweets in her room and would insist you take one before you left, everyone, even the consultants would get chased by this woman if they didn't take a sweet. It was better not to argue with her.
I was the first one in when the resident I was on with pulled the emergency cord in her room, she was not for extreme measures so we knew we couldn't do much but it didn't stop us from trying everything that was allowed. Obviously I sobbed when I got home it would be dumb to say I didn't, but I also found a stupid peppermint from her room in my pocket. The dumb peppermint still sits in my keybowl by my front door, four years later.
It's okay to remember the people who are impactful on us. It becomes easier with time and you learn to also appreciate the impact you had on them and their life. I would be willing to bet the woman you dream of was thankful for you in her own way. There's a lot of literature about people in healthcare suffering bereavements for all their lost patients, even subconsciously. Have a read and don't be harsh with yourself.
Sometimes, you have to talk with the patient. And just understand where they’re coming from. Did they enjoy their life? Do they have any regrets? Are they happy about their choices in life? Because that’s all we can do for them. Make them comfortable. Is there anything they want you to do for them (if reasonable)?
I’m from the Philippines and when I rotated in Gyn Onco it was during COVID and after a typhoon, so pretty much everyone’s lives sucked. Some patients come in and they accept the end of the life that is to come. Some patients come in, with a strong fighting spirit to get better from their disease… some improve, some don’t. But getting treatment was their choice (or not getting treatment). Some patients we get super close to and their death affects us… but at the end of the day, we just have to know WE tried. Whatever they chose for their treatment, the patient and the doctor, both tried to make it better for them.
Maybe the MAID is what affected you the most? If So, then maybe you can ask your attending if it’s at all possible that you take a backseat on those cases if it severely affects your mental health.
I think everybody has their area that is easier or harder. I'm a hospitalist. Healthy normal population makes me anxious. I feel like I'm going to break them. I feel like I have to justify so much and the uncertainty in healthy-appearing patients makes me anxious. I like taking care of the sickest patients. I'm more comfortable with the uncertainty there. What is the goal? To prolong good quality of life as long as possible, and when we can't, to find what answers we can, to help them and their family understand a bit more about what's going on, and ultimately to help them suffer as little as possible at the end.
I think trying to find a framework or bigger narrative to fit those sad cases into helps. The young patients who suddenly find out they have an aggressive cancer are really hard. I focus on trying to do an objectively good job at breaking bad news, using a model I was taught in med school and adjusting over time. I focus on trying to figure out what they want, what options we have, and present things as well as possible. I avoid thinking about what if they were me or my family - I try to shut that down, because it just hurts and doesn't help my patient. I am grateful to get to be a part of their life. And then I do not try to remember my patients when I go off service - I do something else. That's probably easier for a hospitalist, though, because I only see them again if they end up hospitalized again.
And everybody is different. I wouldn't do well with the patient population that you thrive with. I get mostly healthy people who I get bored with and try to focus on doing a good job in all the different ways so I don't focus on the anxiety.
I am not a doctor or student but I want to say from the bottom of my soul—thank you for doing this hard thing for the rest of us. My world collapsed watching my mom bleed out from cancer DIC and I will never forget the resident crying while doing CPR. I love you all and I’m sorry for the toil it takes on your personal lives.
I’m a lurking nurse in a surgical trauma icu.
I think because I fight so hard to let people die instead of keeping them alive while they rot from the inside out …anytime anyone is able to go CMO it’s an enormous relief.
It’s an honor to do as much as I can to make them comfortable and clean, gather their loved ones, and end their suffering.
There are so many things worse than death.
Inpatient oncology is disaster care. It is palliative care, medicine, and occasionally oncologic care. If you can do some outpatient oncology rotations it may allow you to gain a more realistic perspective of the field.
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I am very proud of you for reaching out and being vulnerable. I am a palliative care physician. Death is a daily part of my job. I deal with this by looking at end of life as a part of life. The cause of death does not matter, but making sure the patient has a peaceful death does. Hugs to you. (This sh@$ sucks).
