http://thecheerfuloncologist.blogsome.com/

>
>     October 1, 2005
>
>
>       Within These Hands
>       <http://thecheerfuloncologist.blogsome.com/2005/10/01/58/>
>
> Filed under: The C. O. 
> <http://thecheerfuloncologist.blogsome.com/category/1/>
>
> The following dialogue occured in my office. The dramatis personae: 
> myself and a patient just diagnosed with adenocarcinoma of the lung.
>
> "I became short of breath this summer and went to my doctor. He kept 
> telling me 'There's nothing wrong with you!', but I still was short of 
> breath. Then I had a CAT scan and they found fluid in my right lung."
>
> "Did you have a chest x-ray before the scan?"
>
> "Yes, about two months before, and supposedly it was normal. He kept 
> saying, 'There's nothing wrong.'"
>
> "What happened after your CAT scan?"
>
> "I was in bad shape. I couldn't breathe, and they put me in a room in 
> the office. He came in and said I had a lot of fluid on my right lung."
>
> "What did he recommend to be done?"
>
> "He didn't recommend anything! He said 'It's out of my hands!'
>
> "He said, 'It's out of my hands?"
>
> "Out of my hands!"
>
> Later that afternoon, after finishing my dictation, just at that 
> moment when the glaze of sunlight melting through the window blinds 
> begins to murmur "sleep...sleep" into the ear of the weary worker, I 
> recalled this conversation and suddenly jerked to life like a cat 
> hearing an electric can opener. What was the message being sent to my 
> patient by the doctor whose leadership in this crisis consisted of 
> waving a white flag?
>
> "It's out of my hands!"
>
> I said it to myself a couple of times and felt an uneasy sense of 
> relief come over me, as if I had just climbed into the last lifeboat 
> on the Titanic and was watching the crowd on the deck grow smaller as 
> we rowed into the darkness. Just think of how easy our jobs would be 
> if we were allowed to play the 'out of my hands' card whenever the 
> going got tough. It would certainly bring a sigh of relief to us, but 
> what about the person who is still trapped on the sinking ship? For a 
> physician to admit defeat just when a patient is diagnosed with cancer 
> would imply, in my opinion, three things:
>
> 1. Ignorance - "I don't know what to do!"
>
> 2. Irresponsibility - "It's not my problem!"
>
> 3. Irreversibility - "You're a goner!"
>
> Certainly there are patients who are too debilitated or too ill to 
> have any meaningful chance of recovering from their newly diagnosed 
> malignancy. We oncologists not only recognize this fact, we strive to 
> identify such individuals so that they do not receive futile treatment 
> as a substitute for gentle, if discouraging words of support. The 
> problem is that my patient with the large malignant pleural effusion 
> was not on his last legs. He would benefit greatly from a 
> multidisciplinary approach to his problem, including such things as 
> closed chest thoracostomy with pleurodesis, not to mention 
> chemotherapy and targeted therapy. For this to happen though, someone 
> has to stand up and make the following statement:
>
> "I am here to serve you. The only justification I have for my paycheck 
> is to help people living with cancer. When you come to me for that 
> help, you are putting your life into my hands. Let me tell you what is 
> contained within them.
>
> "Within my hands are responsibility - to ensure that you receive only 
> thoughtful treatments proven to have a chance to relieve your 
> suffering or prolong your life. Within my hands are diligence - to 
> ensure that your care is given correctly and quickly so as to not 
> waste time. I also hold empathy, optimism and good cheer, and will 
> shower you and your family with them whenever the skies turn bleak 
> with despair.
>
> "No mortal being can guarantee a perfect outcome for the patient with 
> cancer. But I can guarantee that until the final chapter of your life 
> is written, whether it be years from now when our time together is but 
> a faded memory, or just a few weeks from now when your last breath is 
> but moments away, I will never let you slip out of these hands. They 
> were designed to grasp, and lift, and pull, and touch. Doctors who use 
> their hands until the day they wear out will only please their 
> designer, who sees how splendid they were and how satisyfing was the 
> work that they completed."
>


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