Saturday, February 20, 2016

Welcome to Hematology! Please place your heart on your sleeve and step this way....

It was a hard week.

It was a week where my hate for cancer grew so strong I felt consumed.

It was a week that left me feeling like no matter how hard we fight, we'll never win.

Earlier in the week, I received notice of the death of a patient who holds a special place in my heart.  She was the first person I ever had the joy of telling that her bone marrow results were back and the cancer was gone.  The transplant worked.  She was in remission.  She gave me the biggest hug and I cried along with her and her son, overwhelmed by the emotion of the moment.  This is why she had pressed on for so long.  This is why she had endured all of the pain and suffering we put her through. To see those sweet words in print on her biopsy report.

"No evidence of leukemia."

A few months later, I was commenting to my co-worker how beautiful her obituary picture was.  I had never seen her with hair.

The cancer came back.  There was nothing else to be done.  It took her quickly.

But Friday is new day, right?

It's a day when the following conversations take place:

Me, answering a direct page: Hi, this is Eva
Kim: Eva, it's Kim, can you come to Charlton 9 desk right away?
Me: I'm with a patient right it urgent?
Kim: (pause)...well, yeah, sort of.  yes.
(I quickly wrap things up with my patient and head out to the desk)
Me: What's up?
Kim: [Insert name here] relapsed.  He specifically asked if you were around to say goodbye.
Me: Where is he?
Kim: Room 41.

Me, walking in the room: What's going on?!?
Him: It's back.
Me: Oh, [name], I'm so sorry.
(Gives long hug while he says all kinds of nice things about how thankful he is for all that we did and how special I was to him and his wife)
Me: So what's the plan?
Him: I'm getting on the first plane south to go see my kids one last time.  Then I'm going home to die.
Me: Is [your wife] here?
Him: No, we separated
Me: Whaaaaat?  What's going on there?
Him: It's been two and a half years of hell.  That's what's going on.
(more conversation takes place)
Him: Alright, I'm getting out of here.  I'm not spending one more minute in a hospital.  I just wanted to say goodbye.  You meant a lot to us.

He's 34 years old.

Two hours later, on the phone with one of my favorites:
Me: We added some testing to your appointments next week.  The scan you had today raised some concerns that need to be checked out a little more thoroughly, so we're doing a PET scan and repeating a bone marrow when you come back.
Him: Does this mean the cancer is back?
Me, trying hard to stay within my scope of practice and not "diagnose": Well, we can't say for certain one way or the other right now.  That's why we need to do the additionally testing, to figure out what's going on.
Him: Tell me honestly, though, what else could it be?
(long pause as I try to think of one other possible thing it could be....)
Me: Well, that's what we need to figure out.
(long pause)
Him: What am I supposed to tell [my wife]?
Me: Well, you can tell her that nothing is certain yet.  That we need to investigate further.
Him, slowly: Yeah, okay....that sounds good....I'll tell her that.

And then I went home and wept.

And it's turning out to be a weepy Saturday, too.

I am head-over-heels in love with my new job.  One of my favorite things about it has been the opportunity to get to know my patients in a way I was never able to in the float staff.  I know their kids, their hobbies, their spouses and their pets.  They show me videos on their iPads of their kids running across the restaurant when Mom & Dad surprise them by coming home after 4 months away, or of the award they received at school (joking, "I think they just made up an award to give me because I have cancer.  When you have cancer everyone wants to give you an award and if they can't think of one, they just make one up.")

I get paged on a Friday afternoon because their kids are in town to visit for the weekend and they stopped up to see if I was available to meet them.  They introduce me by saying, "This is daddy's nurse" or "This is the one we were telling you about who has been so good to mommy and daddy."

One time I say, "Thank you for letting your mom and dad come and stay with us so we can help your dad get healthy again. I bet it's really hard not to have them at home."  The five-year-old responds, "Yeah. Thank you for making him better." and I get choked up at her sweetness and innocence.

My heart just soars with love and compassion for these suffering families.

But then weeks like this happen.  The names on the "death notice" emails get more and more familiar.  And the same family who asked me to come and meet their kids is asking me to come and say goodbye.

I'm less than a year in, and my heart already feels like it's being shredded into a million pieces.  And it makes me wonder how long I can survive in a specialty where I will outlive all of my patients; a specialty where in clinical studies, "long-term survival" is considered 2 years.

I'm not sure how to wrap this up.  Not sure what my point is.  Maybe my point is just that I love my job but some pieces of it are getting really hard and I'm still learning how to navigate that.  And also that I want to capture some of these stories, because I don't want to forget them.  I want their lives to matter to me.  I want to remember their journeys.

I don't want goodbye to be the last word.