Not just about exams

Once upon a time, there was a junior doctor who was getting ready to sit her upcoming professional specialist exams. Now these are stressful and difficult (or commonly so perceived) examinations, and she had dedicated a lot of time for study, and study alone. When her dad tried calling her to catch up several times during that period, she turned him down and said she would make up time with him after her exams were over. She remembered those phone calls, she remembered the promises she made.

Then on the week before her exams finally took place, her dad caught a bad pneumonia, got admitted to hospital, never recovered, and passed away a few weeks later. Among those weeks she turned up and sat her specialist exams in the worst mental situation ever — but she, with her smartness and her hard work, managed to clearly pass. Yet in her smartness she realised too that some things had changed, and that she could not turn back time even if she wanted to.

Two years later today, she is a young consultant specialist with a passion for the education of junior doctors in specialist training. She would keep telling the trainees who have exams coming up — with their brows frowned and head heavy amongst a pile of study notes — that exams are not everything; that family and friends still exist and appreciate your time. And that although they may think they’ll be less busy “after this”, it is rarely true — she would say always try to make time now.

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Breaking bad news

Here I just had one of the most intense and emotionally-charged sessions breaking horrible news to a guy and his family. As you could imagine, when a healthy man, in his sixties who has been selling shoes in Queen Victoria market every weekend until yesterday, is told after a rapid series of events that his life will now not see past the next few weeks.

His wife, his son and daughter, grandson, and nephew and niece were there to listen too. And no, there is no chance he will be able to fight his cancer and win.

Walking out here are some of what went through my mind:

  1. Have some water first before you enter the room, especially if you’ve had a long day seeing other patients.
  2. Deciding whether to stand up or sit down can be tricky. It is nicer for the patient on the bed to be at the same eye level with you, but the family members standing around will find it easier to step over you.
  3. Warn a few nurses first before going in, so that when a group of family members start sobbing and bawling their lungs out around an Asian dude they will not be too alarmed.
  4. Skirt the peripheral questions even though they can be very valid and even if you can answer them well. Those are good questions, but we can talk about them later. Stick with the main issues, keep the points short and then step out. Take charge of the conversation.
  5. It helps to look older, more professional, and probably less skinny. Oh well, maybe one day. I could have worn a necktie, though.

I realise, too, that while I sit comfortably in my room tonight, good headphones wrapping around my ears and a familiar cup of hot chocolate beside me, their world is totally shaken and turned upside down. Forever. I can still picture his wife screaming at me in disbelief.

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Marie and her rosy cheeks

I was asked to review the radiotherapy plan for Marie when I noticed on the CT images that her entire left lung was opacified. It turned out to be a haemothorax, as suspected. Her malignancy had resulted in auto-antibodies rendering her clotting system defective.

Two weeks ago I first met Marie in the clinic. She came with her son, daughter and daughter-in-law. They were obviously concerned about their mum and wanted the best, yet they understood there was only so much Medicine can do. Marie was in her fifties, but she did not look so at all. She came in well-groomed; her cheeks and lips were rosy with mild makeup. She had the gentlest speech, and her smiles were small, but frequent and sweet.

Now Marie was on the hospital bed in the trolley bay. No makeup this time — her complexion was pale, her lips grey, her hair messy from prolonged bed-stay. But she was still soft-spoken, and her smiles were still lovely as before.

I slowly explained to Marie what I found. “Things are progressing quite aggressively… And I’m not sure how rapidly this is going to continue,” I said as I watched for her reaction. “I’m really sorry, Marie.”

“That’s ok,” she said with a smile. It was as if she had expected this all along. “As long as the children are ok,” she added in passing. I didn’t quite understand at the time, but my mind drifted, for an instant, to recall the image of her son, daughter and daughter-in-law during the first clinic consult. She passed away the next day in the hospital.

Kenny and his dreams

In the same week, I had a conversation with Kenny. Kenny was a young man from Hong Kong. He had a wife Yen, and together they have a 5-year old son, who couldn’t understand yet that his dad was dying from colorectal cancer.

In a matter of days Kenny went from walking to being wheelchair-bound. On the CT images, his whole abdomen was solid with metastases. We knew his wife, brave as she was, was struggling to care for both Kenny and their little child at home. It came the time when I advised for inpatient admission to the palliative unit. It may very well be Kenny’s last destination in this life, and I wanted to make sure he and his wife understood the situation.

I remember his wife was wearing a T-shirt with verses from the book of Phillipians on it. I asked her about it, and it turns out I knew the church they attended. I realized too that when patients have a faith and hope to hold on to, these grim conversations become so much easier. I asked how long have they been in Australia for. It was two years ago when they came with their young son, on a working visa.

“What is it that you do?” I asked Kenny.
“I’m a lecturer at RMIT…”
“Oh what do you lecture on?”

“Building construction,” he replied, then added after a pause, “But all of that doesn’t matter anymore, Joseph.”

I guess that’s true. The following day Kenny’s cancer perforated his bowels. He was transferred to a private hospital, and that was the last I heard of him.

These conversations with Marie and Kenny at their deaths’ door helped me put some things back into perspective.

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