Doctor Becomes Patient

Shortly after my mother was diagnosed with cancer of the pancreas, a good friend admonished me for talking to too many doctors about her illness. The remark stung me. At that time, I was an emergency physician in the early years of my career. As a concerned son and the only "medical person" in our family, I felt compelled to gather information and opinions from a number of my colleagues.

Interestingly, my mother didn't feel it was necessary to get multiple opinions about her condition. I realized that my actions spoke more about my needs than hers.

Five years later, when talking to my friend, a retired psychology professor who was undergoing treatment of his recently diagnosed cancer of the biliary tract, I recalled the earlier unsettling conversation about my mother. My professor friend remarked how satisfied he was with the expertise of his surgeon, his oncologist, and his family doctor. He trusted them. He, like my mother, felt no urgent need to canvas for additional medical opinions beyond the group of professionals who were already caring for him.

My Turn

A few years have passed since my professor friend's death. Now, as an experienced 50-year-old emergency physician, I'm facing my recent diagnosis of prostate cancer. I am relieved, of course, that it's not my pancreas or my biliary tract. Still, it is cancer and there are a lot of questions to be answered and decisions to be made.

I began to reflect on how we healthcare people make decisions when we are surprised by personal illness. How, where, and from whom do we obtain information? In whom do we place our trust? To find out, I sat down at the computer and asked nine physician friends how they would go about making a major personal decision regarding serious illness. I specifically did not ask what they would do in my case but rather how they would ready themselves to make a decision.

The comments of my friends contained a number of recurring themes. Most emphasized the importance of gathering information:

I would want all the facts available. I would look at the literature – even beyond reviews and into original recent articles. I would talk to the local experts that I trust. I would then turn to my closest trusted advisors ….

Three of my correspondents shared previous experiences with illness of family members:

Unfortunately, my father got the same diagnosis in autumn last year. The decision was very difficult, because my father is a doctor and also my three brothers (one internal medicine, one anesthesia, and one a dentist). All of us were of different opinions on what to do ….

One friend expressed caution about what the medical profession could offer him. For some physicians, it is easier to give than to take orders:

Presently, in my self-care, I have tried to do it myself, being somewhat distrustful of my own profession.

Some acknowledged that assembling the facts and devising treatment strategies are only parts of a larger healing enterprise:

My first thought was to a notation I made just above Psalm 139 in my first Bible. I've come to it many, many times. Facing Big Decisions: 1. Confess all sins 2. Surrender 3. Wait for word from God, providential circumstances and inner conviction from the Holy Spirit.

My surgeon friend phoned me and listened patiently for two or three minutes. Then, with the economy and precision of a surgeon (while brushing aside my "research" question), he said I needed to have my prostate out – the sooner the better.

One emergency physician suggested I get in touch with another doctor, also an ED physician. Like me, he had been surprised in middle age by cancer of the prostate. During an extended telephone conversation, he shared with me his investigation of treatment options, his careful consideration of diet and exercise, his choice of doctors, and his overarching faith: in the abilities of those doctors; in the support of his friends; in the inscrutable power of prayer; and in God.

Life as a Journey and Life as a Battle

Buddhist monk and teacher Thich Nhat Hanh states: "The most precious gift we can offer others is our presence." It became apparent that I was doing more than turning to doctors for information or advice. I was, in effect, gathering a "coalition" of supporters to help me on my way.

Writer Alberto Manguel recalls an observation by Jorge Luis Borges, his mentor: "Borges once pointed out that The Odyssey and The Iliad move us because they are two ancient metaphors of our existence: life as a journey and life as a battle." Whether for the battle or for the journey, we need companions. To my surprise, some people whom I wouldn't have chosen to accompany me "into battle" came to my assistance. One such person is a former classmate. Who would have predicted 25 years ago that the class clown of our first year medical class would turn out to be a trusted source of information, and an upbeat and reassuring friend during this crisis?

The issue of trust is crucial. Where does trust come from? Certain physicians find it easier to say, "Trust me, I'm a doctor," than to say, "I trust you, now that I'm your patient." I'm one of those doctors.

I will need and depend on various people, with different skills and resources, at different stages of the journey. A friend's gentle affirmation, "All will be well," on a given day can provide as much hope and reassurance as knowing your surgeon's complication rate. I trust that my spouse, my surgeon, my siblings, and, perhaps, a loyal buddy will all be present for me at the appropriate time and place. All these companions bring order, clarity, and moments of calm to the process of making a decision and to the time of healing that lies ahead.

And I hope I will be around to accompany them on their present and future journeys.

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