Has Living with Cancer Made Me a Better or Worse Doctor?

The following is a translation of an article published on 20 September 2018 in the scientific journal NEJM by Adam Philip Stern, an assistant professor at Harvard Medical School, describing "how a doctor's outlook on his life changed after a cancer diagnosis."

Recently, a patient sat across from me in tears. She had lost someone she loved two months earlier, and her pain was indescribable. I listened carefully, but felt almost nothing. I had always felt genuine affection for this patient, and connecting emotionally with losses in my patients' lives had never been so difficult. Even when she reproached me for not being there at the moment of death, I could offer condolences, but my words seemed to contain no feeling...

Psychiatry Had Always Been Synonymous with Empathy for Me

Knowledge of psychopharmacology and clinical neuroscience is essential for me to work comfortably, but if I cannot establish an empathic partnership with my patient, nothing else matters to me.

Note: Empathy means understanding and internalizing another person's feelings, circumstances or motivations for behavior. The term is also used for projecting one's own feelings onto other objects.

In January 2018, I received a diagnosis of stage 3 kidney cancer ; my prognosis (the likely course of the disease) is uncertain, and there is a strong possibility that I will die from it. I spend much of my time hoping things will not turn out that way and try to live my life with that thought. I thought it would be easier that way, and carried on.

Although explaining my diagnosis and surgery to my patients was difficult, it somehow suddenly created a "2-month leave." That delicate dancebetween psychiatrists and patients had been shaken by an earthquake occurring only on my side of the room. Although my patients are coping with my absence and, whatever happens, seeing some form of return for me, I wonder how much of my former professional self is still here to work with them. I never thought a healthy left kidney could have such an impact on a psychiatric practice.

"At Least You Still Have Your Health!"

It is clear that in some respects I cannot perform as I once did. As with my patient who had lost a loved one, I have found it harder to empathize with certain other stressors. Problems that could genuinely be major and devastating have begun to seem more survivable to me than before. Job loss? Marital stress? Interpersonal conflict?... These are the real causes of today's mental health problems in modern life, the things that bring most of my patients to my office. Yet my mental response to each is simply a variation on the same thought, and what I actually want to tell them is: “At least you still have your health!”

Even though my perspective changed somewhat after my illness, I am confident that my technique and professionalism can remain as they were before my diagnosis and that I can manage well enough to continue. But this is not the doctor I want to be, the doctor in my mind . I generally leave the thoughts lacking empathy and tolerance that sometimes occur to me unspoken. In particular, patients I see at scheduled appointments have perhaps become the hardest for me to work with, because everything looks different from my side of the room. Even the clock ticking on the wall seems to make itself known now.

As a psychiatrist, I am good at finding positive aspects even in bad situations. Now I am in my own psychotherapy, trying to find balance in a world that seems full of worry and fear. As I try to find a way forward, I look within myself. Perhaps the changes brought by my cancer diagnosis have also brought some professional abilities—who knows?

I used to examine patients whose inner worlds I could never see even when life was going well, whose problems' causes I did not understand, and wonder: How? Now I know what it means to feel insecure even when everything looks positive. I understood anxiety and post-traumatic stress disorder through textbook definitions, but this situation is not something in which I can mentally rehearse every possible scenario to protect myself.

Every sensation and pain that makes me think my cancer has recurred has brought me to the point of being unable to trust even my own feelings.

I hope these instincts have created a strong foundation for the empathy that will allow me to offer my patients better therapy. The truth is that it is probably too early to say anything about the course of my cancer. There are days when I wonder whether everything changing means I must transform my work too. On those days, when I engage with a patient and focus completely on them, connecting both superficially and deeply, I feel—even for a brief moment—that I am doing my job well.

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