To My Fellow School of Medicine Graduates: Give It to Them Straight

To My Fellow School of Medicine Graduates: Give It to Them Straight

Previously published in Kevin MD.    May 23, 2016.

I would have graduated from medical school this year.  That’s right.  Just like you, I’d be getting ready to move to another city and take up residence at an academic medical center to begin my clinical training. Things don’t always work out the way we planned—like Lenny and George in Steinbeck’s, Of Mice and Men.  Sometimes, the best laid plans have a way of going awry no matter how carefully we prepare  them.

 Cancer.  I wasn’t worried.  It was just a little mole.  Melanoma. Only a few microscopic cells hiding  in my lymph nodes.   If I was older, I might be concerned.  Interferon alpha (a) was the prescribed treatment for an entire year.  Recombinant DNA.  Ineffective, but brutal: fever, chills, every day, and every night.  After the year was up, I went back to being my twenty-something self: working, studying, taking the MCAT.   I don’t have to tell you what happened next.   The black vine took root in my lungs. Its tendrils grew, tangled in knots, and I became a statistic.  Death came totally unexpectedly.  Sure, I knew that pain wasn’t a healthy indicator of recovery, but my fiancé and I kept hoping—waiting for the immunotherapy to work.  I’m only twenty-eight. I got this; I can beat it. That’s what everyone kept telling me.  “You’re going home tomorrow,” they sang as they passed by my hospital room—except that I didn’t.  I went to the morgue.  The hard conversation?  It never happened. No one ever told me or my family that I was actively dying.  No one even asked me my preferences.  So before you head out into the world to treat patients, let me persuade you to embrace  the only acceptable course of action.  If your patients want to know their prognosis, give it to them straight. 

Everyone knows there are no guarantees with cancer.  But not informing me that my medical status was heading south, well, that was a problem.   My doctors, who are undeniably just human, let test results and communication details get away from them as we humans sometimes do.   It may even be that one day, in your own human frailty, that you will make the wrong call when you are harried and busy and trying your best to take care of everything and everyone all at the same time. You may unintentionally set into motion a series of events that you cannot control, but don’t beat yourself up about it.  You can’t let the fear of human error paralyze you.  What I would wish for right now, in my case, is for all of the suffering surrounding my death to end. It cannot be undone. So what is the point?   Unfortunately, I have no control over the way other people lead their lives.  Neither do you.  So do yourself a favor, and let it go. 

If your patients want to know their prognosis, respect their wishes and tell them the truth. They may be angry at you, but don’t take it personally.  Life is extremely disappointing for them at the moment, and you are just a convenient target.  You do not get to see this patient when he leaves your office and goes home to the loving fold of his family.  You do not get to see the rally of support from coworkers and friends.  So erase the mental image of the distraught patient that just left your office, and replace it with the patient that you have just liberated from everything that isn’t important to him.  He doesn’t realize it yet, but you have just given him a gift that no one else can give.

 My dream of graduating medical school would have been out of the question, but I would have really liked to marry the love of my life and taken off with her and  two of those travel-around-the-world airline tickets. Time is the gift, and time, when finite, cannot afford to be wasted. It slips away by first one appointment, and then another, and before you know it—never starts looking like a good time to tell your patient that their disease has progressed beyond your control, and you can not do anything to stop it. 

 I may look over your shoulder from time to time, but I will never treat a patient, and I will never ease their suffering.  The only thing I have to give is my story.  I have lived inside the skin of your patients.   I have danced in their shoes with hope, and I have walked the same walk in their pain.  The simple things are the things that matter.  Look at your patients when they speak to you.  They chose you to be their doctor.  They are afraid of what is to come, but they believe in  you, and they trust you. Let them know that you will do the best you can to take care of  them, and that  you will not abandon them in the end to face what we all fear, alone.

My story ends here.  I hope that your story will be that you made a difference in the lives of others. Your success will not be measured by how many patients you treated, or how much money you earned, or how many titles you held.  It will only be measured by the legacy that you leave behind, and how you are remembered by your family, friends, colleagues, and yes, by your patients.  Your kindness, your compassion, and your love for your fellow man will define you.  Love is greater than all, and in the end, love—it’s all we ever really have.

Your colleague,

Colin J. Haller
Posthumously 2016.

Originally posted 2016-04-23 22:37:39. Republished by Blog Post Promoter

8 Responses to To My Fellow School of Medicine Graduates: Give It to Them Straight

    • This story is a heartfelt account written to reach out to all who have loved ones who just need, want and deserve the truth about their health problems, disease, cancer!

  1. Thank you for sharing this story. It happens more often than patients realize. Unfortunately, the culture of medicine is hard to change. Patients and their families need to keep stories like this in the forefront so that hospital administrators and health care professionals recognize the need for change. Until health care professionals start collaborating with their colleagues to identify what their priorities should be in patient-centered care, stories like this one will continue to be told.

  2. I hope all the doctors and other medical professionals who read this and are in any position to follow the advice of this great and beloved man will do so. Their plans to finish out their life is in your hands. Do the right thing.

  3. It has been my experience that compassionate, kind and caring physicians are born that way. You can’t pretend to be compassionate or kind or caring — you either are or are not one of these gifted individuals. The gift of a physician who listens to and hears your concerns and worries about your health is more rare than common. If you are fortunate enough to have found one of these doctors who is devoted to their profession and to you as their patient, hold on to them. You may never meet or be fortunate enough to find another one in your lifetime.