My dad is a doctor. A GP to be precise. I’ve talked to him all his life about it, and he told me, “When you’ve been a doctor as long as I have it all becomes repetitive. You occasionally get something that provides some kind of mental stimulus, but the thing that keeps you going is the people”
By that, I take it to mean, enjoying being around them, and also importantly, feeling better when you see someone and their loved ones happy about their improvement.
I was also talking to a friend of mine who is in med school trying to decide his specialty. I thought, how could you be a cardiologist? So much of that is out of your control. You can only tell people that they need to live more healthily, and if they do, they’ll most likely take credit for it, because it’s something we all know.
But what about oncologists? With cancer survival rates, it seems like you’d be around grief and doom your entire life. What can be the benefits of doing this? I can’t imagine nothing more sad than constantly treating patients that are facing uncertain death.
I can’t speak for Doctors, but the couple of nurses I know who work in a hospice say they are often inspired and impressed with the way people handle their situation.
From the was they describe it I can see people who have accepted the end feeling very peaceful. They’ve also seen some wonderful moving moments with family members.
The way your dad describe being a doctor I think is the way most people would describe their jobs once they’ve been doing them for years. But how many people get to see humanity at it’s best?
My sister also works in Hospice, and says the same as above. A friend of mine is a veterinarian who does house calls primarily to euthanize pets; she says it is hard, but she thinks somebody ought to be doing it. She limits it to 2 days/week, though.
My hat is off to all of the folks who take care of the ill and dying - they are stronger than I can ever hope to be.
Not a doctor yet, but I am a medical student who has been considering “depressing” specialties like oncology, so here’s my two cents.
One coping mechanism I think a lot of people use when facing an incurable illness (whether as a patient or a caregiver) is to redefine your sense of what a “victory” is. Once a cure is no longer an option, you can focus on other goals you can attain for the patient.
For terminal cancer, that might mean focusing on issues like how to maximize the time the patient does have left.
Even with late stage cancer, there is often some kind of treatment that can at least slow the cancer down even though it can’t eradicate the cancer, so the patient can get just a little more time than they’d otherwise have.
Sometimes even just living a few more weeks or months could make a huge difference to the patient. For example, a patient might consider it extremely meaningful to be able to live just a few more weeks or months if it means they can witness a loved one’s birth, wedding, graduation, etc. There is some satisfaction for the doctor in knowing you helped someone reach their goals.
As the patient is closer to death, the new “goal” might be to focus on how to maximize the quality of whatever time the patient has left (hence, helping the patient decide when to stop pursuing chemotherapy treatments) and, of course, how to control the patient’s pain. I’d consider it a great honor to know that I had helped someone spend their final days peacefully saying their goodbyes to their loved ones instead of writhing in agony.
We all die sooner or later, so all doctors are just delaying the inevitable. But the journey you take to get to the point of death makes all the difference!
On the issue of cardiology in particular, since I just recently had to spend several weeks studying a vast array of heart and blood pressure medications, I’d just mention that cardiology is about a LOT more than just telling people to eat right and exercise. Cardiologists also deal with people who have valve problems, arrythmias, and so on. Even with clogged arteries and heart attacks, while diet/exercise are obviously helpful, nowadays there are so many different medications that also play a role in those patient’s care. With people living longer (having more time to accumulate other complicating conditions like diabetes, kidney disease, etc.), it might be a bit of a challenge juggling all the different medications a patient is on to maximize their effectiveness with minimum side effects. Some people might find some satisfaction in taking on such challenges.
Not an oncologist myself, but I’ve dealt with dying patients in my 25 years of practice, and currently oversee a prison hospice.
Frankly, it can be very rewarding to help a person come to terms with death and dying. All the extraneous BS gets pulled away, and you really get to look right into that which makes folks human, including yourself. And sometimes, you actually help folks get better!
Even so, it’s exhausting and draining at times, and a close friend who is a pediatric oncologist had to give that up to work in basic research, as it was just too much for her, as I am sure it would be for me.
Another oncologist friend told me that he keeps on because he makes people’s lives better than they would have been without him, even with bad outcomes. He also makes a point of being honest and straightforward, and doesn’t avoid questions like “what are my chances”.
The oncologists that I have noted to have the most trouble with coping in the long run (anecdotal, I know) are the ones who seem so optimistic in front of the patients, constantly telling them they’ll try something new that might cure them, even as the patient themself comes to understand that they are dying, and any more treatment just adds more misery. Some physicians just cannot seem to surrender to the idea that the patient will lose the battle, and that the patient may want to surrender and go out with dignity and proper pain medications.
Our good friend, Dr. R, is an oncologist. He is currently being treated for depression. The older he gets, the less able he is to cope. He confessed to me over dinner one night that he felt that his soul was being pecked away every time he had to deliver bad news.
Cardiologists also may perform a variety of procedures including angioplasties and placing stents in blood vessels to keep them patent (open). From this description of “invasive cardiology”:
“In many cases, special instruments or tools are introduced through the catheter during cardiac catheterization to perform certain functions.
