Over the last three weeks, we have seen how medicine is changing in the USA. Last week my clinic went from face-to-face visits to >90% telemedicine encounters. We are facing a pandemic, the burden is growing and at times it feels unbearable.
My love for medical oncology started early during my medical training. Coming from a family of surgeons, it was expected for me to become a surgeon. Still, during my clinical rotations, one patient changed my medical career course and ultimately, my life. Maria (pseudonym) was a 68-year-old woman with metastatic lung cancer who, even conscious of her diagnosis, never lost her smile. Every day she taught me a new lesson. The one that has stayed with me was about my career in medicine and the current difficult times, “No matter how hard life can be, you should know you are doing the right thing”.
One day, I went to visit Maria after my shift and found only an empty bed. My patient and friend had passed away the night before. Her hospital roommate shared something from a conversation the two had that touched me deeply. Before passing, Maria had said, “God sent me the daughter that I always wanted just before he wanted me to go.” At that moment, I realized how profoundly doctors could change patients’ lives. This is a responsibility and honor that I will never take lightly. Moving forward, I have focused on developing a lasting relationship with my patients and many of them have become family.
I often cry with my patients and all of them know that I am a ‘hugger’. We hug during difficult times, after the birth of a new grandchild or when therapy is working (always with permission). That human touch makes bearable some of the conversations we have in our oncology clinics. Touching someone’s shoulder, shaking hands and patting on someone’s back are often ways in which physicians share their empathy and compassion. These gestures may not be for every physician. However, they are a way of coping for many of us.
Being an oncologist is an honor and something that I feel I was born to be, but unfortunately we often have bad news to share with our patients and families. We often have to say goodbye to our dear patients. A few months ago, one of my medical students asked me: “How do you do it? How do you cope with the burden?” At that time, I answered: “With exercise, sleep and spending time with family.” Now, I have realized that hugging is one of my coping mechanisms. Since the outbreak of COVID-19, we have been limiting patient contact. As healthcare workers, we are at risk for becoming SARS-CoV-2 vectors and my patients with lung cancer are at high risk for complications if they get infected. Read the latest news on risk factors for COVID-19 patients here.
First, we were increasing hand-washing and disinfecting surfaces. Then, we reduced exposure and now we are moving to 100% telemedicine encounters and limited face-to-face interactions. As I have told many of my patients, we need to be apart now so we all can be together once again. The first telemedicine encounters were fine, they were follow-up visits and reviews of possible toxicities associated with treatment. As days passed, it was time for re-staging scans and the telemedicine encounters were progressively getting harder. Now, we have to share bad news over the phone several times per day and on some occasions we do not have the opportunity to even to see our patients, as many do not have access to a smart phone or the internet.
I keep repeating to myself that it’s the best decision and I need to protect them from the virus, but my heart keeps telling me that I am failing them, that they are alone receiving this news and they cannot even see their doctor. Even if we talk on the phone weekly, I still feel like I am abandoning them.
A few days ago, I had to see one of my patients as it was time to discuss the results of her most recent scans. Unfortunately, her lung cancer was not responding to therapy and her pain was getting worse. After sharing the news, she asked, “Can I hug you?” I could not hug her, I was in the hospital service getting exposed to many patients and I could not put her at risk. As I said no, I felt a sense of emptiness in my stomach that I have never felt before. Within seconds we started crying, we were once again apart from each other. That day, I realized that hugging is one of my primary coping mechanisms and the current COVID-19 outbreak has taken that away from me.
You often do not know how much certain coping mechanisms are helping you until you lose them or stop practicing them. Since all of this started, I have found myself crying more often and watching the Great British Bake Off almost every night. I am unconsciously trying to compensate for the lack of human touch. I started wondering if this was a selfish mechanism of defense and that my patients did not notice the difference.
One morning, I started calling some of my patients to follow-up. Many were happy to hear my voice even if I did not have good news and I started saying, “I wish I could hug you.” As soon as those words were pronounced, the sense of emptiness diminished and I learned that many patients also wished they could hug me. I cried after every phone call that morning as I felt how vital those hugs were for my patients and how now I cannot provide them with the comfort I once did. I used many comforting words during phone calls, but it was not the same. One patient told me: “It is like an egg without salt. It is ok, but you know you are missing something.”
In this current crisis, tears are not a sign of weakness, but strength and they are filling the void that hugs used to fill. Ice cream is also helping and we will overcome these dark times. We owe it to our patients, families and colleagues. I cannot hug you right now, but you better be sure that I will hug all my patients (with permission) once we finally can.
I am proud to say – I am a hugger and you may be one too!
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Author profile: Narjust Duma, M.D. is the 2019 Mayo Brother Distinguished Fellowship Award winner, considered the highest medical trainee honor in the Mayo Clinic (NY, USA). Dr. Duma is an Assistant Professor of Medicine at the University of Wisconsin in Madison (WI, USA) and a distinguished member of the University of Wisconsin Carbone Cancer Center. Dr. Duma is a regular contributor to Oncology Central; you can view her full biography here.
The opinions expressed in this Editorial are those of the author and do not necessarily reflect the views of Oncology Central or Future Science Group.