It was not so much the words as the overall tone of the interaction. The doctor-patient relationship had been generally affable. There was the usual exchange of pleasantries over the years. Questions about family, children, and grandchildren. It was a good relationship — until Harvey got sick, that is. Originally, there was weight loss and fatigue. The initial physical exam and slew of testing showed nothing but a frail, cachectic, middle-aged man. A few CT scans later, and he was in the oncologist’s office discussing chemotherapy. A regimen was decided on, and therapy began the next day. Therapy was hard. Nausea. Retching. More weight loss. Far from feeling better or cured, Harvey could feel the clothes slipping from his emaciated body. It was as if life itself was drip dripping away as the chemo bulldozed into his broken veins. And this pissed Harvey off. He lashed his family. He cursed his friends. He spun into a whirlwind of the most resistant depression. A depression, his therapist would later tell me, whose only salve was anger. While the anger allowed him to carry on, often he left those around him scorched. His doctors were no exception. We often spent half of each visit withstanding abuse before getting down to the business of the appointment. He blamed us for the cancer. He blamed us for the lousy response. He blamed us for the side effects of his abysmal treatment. So when I walked into the hospital room to tell him the scans showed his latest chemotherapy had failed to stem the red tide of death, I have to admit that I had already somewhat detached. How could I not? Although he was fairly lathered by the results, it was the mentioning of hospice that finally led to my expulsion. His wife ran after me with tears in her eyes. I’m quite certain that she paid dearly for her kind act of decorum. Harvey died shortly thereafter. I am prone to remember the pleasantries Harvey, and I enjoyed before his health deteriorated. I am neither disturbed nor saddened by the anger. I cannot even say that I would not have been the same way if I had been lying in his hospital bed. What surprises me, in retrospect, is how little he affected me and how his anger didn’t penetrate the hardened shell. Over my career, I have been yelled at, cursed, blamed, hugged and even loved by my patients. And like the poor life force oozing out of Harvey’s beleaguered body, it drip drips down my back. And into a forgotten puddle on the ground. Jordan Grumet is an internal medicine physician who blogs at In My Humble Opinion. Watch his talk at dotMED 2013, Caring 2.0: Social Media and the Rise Of The Empathic Physician. He is the author of Five Moments: Short Works of Fiction and I Am Your Doctor: and This Is My Humble Opinion. Source
