Wednesday, January 31, 2007

Voids and Memories

Today I went to class, dropped by the Basic Science Journal Club for some stimulating science, and visited the Mt. Zion UCSF cancer center for the first time. When I got home and opened up my e-mail this afternoon, I learned that a former patient whom I met at Stanford last year recently died from pancreatic cancer.

So far, I have postponed discussing my secret obsession with oncology, but this news has prompted me to start reflecting again. Certain stages of pancreatic cancer have a median life expectancy of six months, and when I heard that a former patient had passed away, it flashed me back to the old feeling that another soldier has fallen.

And then I always start thinking about my former interactions with that patient...When did I first meet him? What did we talk about? What did he look like? Every death is like a small electrical shock to me, and it forces me to think about the mysterious void that we all seem to disappear into eventually. To flesh out this concept, I am attaching a piece of an essay that I wrote last year for medical school:

"Growing up, I felt haunted by the loss of a grandfather whom I would never meet. Tiptoeing around this void as a child was like trying to resist the gravitational force of a black hole. Since my grandfather died from colon cancer when my mother was seventeen years old, I never had the opportunity to meet this shadowy figure buried somewhere in a New York City cemetery. A passage from Tom Stoppard’s Rosencrantz and Guildenstern perfectly expresses that curious emptiness left by my grandfather: “Death is not anything...death is not...It's the absence of presence, nothing more...the endless time of never coming back...a gap you can’t see, and when the wind blows through it, it makes no sound.”

For the past seven months, I have worked at Stanford University Medical Center as the full-time clinical research coordinator, and the most compelling part of my job stems from my close interaction with terminally ill patients.

Of all these patients, I will never forget Mr. David Lee,* a seventy-five-old patient with metastatic gastric carcinoma whom I met during my first week. He was a cheerful, little old man with round glasses and a padded suit jacket that hid how emaciated he had become underneath. When Mr. Lee visited us last July, he was already dying. As he sat in the examination room with his wife and three grown children, the hardest thing that I have yet experienced was being present when Mr. Lee learned that he would likely die within six months.

After the doctor gently suggested that the family should consider “end of life” options, Mr. Lee’s daughter broke into uncontrollable sobs. I struggled to maintain eye contact with David Lee and his family in the cramped clinic room. It was difficult to breathe and remain objective in the midst of such grief. For the rest of the week, I could feel the blood pounding in my brain as my head ached with unshed tears. The greatest challenge in working with patients who have gastrointestinal cancers is learning to accept that some people will never quite recover from their illnesses and that no families will ever be the same. Two months later, Mr. Lee passed away.

Strangely, I cannot forget Mr. Lee. I remember his shuffling gait, his facial expressions, and his plastic frame glasses with remarkable clarity. What I marvel about death is its ability to take away someone so real and lifelike to me…to make him disappear into a void. That is the mystery of death that Guildenstern so eloquently described: how can Mr. Lee exist and yet not exist anymore? The more I pondered this, the more I realized that Mr. Lee represents to some degree an echo of my missing grandfather.

Working with terminally ill patients every day teaches me that I can be stronger, wiser, and more compassionate. But the deaths of patients like Mr. Lee also push me to realize that I am imperfect, that any clinical study is imperfect, and that our knowledge of cancer remains imperfect. Learning to recognize these imperfections and yet refusing to simply accept them motivates me to continue my research when I am a medical student and a physician to develop new treatment therapies against cancer in a never-ending quest to enhance a patient’s quality of life and chances for survival.

My reasons for pursuing a career in medicine stem from the people who have impressed me deeply, such as cancer patients like Mr. Lee. And yet, ironically, if I were to trace back the origin of my interest in healing and helping others, it would lead back to the void left by another person suffering from cancer whom I will never meet."

* Names are changed to protect patient privacy under HIPAA.

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