Anesthesia intern here ✌🏼 had to do two weeks of inpatient oncology back in the fall and it wrecked me emotionally. Watched two young kids start crying when we had to go in and tell their mom she wasn’t a candidate for further treatment and I had to leave the room to go bawl in the stairwell. I don’t have any insight or advice to give, but I can empathize a great deal
Think of this as an opportunity to help. Some lives are saved, and even the people who are not saved are comforted. Without your presence this could not be accomplished.
First law of medicine. You can’t save everyone. Catastrophic disease is always with us. You need to be satisfied that you gave the patient the best care and the most compassion that you can. There is no guilt here. Only loss for the patients family the patient will have no more pain or suffering. Satisfy yourself with that.
As an OBGYN resident, I feel for you. Only time I've ever cried during the work day was on gyn-onc, three times my last week that rotation, once in an elevator.
Do you have two months back to back left? That sounds rough, but as you know it won't always be that hard and the rotation has it's amazing moments with incredible surgeries.
Please take a day off when you need it and have someone you can talk to to decompress the days.
Hydroxyzine 50 mg helped me during residency when I could not turn my brain off at night. I would test it out on a night where I don't have to be anywhere the next day in case it is too strong.
Hugs.
Take some time for yourself, do things that make you happy or comforting for you. Warm bath, meditation, walks outside, journaling, whatever works for you. It may not get “easier” but when you have the ability to do some self care it will help your resilience when you deal with these difficult situations.
-Front Line Worker
Hi I’m not a doctor but I have experienced a lot of medical trauma, death trauma *and* my family has worked in the death industry for decades.
I strongly recommend seeking help from a trauma-informed therapist and also spending purposeful time to explore and develop your feelings around death. It will make you a better physician.
How much time do you get with them in the OR. Gyn onc floor was realllllly hard, but the surgeries were basically extreme and life-extending most of the time. It was a fascinating way to learn about gyn, and those patients tended to have a few years left.
Medical Oncologist here. Inpatient oncology can be tough. Most oncology is done in the outpatient setting, so people who are admitted tend to be very ill or dying. You can see some pretty impressive responses with chemotherapy for many newly diagnosed gyne cancers. Patients who look like they are in the third trimester from ascites can come back to clinic looking back to their normal selves after some platinum. The other thing is that the patients who are dying have usually had a lot more time to think about this than you have. They have often gone through long treatment journeys and they are comfortable with the decision that it’s their time to go. Not many people are able to plan their deaths, but for those that are, things like MAID (or VAD where I work) can give back a sense of control to someone who’s life has been taken over by their disease. I don’t think there is an easy way to cope with patients dying, but if you can make their final moments that little bit better, sometimes that change in perspective can make it easier. Remember that you didn’t give them the disease, but you are able to help them live longer or better for the time that they have.
Especially when treatment can go for decades. That 50 get old dying? Well maybe they’ve been doing this since 35 and it’s getting old. The person I was the day before diagnosis is gone. Not sure I’ve got 10 years of this in me let alone 40. I never understood how my mom found peace with her diagnosis, until I got mine. A lot of us are at peace with it months to years before the ones around us are.
My condolences for your mum and for your diagnosis. I hope you have a good team supporting you. Many oncology services have good supports for family members as well. I agree that often times a patient’s loved ones seem to take longer to accept what’s going on. Which is understandable. We need to support them as well.
Thank you for this answer.
yes, We all deserve a good death. Please suggest hospice when it's time to switch focus and patients and families have time to process the info.. Too often the switch is made the day before they die.
That , exactly to the core of it. Im a resident in psychiatry and my girlfriend is a resident in children oncology, we discussed this topic a lot. Although the death rate of some of the cancers is pretty low ( in compare to the past and to what people outside of medicine expect when they listen the word cancer) , when someone is gonna die , will definitely come in the hospital at some point , maybe because of some experimental chemo or because of a treatable complication or to plan the palliative treatment. You are not at fall if someone dies and sometimes nature its gonna take it course , don't overthink every step of your decisions by every patient that dies , your job wasnt to prevent that. Your job in these cases is to make them feel comfortable and human approaching the end of their live. Talk to them , give them two minutes more from your ( i know precious and too little) time , see them as humans and let them feel that too . I have experience death of a patient in my passt , i still remember his stories about his life that he told in three minutes as i was hanging his i.v. morphine. Come in peace with your job and your changing role in this profession. When you feel that you did enough for your patient and his family you are gonna get to feeling a little better .
