As medical students and doctors we deal with sickness every day. We show compassion and care and are hopefully moved by the suffering around us. Those feelings may be particularly acute when suffering is closer to home: an ill relative or friend, for example. How do we manage then? We are professionals and have to act as such, but we are also fellow human beings in personal relationships with all the accompanying emotions. I want to share an experience I have had recently and pray this might help others going through similar situations.
J’s story
J is my friend and housemate. For six months she had developed asthmatic symptoms. One day she went to her GP and he noted a new finding of dullness at the left lung base. An urgent chest X ray showed a mediastinal mass and pleural effusion. A chest drain, mediastinoscopy and bone marrow aspiration followed and the diagnosis of Hodgkin’s lymphoma was made.
Three months into J’s chemotherapy I got a job in oncology (what I’ve always wanted to do) part time as a clinic doctor in order to be able to work for CMF. I had delayed contacting them about jobs because of J’s diagnosis but thankfully she was already having chemotherapy at the haematology unit of another hospital. I did not really want to be responsible for her care professionally.
I actually ended up doing a lymphoma clinic once a week. My consultant didn’t know about J – I didn’t think it would be important – or did the matter never arise?
The first patient I saw with Hodgkins’ lymphoma was really difficult for me – a man, even younger than J. I managed to detach J from the older patients, but here was someone just like her. I needed to take the history, organise a heart scan and sperm banking for him. Instead, I sat at my desk and felt completely unable to cope. A busy clinic didn’t seem like the right time to tell the boss about my problems, but thankfully the nurses rescued me with a cup of tea. As time went on, I became used to dealing with the younger patients and the moment for speaking up seemed to have passed.
Looking back, I still wasn’t sure about why I’d taken so long to talk to my consultant. I only finally plucked up the courage to mention something five months into chemotherapy. J had developed a temperature and I asked her to go to hospital but she pleaded with me not to make her go, as she hated hospitals so much. We tried a course of antibiotics she had at home as the temperature had settled. Four days later she was admitted from clinic with neutropenic sepsis. Another four days again and she was on ITU with adult respiratory distress syndrome. Both my consultant and her haematologist reassured me that the sequence of events was not my fault.
She has, at the time of writing, been in ITU for over 200 days.
There have been several times when she was close to death but miraculously she has survived. After three months the doctors considered switching off the ventilator as her lungs were so badly damaged there was little chance of survival, but the Lord changed their minds. I have just been to see her today and she told me because she can only stand for a total of 37 seconds she doesn’t think she will be home for Christmas. But she is making progress, albeit painfully slow.
Friend or doctor?
People respect you as doctors: with this comes a responsibility to provide accurate and measured information as they ask. As the only physician among J’s family and friends, I felt it was my responsibility to provide a running explanation of what was going on. Also within my church, people turned to me to ask about what the problem was with J, how she was doing, when I last saw her. When news broke out I was at a dinner with friends from my church, including the pastor. I had a good idea of what was going on, but others around the table just knew that it was serious, but not necessarily ‘catastrophic’. For the layman, cancer for a person under 30 is very far from their minds – and not many would jump to this conclusion. It was difficult to know what to say. I didn’t want to scare anyone, but at the same time, I knew they didn’t then understand the severity of her condition. J didn’t know my worst fears -I couldn’t tell others.
Indeed, if it ever falls to you to provide information in this manner, consider what you might do. On the day that J went to ITU, I had to explain to a few of her closest friends that she may die. It was very hard, but also a privilege.
With all the goings-on, you can be pulled into pseudo-managing your friend or family. While there is a certain degree you can do, it’s important not to overstep your boundaries of expertise, for professional reasons of best practice. You’re not likely to know more than the person in charge, and they probably won’t thank you for questioning everything that they do! Be content to take time off for your own personal space – whether from work or suffering from burn-out with dealing with these issues. Pray for wisdom in how you might be most effective as a Christian with your medical knowledge.
As an aside, young medical students or junior doctors are rarely on the side of receiving treatment. While I wouldn’t go out of my way to experience it, understanding what your patient goes through is invaluable. It allows you to be empathic in the true sense of the word – rather than its rather overutilised form in medical school. Three hours spent with J’s family in the ITU waiting room seemed much more like 24. I began to realise how relatives felt while waiting for me to tell them news of their loved one, in accident and emergency or coronary care units.
Reflections
Looking back, I’ve only just realised how tough it has all been. Lots of events surrounded me at the time – there was an instance when I was in the doctors’ mess bawling my eyes out having heard that J had been admitted to ITU. It was embarrassing in front of my colleagues, but a dose of honesty in admitting to myself and others how awful it was made me look a bit more human!
People at church were extremely supportive. While I didn’t initially appreciate the help that they offered, I learnt to put aside my independence and accept the offers of meals, a bed for a few days for a change of scene, and even ironing – although perhaps I could have done that myself! They were and still are, a blessing from heaven, and I will always be grateful to them. I also found it important to include my non-Christian friends too, to let them help. One friend said that while she couldn’t quote the Bible at me she would always be there for me.
I can’t pretend that I have all the answers – I hope that these insights will help. Pray to God that he will guide you through a situation that is intrinsically sensitive. In the situation of medical school, the same thing applies as it did to me: be prepared to speak to people, for example your consultant, the registry, your colleagues who are on placement with you, with your church family especially. In the case of church, it’s worth chatting things over with your pastor, and you’ll need their guidance on how to go about things. My consultant was generous in allowing me to take time off when I needed the space, as well as having permission to leave clinic at any time, if there was a change in J’s condition. People are ready to make allowances for difficult circumstances, but they can’t do that if they don’t know! Times can be awkward during exams, or when multiple deadlines arise, and then especially is the time to speak up.
Most importantly, it has been a time of growth for me as a Christian and an amazing opportunity for evangelism. As everyone began to know about the situation, Christian and non-Christian alike, I have had my best chances to talk to friends and colleagues about Jesus, and allow God to work out his purposes. The common question of ‘how can you possibly still believe in God while your friend is in ITU’ arose frequently! However, work pressures, other more general matters, or even plenty of support from Christian friends can crowd out your own, personal time with God – guard that jealously, because his grace is sufficient for every trial.
So what if you are friend to someone going through a similar situation? What advice can I give you? Everybody is different in how they deal with hard times, some will want space, some will hate being alone. The main thing is for the person involved to know that you are there if they need you. Text, call, send a card, listen, tell them it’s OK to cry (some of the best advice I got!). Offer to cook, to get the food shopping. But above all of this keep them focused on Jesus, our great high priest. He alone is the rock and unchanging foundation in every changing circumstance and only in him do we find the answers to our deepest needs. I finish with the words of 2 Corinthians 1:3,4:
Praise be to the God and Father of our Lord Jesus Christ, the Father of compassion and the God of all comfort, who comforts us in our troubles, so that we can comfort those in any trouble with the comfort we ourselves have received from God.
