I walk into the room and introduce myself. She is sitting across from me with her teenage daughter.
She was last seen 3 months ago and has been in remission for over a year now. I explain that her lab results were normal so far. Some are pending. No recent imaging.
“So, how are you feeling?” I ask.
“Is it possible that the labs can be normal but the cancer is back?”
“It’s not impossible”
“Oh my God…” she turns to her daughter, fear etched onto her face.
“Something isn’t right,” she says, turning to me, “I booked an appointment today because inside me, it feels… off. I have a lot to live for, I don’t want to die! I want to see my kids grow up! I have two more boys at home…”
She reaches for her daughter’s hand, and trembling, kisses it.
Somewhere, deep within the sinews of my heart, I feel a tug. Touched. I keep my composure. My eyes sting a little. For a split second, this gesture, somewhere in my subconscious mind, reminds me of my mother, and suddenly, I miss her terribly.
Her daughter tries to comfort her, but what consolation can calm an aching soul.
I realize immediately that I hadn’t taken a moment to gage her emotional state when I walked in. My mistake. I was caught off guard by the extent of her distress. Momentarily, I was stunned into silence.
“Tell me more about how you’re feeling different” I ask.
She struggles to find words to complete her sentences. Her eyes are wide with dread, an overflowing ocean of fear.
In the best words I knew how to gather, I explained that whatever the outcome of this visit, we will tackle it together with the best treatments we have to offer. Despite her overwhelmed state, I illicit a history of her symptoms.
In my differential, I also consider benign entities, but given her history, a physical exam is necessary to differentiate this from a recurrence of her malignancy. This offers her no solace.
I excuse myself to allow her to change before examining her and to discuss the case with my supervisor.
To our dismay, the patient’s examination is highly suspicious for a recurrence.
I stood there, feeling entirely helpless as I watched the truth of this confirmation sink in and carve trepidation into her expression.
There is a plan, we explain. Imaging. More labs. Close follow-up. Then we decide how to proceed. If it’s localized enough, we have the option of surgery. If it’s too spread out, we have the option of more chemotherapy. The scans will guide our decision-making process.
I take care of the paperwork. There is a lump lodged in my throat and I am at loss for words, truly.
I wish I could apologize to them all for the inadequacy of my limited experience. I wish they could feel my profound gratitude for the privilege of allowing me to be present during their most vulnerable moments.
I wish I could wave some magic wand and watch their fears, uncertainties, and pain fade away.
But I can’t.
Instead, to ease the turbulence of my emotions which I struggle to keep in check, I pray, silently. I ask God to put my heart at ease and to ease their pain. I repeat a supplication which reminds me of the inevitability of our mortality: “Inna Lillahi wa inna ilayhi raji’uun”. To God we belong and to Him we shall return.
Reviewing her file, I realize her daughter has the same mutation. Will she, too, suffer the same fate as her mother and grandmother?
“Inna Lillahi wa inna ilayhi raji’uun”, I remind myself.
As I speak to the secretary to organize the urgent investigations I glimpse her as well as her daughter sitting in the waiting room next to each other, each of them staring into space. More silence.
My heart aches for them.
“La hawla wa la quwata illa billah”, I whisper to myself. There is no power or strength except with Allah.
On the train that evening, the tears blur my vision as they make their way down my cheeks. There is no stopping them. I allow myself to feel. Courage, dear heart! In moments like this, “Inna Lillahi wa inna ilayhi raji’uun” is my only consolation.
I am often asked, “how do you cope with it all?”
In all honesty, I don’t know. I’m not sure I have it all figured out. I’m not sure that any physician has. I’m not sure I will ever truly have a clear-cut answer to that question.
But I know I am not alone.
I know that losing my equanimity in front of my patients doesn’t help. So I keep it together. I give them the emotional space and freedom to express themselves without burdening them with my own vulnerability. I am entirely present, through the long, painful silences. I do not shy away from acknowledging the intensity of their sentiments and of their experience. When I make a mistake, I apologize, openly, honestly, and wholeheartedly for it. I approach them with great dignity and respect for their struggle, a warm smile, a calm demeanor, and I hope, always, with an eternally compassionate heart.
But most importantly, I pray… It is within prayer that I have found the most powerfully liberating antidote to my vulnerability. I pray that God may give me the strength, knowledge, and wisdom to learn, discover, and implement genuinely meaningful ways to help treat my patients and ease their suffering to the very best of my ability.
“Bon courage”, I whisper, as they walk out.