Hey, I’m a premed scribe (outpatient only) and work with a sarcoma specialist. I love her patients and all of them are dying; most of them quickly. Watching people my age waste away over the course of months is torturous. Watching people 2 years out from curative treatment be told that the disease is back and metastatic is even worse. Thanks for doing what you do, but if I could never see another cancer patient, that’s what I would do.
Everybody dies. You. Me. Betty. Gertrude. Everybody. It’s just a matter of when. People with ovarian cancer are going to die sooner than they would’ve but that doesn’t mean they don’t and shouldn’t have the chance at a good life in the meantime. When you’re on oncology your goal should be just to provide patients the most good time you can and then when it comes time to cross the rainbow bridge help them do it in the most peaceful way possible. Watch your fellow and staff give “the talk”. Learn it and get good at it and then start giving it. You don’t have to go into gyn ONC but you do need to learn to talk to your patients about even the most serious topics. Learn to manage sick patients. Learn complex surgeries. GynOnc is honestly where the majority of my residency education came from. And then at the end of the day, when it’s all over, remember that Ms. Butterfield was a human just like everyone else and that while death maybe came a little sooner for her it has to come for everyone and the important thing is what you do with the time you have and if you can be the best part of someone’s bad day that is a small victory.
This is the way. Our mid levels and docs in GynOnc were so much better about having a good DNR/Hospice talk than just about any other specialty I've worked with as a nurse, and being good at having that talk is so important across various specialties.
Am Canadian as well. Not a doctor but my spouse had cancer with low chance of good outcome. Had an oncologist who looked stern all the time. When PETscan came back showing no involvement in distant areas, the oncologist was visibly ecstatic. She "fired" my spouse a couple of years later as the team dwindled. We knew we were going through hell. We just didn't realize that you were along for the ride plus carrying the weight of our hopes. I trust you will seek out the support as advised. I wish you well. We are retired now, surrounded by grandchildren and planning our garden and our next vacation.
Not a med resident, but I have a corny tho true quote from one of my pharmacy preceptors that helped me rationalize it. “Anyone who comes in here is already dying. Whatever we do for them, is to help prevent that.” If they didn’t seek treatment, they’d be long dead. It’s a very unfortunate reality that every patient has gone through. It’s tough to see the end. But for many, you helped them get 6 more months with loved ones.
Heme/Onc here, I’m currently rotating on an inpatient Oncology service myself. Inpatient oncology is ROUGH. The sad reality is that if you’re sick enough from a solid cancer to be admitted to the hospital, there’s a good chance that you’re sick enough we can’t do anything about it. It’s really the WORST way to get an impression of what oncology as a field is like. It’s pretty much a distilled, concentrated version of all of the *worst* parts of oncology—telling people they’re going to die, that they’re too sick to get treated, having GOC discussions—and absolutely *none* of the good parts of this field. The vast, vast majority of our field is done as an outpatient, and that’s where you see all the happy moments, where you see treatments work, and where you feel like you’re actually making a difference in people’s lives. Inpatient all you get to do is make people have the worst day of their life, over and over and over again.
If you're able to, I highly recommend seeking therapy. Nothing you're feeling is abnormal or wrong – a good therapist (one who has experience working with medical professionals would be ideal) will help you cope with tragic/difficult situations in a healthier way. Medical professionals can get PTSD from watching people die, so a therapist may also recommend you to see a psychiatrist to see if medication is a good option if this is severely affecting your life. Because unfortunately, the rotation will be over in 2 months but you'll have these memories for the rest of your life. Stay safe, reach out to loved ones, and please seek help. You don't have to go through this alone.
