Heal Thy Patient … Reflections on the Human Side of Medicine

Physician Perspective


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Chandrakanth Are, MBBS, MBA, FRCS, FACS

The ability to touch lives and build relationships with patients and families may be the most gratifying of [a physician’s privileges]. Let us not let anyone—or any system—deprive physicians of that privilege.

—Chandrakanth Are, MBBS, MBA, FRCS, FACS

The first time I met Mrs. X and her husband was to discuss the surgical treatment options for pancreatic cancer. She had just been diagnosed with pancreatic cancer at her local hospital and was being referred to a tertiary care center for operative management. Mrs. X and her husband were no different than the approximately 45,000 patients diagnosed with pancreatic cancer on an annual basis in the United States. They were anxious, as is expected, but maintained a calm grace and dignified composure. They were in their 60s and were extremely polite and courteous, despite the enormous burden of the diagnosis. They were well informed of the nature of pancreatic cancer, its lethality, and the likely treatment options.

After performing the appropriate preoperative clearances, the patient was taken to the operating room for a pancreaticoduodenectomy, which she tolerated well. After an undulating but nonetheless uncomplicated postoperative course bereft of major events, she was discharged to a skilled nursing facility. Over the next few months, she returned to the clinic for follow-up and was in good spirits.

A Diligent Family Caregiver

While this course of events may appear similar to that of any other patient with pancreatic cancer, the reality was and continues to be far from it. At our very first meeting, I noticed that the husband, an electrical engineering professor, was very involved and methodical. In the postoperative period, I was impressed by his diligence and involvement in his wife’s care. Every morning, by the time I got to his wife’s room, he was already there ready to give me a very inclusive progress report along with appropriate documentation of drains, ambulation, and so forth.

Although he continued working at his daytime job in another city about 50 miles away, he was at the hospital everyday without fail until the day she was discharged. I even commented that maybe I could put him to work with other patients, considering the comprehensive care he provided for his wife. All of these interactions led to the development of a very strong physician–patient/family member relationship.

After her discharge, we met each other during his wife’s clinic visits. He was always the same—very informed, methodical but professional, and courteous to a fault. As is the case with many patients with this lethal disease, the patient passed away the next year.

A Continuing Friendship

The first time we met after Mrs. X’s demise, her husband reminisced about her last few months in this world—how she remained so graceful even while living under such a blanket of physical and mental suffering; how she had always looked forward to visiting us in the clinic and she made an extra effort to look good for the trip; how it was difficult in the final few days of her life; how he feels that she is better off now, as death is the ultimate relief from suffering in this world.

Our discussions were always based on frankness when his wife was alive, and they continued in that manner even afterward. There were many times he wondered in my presence whether she should have had the operation, considering the comorbidities his wife had prior to the operation and her need for several months of postoperative care at a skilled nursing facility. Acknowledging that hindsight is a luxury, we have agreed that the best decisions were made at the time, with the information on hand.

As our friendship continued, the husband decided to dedicate a part of his life to join the fight against pancreatic cancer on multiple levels. He got involved in advocacy groups that lobby for funding for pancreatic cancer research and treatment in Washington, DC. This has required multiple trips to the capital, which he undertook with the utmost enthusiasm. To make himself even more useful in this endeavor, he stays remarkably up to date on statistics and advances relating to pancreatic cancer.

Heartwarming Stories

Our friendship continues at regular lunches or the occasional dinner meeting. On these occasions, it is heartwarming to hear the stories he recalls about his wife of 50 years. Although his wife departed this world nearly 4 years ago, anyone listening to him would think that she might walk around the corner at any minute. His love and affection for her are undiminished from the time of their courtship, when he was a shoe salesman and his wife was the attractive woman who worked as the boss’s bookkeeper.

He recounts how a young man funding his own university education thought that stealing a kiss from the boss’s bookkeeper might translate to a pay raise. He tells of how, in a long-ago era devoid of pretense, they worked in the morning and drove in the afternoon to a local church to get married, and he remembers the happy life they shared for the next 50 years before fate separated them.

For the occasional dinner meeting, my wife and I have had the pleasure of visiting their home. We were served a nice home-cooked meal, something I am sure was much like meals the couple had shared. We talked about their European ancestry while reviewing some black-and-white and sepia-toned photographs. We were shown around the house, with every sentence during the tour including his wife’s name or a reference to her. As we departed after dinner, I could not help but remark that the house is a shrine to his wife.

He is blessed to have his family in the same town and is kept extremely busy with his teaching commitments. Nonetheless, the loneliness he feels in the absence of his life partner of 50 years is painfully obvious. Our meetings likely rekindle his memories, giving him the opportunity to think of his life partner with fondness.

The Human Touch

I have gained immensely—both personally and professionally—from this relationship with Mrs. X’s husband. This is what we should be inculcating into the education of today’s physician trainees. In this era of artificiality, consisting of electronic medical records, cookie-cutter measures, metrics on patient satisfaction, tick-the-box curricula, and inordinate emphasis on controlling costs at the expense of everything else, it is very easy to forget the human side of medicine. All of these modern concerns have the potential to drive us away from the basic tenet of medicine—not only to cure the disease but also to build a relationship with the patient and family.

Our relationship with the sick does not stop when a soul departs. It continues to provide comfort to the rest of the family as needed. While this may not equate to any direct medical intervention with its essential “relative value unit” generation, this post-crisis relationship should be considered just as crucial a part of treatment.

The medical profession is based on the “human touch.” Our patients provide a unique privilege for us to touch their lives and, in turn, be touched by them. They provide us the honor of becoming a part of their lives at their happiest and saddest moments. They open the door to their most private and intimate moments. They invite us into their past, present, and future life journeys, with all the attendant emotions. There is no other profession that offers this rare privilege.

For all the rigors, trials, and tribulations, as well as the sacrifices made over the years of training, we physicians are granted many privileges. The ability to touch lives and build relationships with patients and families may be the most gratifying of those privileges. Let us not let anyone—or any system—deprive physicians of that privilege. ■

 

Dr. Are is Associate Professor of Surgical Oncology, Vice Chair of Education, and Program Director of the General Surgery Residency Program at the University of Nebraska Medical Center, Omaha.

Disclaimer: This commentary represents the views of the author and may not necessarily reflect the views of ASCO.


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