“Birth is a beginning
And death a destination.
And life is a journey:
From innocence to awareness
And ignorance to knowing;
From foolishness to discretion
And then, perhaps, to wisdom;
From weakness to strength
Or strength to weakness–
And often back again;
From health to sickness
And back, we pray, to health again;
From defeat to defeat to defeat–
Until looking backward or ahead,
We see that victory lies
Not at some high place along the way,
But in having made the journey, stage by stage,
A sacred pilgrimage.
Birth is a beginning
And death a destination,
And life is a journey,
A sacred pilgrimage--”1
After both giving and receiving care, the true meaning of health becomes evident. Besides the sacred Oath that physicians take upon entering the medical profession, Hippocrates also wrote, “A wise man should consider that health is the greatest of human blessings, and learn how by his own thought to derive benefit from illness.”2
We all face the reality of life and death, but few extend the understanding to both themselves and their patients. When I was in the throes of my life threatening illness, a physician told me that my experiences were meaningless to others because that unless it is personal, that knowledge will not change one's insight. I hope that is not true for all.
For 30 years I have been caring for patients with every type of genitourinary disease, but particularly malignancies. In September 1995, I discovered a malignant melanoma on my right knee. It was quickly removed, and then widely excised. That was just the beginning.
Six weeks later, I developed left chest pain that was quickly evaluated. A 20-cm non-Hodgkin’s lymphoma was subsequently removed from my abdomen along with my spleen and a portion of my pancreas. After seven courses of chemotherapy, a bone marrow biopsy revealed a minimal residual lymphoma.
After several consultations at major medical centers, I agreed with my truly astounding physicians and aggressively treated the disease with a autologous stem cell rescue therapy (transplant).
Douglas MacArthur said that the 2 words that summarized all lost battles were, “Too late.” Just as in war, I thought that the treatment for my cancer must be more aggressive than the disease, or else the disease would win.
The experience of being as sick as a person can be, and still believe that there is a chance for not only recovery, but also cure is an extraordinary physical as well as philosophical experience. Profound exhaustion due to inadequate, restless sleep, anemia and weight loss sapped my life. I literally saw my life disappear day by day. When you are uncontrollably losing weight, you are losing your body . . .you are losing your life.
However, I kept my optimistic eyes on the prize - the future good health, enjoyment of family, friends and profession. Denial is only pathologic if it interferes with one’s life. I may have used denial to ignore the present and look toward the future. In fact, this mindset allowed me to ignore the potential fatality and the certain miseries. I was able to live at that time so that I could live in the future. The entire health care team, including family promoted the feeling that I would recover. Their confidence and encouragement gave me the strength to endure.
Thus, by projecting a positive attitude toward patients, the doctor gives more than life-sustaining medicine; the doctor gives life-sustaining hope. The patient will identify with the doctor’s positive attitude immediately, and live by his or her words, in fact, live because of the words. Hippocrates wrote: “For where there is love of man, there is also love of the art. For some patients, though conscious that their condition is perilous, recover their health simply through their contentment with the goodness of the physician.”3 In my experience, the patients or their families that are the most appreciative of my efforts, are the ones that I scientifically help the least. If the physician has no medications or surgery, there is only one thing left to give . . . to give of oneself. The inner strength that transfers from physician to patient overcomes many deficiencies in science.
It would be dishonest if physicians were not realistic in the assessment of the prognosis, but confidence and positive attitude may improve the patient’s chance for life and future quality of life. Clearly, it will not hurt.
The personal time the physician spends is the lifeblood of the doctor-patient relationship. We are all one diagnosis away from being on the other side of the doctor/patient relationship. The patient’s emotions and knowledge, and possibly his life hang on every word you say. By placing yourself in the patient’s position, your bedside manner, your compassion and empathy will improve and give your patient and you greater satisfaction.
If it were not for the personal care giver, a spouse, a friend, a child, or a sibling, there would be no survival. It is nearly impossible to endure a transplant or severe illness alone. The patient gets all the credit, but it must be shared. There is no quality life without the survivor having the caregiver to share the survival. Thus, the care receiver and the caregiver are inexorably linked forever.
Just as the patient’s personal caregiver is forever linked to the patient, the physician is also linked to the patient and brings the life force to the true meaning of the word “doctor.” Though time will pass and I will be physically and mentally in a different state, my physician is with me; for I am the embodiment of his art and science. I am proof that science, art, and acts of human kindness lead one from the grips of death to the ecstasy of life.
Some pass through a challenging time, others learn from it. Understanding life means grasping its meaning, and appreciating that personal experiences impact on interpersonal relationships. I always tried to be a compassionate physician, yet I wrapped myself in the protection of objectivity. However, now as I tell my patients about their illness, perhaps their malignancy, I identify with them physically and emotionally. Further, and what is more important, the patient identifies with me. They sense that I would not order a test or a procedure without first understanding how these would affect them and possibly cause pain or discomfort. However, they also know that these tests may mean . . . hopefully mean . . . a passage to health again. They also know that as soon as the tests are complete, I will tell them the results. Physicians who do not immediately report to the patient results of crucial blood tests, x-rays or especially a biopsy when anxiety and well being are hanging by the results, have never waited for test results on themselves or their families. The simple act of human kindness of calling the patient the day of the test can save an enormous amount of anxiety.
I survive because of those who came before me. I live because of the research performed by others, often funded by the generosity of the American people. But the generosity is beyond their tax dollars supporting research; I live because others participated in clinical trials that may not have helped them. By volunteering for clinical research, they helped push back the unknown and shed light upon the darkness of the undiscovered.
Our patients are our professors. They teach us every day about the disease processes we treat. But they also teach us about the subtleties of life and of illness. They teach us how to live with disease with dignity, and how to die with disease with dignity. For that, we owe them our livelihoods, but more important, our spiritual understanding of life and death.