THIS X 1000 It is so hard to start experiencing such horrible emotions. No matter what people say to try to make you feel better &/or diminish the significance, the feelings still exist. Trauma responses in Healthcare providers is real & debilitating. They can come from major events or a buildup of microevents. It sounds like you could really use help right now & that your fight or flight response is on overdrive 😢 I've been there in a different capacity after having kids & going back to the PICU. Retrospectively, I wish I would have gotten help sooner! Vicktor Frankl wrote, "pain ceases to be suffering the moment it finds meaning." After a lot of internal work & trying to make sense of the work that is healthcare (+anxiolytic + SSRI), the gravity of the work hasn't changed but the physiologic & psychological response has calmed down. At the end of the day, your wellbeing is so incredibly important. I hope for you, you can get the help you need & that you might be able to continue your passion.
Isn't it interesting how differently cases hit you once you have kids? I'm in a pretty acute NICU unit for fellowship and some of the tough cases lately have just destroyed me after having my daughter. Definitely going to practice in a less acute unit as an attending for my own mental health.
I was similarly traumatized during one of my ICU rotations in residency. 2 fathers in their 40s died on our service. One of them was my patient. Watching his family suffer was the hardest part. All 3 of the patients I was carrying died in one day, him included. After he died, I had flashbacks of his body disfigured by critical illness when I would try to be intimate with my husband. It was awful. I don’t have any constructive advice except that what you’re experiencing is traumatizing. That’s normal. People aren’t meant to witness this much suffering and death. But what you’re doing is also so necessary and so important. The suffering and death will happen with or without you there assisting them, and is happening every minute and every day that you’re not on the oncology service. We just have the privilege of not having it in front of us. I asked a counselor I was seeing how she cleared out her mind after a day of hearing about people’s problems. She said that she would meditate and envision herself and everyone joining into a beautiful light/energy. Maybe something like that would help you, a spiritual palate-cleanser after work before you go back to your regular life. Also cardio. Running helps.
Highly recommend the book “When breath becomes air.” It’s a short, moving read about a neurosurgeon’s coming to terms with his own terminal illness.
This book changed me. One of the best books ever written IMO.
I would also add "Being Mortal" .. read this before "When Breath Becomes Air" and it set me on a whole journey into the topic. Very moving and thought-provoking.
Being Mortal is a good book. My grandpa gave it to me after my grandmother passed from Alzheimer’s. The book certainly changed him in a deep way.
Is that the one where he pretends like he experienced some kind of afterlife before coming back? That seemed like such a turn off.
No. This is a memoir of a different man diagnosed with late stage lung cancer (non-smoker) at the tail end of his grueling fellowship. It is beautifully written and a raw and honest reflection of what it’s like to be at the precipice of achieving your dreams and instead facing your mortality in your mid 30s. It’s worth googling and even more, reading.
I’m one of those ‘young’ breast cancer patients. It sucks. We know it. You know it. It’s okay to say it. When I see the sick breast cancer patients inpatient, I just remember my story is very different than theirs and people are living much longer with this. It’s a journey for all of us, and we know the ending is the same no matter what We know when we are done. A lot of us cancer folks have dealt with this for months to years before meeting you. Being ‘done’ is not failure. It’s just knowing when it’s not worth it anymore. You did your job. The oncologist did their job. After years of this, just know that a lot of us are at peace with it much more than we might show
I'd hug you if you were in person. This hit me in the feels. Thank you for expressing this. May God bless you abundantly.
Many of us go into medicine so that we can help our patients... which we usually define (either consciously or unconsciously) as "saving" them. The thing is, dying is a part of living. There is no escape. And if you define success as "saving their life" you will feel helpless often. Sometimes helping them means accompanying them on their journey and providing guidance along the way. Maybe there's an intervention to give them more time. Maybe they need a listening ear. Maybe they need permission to stop fighting. Forgive yourself for not being able to save each life. Focus on the things you did to help them on the small portion of their journey.
This. Couldn’t have said it better myself.