Radio-frequency ablation - this is a procedure used for certain types of irregular heartbeats, also called arrhythmias. Arrhythmias occur when the electrical system inside the heart is not working properly. In some cases, small areas of abnormal electrical activity in the heart can be destroyed using radio waves. This can stop or “cure” the irregular heartbeats;
Management of heart defects present at birth - this may involve taking pictures of the inside of the heart cavities and arteries. In addition, tools may be used to fix abnormal heart valves or create special openings in the heart to reduce symptoms and prevent further heart damage;
Management of heart valve abnormalities in adults - in some cases, the valves inside the heart can become narrow or stiff, which prevents normal blood flow through the heart. Tiny tools can be inserted through the catheter and used to open up the valves.”
I’d suspect that oncology can be depressing at times, but there’s the satisfaction (beyond those cases in which outright cures occur) of greatly extending people’s lives when possible. We just had a case here of a woman who’s survived more than 12 years after a diagnosis of small cell carcinoma of the lung, which is quite unusual.
Finally, a question I feel really qualified to answer–sort of. I am not a physician, but I am a psychologist who has a) worked with dying adults and children (and their families) and b) written articles for physicians on how to tell their patients bad news and how to handle their own grief.
As to how you work in a “depressing” field, well…for me it isn’t that depressing, frankly. As mentioned above, I get to see families pull togther and really show their love. I get to work with patients at a special time, when, as QtM pointed out, the BS is over and they are often more willing than they have ever been to be honest with themselves. Finally, I get to help someone have a “good death” however that person defines it.
For me, being able to help others with their death is like having perfect pitch or something. This ability I have to be with others in their sadness is a gift I somehow have, and I want to use it.
As for how physicians handle their own grief, many hospices and some oncology practices have memorial services to help the staff mourn, which is an important part of coping. Some have debriefings on a regular basis, others when they need them. Others, like me, may find that it is not as emotionally draining as others assume.
While I can see oncology as a discipline that might have a higher turnover/burnout rate, in addition to the “helping people cope” aspect mentioned by most of the preceding posters, there is also the increasing success rates for many forms of cancer treatment. When i was a kid, juvenile leukemia was pretty much a death sentence, yet had already become “curable” (with all the problematic issues of that word) before I got out of my teens. Melanoma, one of the more lethal varieties of cancer, can actually be arrested if caught in time–and more people are becoming more aware of indicators so that it is caught earlier more often these days.
This is not to say that oncology will not remain a high stress occupation, but there are many careers that can only be pursued for limited periods of time and while a person is in oncology, they may be very effective for their patients and derive a fair amount of satisfaction, themselves.
I work for a doctor like this, and it really works. I’m in clinical trials research, dealing exclusively with multiple myeloma. One of the upsides to working with this cancer (which has no cure) is that strides are being made all the time in prolonging life after first diagnosis. The median survival after diagnosis has gone from three years to five to more in the last couple of years! I’m working with patients who have had cancer for over ten years–one who’s been living with it for 16. (She looks amazing.)
People are very, very gracious to you when you can provide help and support and comfort, and that makes it easier. I’ve known only a few patients who have died in my 10 months at this job, but many more who have gone into remission or regained their strength. And nine out of ten patients who participate in research (about 50-60% of the patients in this practice) leave you feeling all warm inside–they’re happy, hopeful, strong, and ready to do whatever they can for “the cause.” It means so much for them to be able to take part in something that might help others with this disease in the future. You can really tell.
Cancer survival rates are improving all the time. There are lots of different treatments and the options change with each new discovery. I think oncology would be a great field to be in. After all, the oncologist rarely watches anyone die. Once it’s to the point where they can no longer treat the patient, it’s passed on to the GP or the hospice people or whoever. They deliver bad news, but they also deliver lots of good news.
Cyn, OB/GYN RN
I was offered a position on an oncology floor as a new grad RN and passed. I took Labor and Delivery at the 2nd busiest high risk birthing unit in California.
L&D and postpartum are seen as happy places; new life, happy families. I have discovered the value of doing what needs to be done when things go terribly wrong. I have the skills and I have a gift and I can really help. I can wish I never had to do it, that there was a great outcome with every birth, but there isn’t, and I’m there. I’m lucky that my unit recognizes my value and doesn’t overburden me, and I help other nurses when it’s their turn, because it’s hard. No one wants to do it every time, but some of us are better than others, more detail-oriented.
Interesting blog by The Cheerful Oncologist. this guy is a great writer, and he seems to have a good balance between over-identifying with his patients and shutting down completely.
Cyn, it’s wonderful to know that there are people like you who can find the positive aspects in less-than-positive situations and be there for others. I delivered my niece, and apparently fairly well, because the attending doctor suggested I look into formal training as an OB nurse or even midwife - but I know too well that not all birth stories end happily, and I know myself. I’d go to pieces and be useless to anyone else.
When my Mom died, I was frankly amazed at the Hospice people who helped her and us get through it. I honestly can’t imagine what kind of strength it would take to deal with families in grief all the time, but I will be grateful for them for all eternity.
Cardiologists also deal with people who have valve problems, arrythmias, and so on. Even with clogged arteries and heart attacks, while diet/exercise are obviously helpful, nowadays there are so many different medications that also play a role in those patient’s care. With people living longer (having more time to accumulate other complicating conditions like diabetes, kidney disease, etc.), it might be a bit of a challenge juggling all the different medications a patient is on to maximize their effectiveness with minimum side effects. Some people might find some satisfaction in taking on such challenges.