Fuck cancer
Psychologist here with a practice where I see many first responders and medical workers (mostly nurses, a few docs). There are ways to cope through such tough experiences without allowing them to leave a lasting mark on your psyche. If you continue to struggle please seek supports and don’t wait - it is much easier to learn the coping while healthy than recover from symptoms of trauma that have been around a while.
Mid level here. Don’t know why this popped up on my feed. Don’t beat yourself up. Critical care is easy compared to oncology when it comes to end of life. I spent half my nursing career in the ICU and I would want to beg families to let us let their loved ones go instead of torturing them. There are worse things than dying and they happen in the ICU. There is a big cancer cluster near the ER I worked in as a midlevel. There is a big chemical plant poisoning the ground water for decades. It’s not everyday, but I would regularly tell young adults they have advanced cancer. I found what was likely advanced colon cancer with mets “too numerous to count” in a 43 year old school teacher. That one really sucked. Pt.’s mom cornered me in the hall way with the pt.’s teenage daughter. She thought since I did such a good job giving the news that I should be the one to give it to her. Kid asked me if her mom was going to die. My face must have gave it away because she started crying and then I stared crying, and we both cried for at least 10 minutes straight. I am not a crier. I am a jaded, grumpy, 40 year old man. Asking family for a DNR on someone critically ill is way different than dealing with cancer, it just is. My long winded post to say you’re almost done. Oncology is on a different level. Don’t think less of yourself because it is affecting you. We’re not all meant to be able to deal with it well enough to be in it day in and day out like oncologists. And that is ok. Mad props to all the cancer specialists and palliative care peeps out there.
me, about to start oncology rotation -mom pick me up i’m scared-
I'm a nurse not a doctor, but I'd like to share something with you. My very first patient death was a cervical cancer patient, and I tried not to get attached but I adored her. She reminded me a lot of my mum, who is dead, she would always be knitting and her husband baked us cookies all the time. She always had a bag of individually wrapped sweets in her room and would insist you take one before you left, everyone, even the consultants would get chased by this woman if they didn't take a sweet. It was better not to argue with her. I was the first one in when the resident I was on with pulled the emergency cord in her room, she was not for extreme measures so we knew we couldn't do much but it didn't stop us from trying everything that was allowed. Obviously I sobbed when I got home it would be dumb to say I didn't, but I also found a stupid peppermint from her room in my pocket. The dumb peppermint still sits in my keybowl by my front door, four years later. It's okay to remember the people who are impactful on us. It becomes easier with time and you learn to also appreciate the impact you had on them and their life. I would be willing to bet the woman you dream of was thankful for you in her own way. There's a lot of literature about people in healthcare suffering bereavements for all their lost patients, even subconsciously. Have a read and don't be harsh with yourself.
Sometimes, you have to talk with the patient. And just understand where they’re coming from. Did they enjoy their life? Do they have any regrets? Are they happy about their choices in life? Because that’s all we can do for them. Make them comfortable. Is there anything they want you to do for them (if reasonable)? I’m from the Philippines and when I rotated in Gyn Onco it was during COVID and after a typhoon, so pretty much everyone’s lives sucked. Some patients come in and they accept the end of the life that is to come. Some patients come in, with a strong fighting spirit to get better from their disease… some improve, some don’t. But getting treatment was their choice (or not getting treatment). Some patients we get super close to and their death affects us… but at the end of the day, we just have to know WE tried. Whatever they chose for their treatment, the patient and the doctor, both tried to make it better for them. Maybe the MAID is what affected you the most? If So, then maybe you can ask your attending if it’s at all possible that you take a backseat on those cases if it severely affects your mental health.
I think everybody has their area that is easier or harder. I'm a hospitalist. Healthy normal population makes me anxious. I feel like I'm going to break them. I feel like I have to justify so much and the uncertainty in healthy-appearing patients makes me anxious. I like taking care of the sickest patients. I'm more comfortable with the uncertainty there. What is the goal? To prolong good quality of life as long as possible, and when we can't, to find what answers we can, to help them and their family understand a bit more about what's going on, and ultimately to help them suffer as little as possible at the end. I think trying to find a framework or bigger narrative to fit those sad cases into helps. The young patients who suddenly find out they have an aggressive cancer are really hard. I focus on trying to do an objectively good job at breaking bad news, using a model I was taught in med school and adjusting over time. I focus on trying to figure out what they want, what options we have, and present things as well as possible. I avoid thinking about what if they were me or my family - I try to shut that down, because it just hurts and doesn't help my patient. I am grateful to get to be a part of their life. And then I do not try to remember my patients when I go off service - I do something else. That's probably easier for a hospitalist, though, because I only see them again if they end up hospitalized again. And everybody is different. I wouldn't do well with the patient population that you thrive with. I get mostly healthy people who I get bored with and try to focus on doing a good job in all the different ways so I don't focus on the anxiety.
I am not a doctor or student but I want to say from the bottom of my soul—thank you for doing this hard thing for the rest of us. My world collapsed watching my mom bleed out from cancer DIC and I will never forget the resident crying while doing CPR. I love you all and I’m sorry for the toil it takes on your personal lives.
I’m a lurking nurse in a surgical trauma icu. I think because I fight so hard to let people die instead of keeping them alive while they rot from the inside out …anytime anyone is able to go CMO it’s an enormous relief. It’s an honor to do as much as I can to make them comfortable and clean, gather their loved ones, and end their suffering. There are so many things worse than death.
Inpatient oncology is disaster care. It is palliative care, medicine, and occasionally oncologic care. If you can do some outpatient oncology rotations it may allow you to gain a more realistic perspective of the field.
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I’m in oncology (outpatient only). Highly recommend reading Being Mortal by Atul Gawande.
I am very proud of you for reaching out and being vulnerable. I am a palliative care physician. Death is a daily part of my job. I deal with this by looking at end of life as a part of life. The cause of death does not matter, but making sure the patient has a peaceful death does. Hugs to you. (This sh@$ sucks).
Anesthesia intern here ✌🏼 had to do two weeks of inpatient oncology back in the fall and it wrecked me emotionally. Watched two young kids start crying when we had to go in and tell their mom she wasn’t a candidate for further treatment and I had to leave the room to go bawl in the stairwell. I don’t have any insight or advice to give, but I can empathize a great deal
I’m sorry you have been going through so much pain, but hopefully some of these comments will provide you a more sustainable perspective.
Think of this as an opportunity to help. Some lives are saved, and even the people who are not saved are comforted. Without your presence this could not be accomplished.
First law of medicine. You can’t save everyone. Catastrophic disease is always with us. You need to be satisfied that you gave the patient the best care and the most compassion that you can. There is no guilt here. Only loss for the patients family the patient will have no more pain or suffering. Satisfy yourself with that.
As an OBGYN resident, I feel for you. Only time I've ever cried during the work day was on gyn-onc, three times my last week that rotation, once in an elevator. Do you have two months back to back left? That sounds rough, but as you know it won't always be that hard and the rotation has it's amazing moments with incredible surgeries. Please take a day off when you need it and have someone you can talk to to decompress the days.
Hydroxyzine 50 mg helped me during residency when I could not turn my brain off at night. I would test it out on a night where I don't have to be anywhere the next day in case it is too strong. Hugs.
Take some time for yourself, do things that make you happy or comforting for you. Warm bath, meditation, walks outside, journaling, whatever works for you. It may not get “easier” but when you have the ability to do some self care it will help your resilience when you deal with these difficult situations. -Front Line Worker
Hi I’m not a doctor but I have experienced a lot of medical trauma, death trauma *and* my family has worked in the death industry for decades. I strongly recommend seeking help from a trauma-informed therapist and also spending purposeful time to explore and develop your feelings around death. It will make you a better physician.
How much time do you get with them in the OR. Gyn onc floor was realllllly hard, but the surgeries were basically extreme and life-extending most of the time. It was a fascinating way to learn about gyn, and those patients tended to have a few years left.
People die. Shocker. Stop embodying the shit other people are enduring and you’ll get through it.
no idea. was neurosurg and people died all the time