The Tie That Binds

Craig R. Hildreth, MD

Any man’s death diminishes me, Because I am involved in mankind. And therefore never send to know for whom The bell tolls; it tolls for thee.

- John Donne, Meditation XVII

In a perfect world the best teachers are also the saddest, for as their students eventually find nothing new to learn, the classroom falls silent. Likewise, those parents who succeed in raising happy, independent adults feel a sense of emptiness at the closing of a long, momentous project. What about people living with cancer? If a cure was found, would oncologists lament the breaking of this unique bond?

If they did I’d say they had a screw loose somewhere. Nothing would make a sane doctor happier than to say adios to cancer. Perhaps in a few generations we will finally bury this disease forever and push a gaggle of oncologists over to the unemployment office. Until then, cancer is still a worldwide health problem. Its remedies, however, are multiplying quickly and becoming more complicated, thus challenging cancer doctors to raise their game. Selecting the best therapy from an expanding inventory of agents requires knowledge of genomics, proteomics, cell biology, and drug toxicity, to name a few. A modern-day treatment plan requires coordination with surgeons, radiation oncologists, pathologists, oncology nurses, and many other disciplines.

It also requires patients.

For clinicians, a day without patients is grounds for retirement. Despite the narrow scope of our relationship compared with the family doctor, we do get close to our patients. It is unavoidable. Sometimes we see them every week for months on end, and these visits are not grocery store aisle “whassup?” chitchats. Our patients typically have multiple issues to manage at one time. From my experience, it is impossible to spend too much time with a cancer patient. In fact, I often feel bad when I realize I must move on, lest our waiting room resemble an electronics store on Black Friday.

Like a director and his actors or a sergeant and his platoon, our work is defined by what we do to teach, guide, and protect patients in our care. Without patients our expertise is meaningless and our professional calling is forfeited. Working together, sharing happy times as well as sad, binds our patients to us like acrobats swinging through high space, each hanging on to the other for dear life. Oncologists thrive on being on high alert for danger, whether in the form of missed diagnoses, complications, treatment failure, or even hindering emotions such as discouragement. Without patients we have no mission to accomplish; whenever we lose someone to cancer our responsibilities, our skills, our very identity of ourselves as cancer fighters is threatened with extinction.

Therefore dear patients, families, caregivers, never think that oncologists, at least the good ones, ply their trade in solitude. Never wonder if we ever worry about the people entrusted to us; never doubt our commitment because it is you who defines who we are. We are entwined with our patients, and the loom that wove us together uses only the strongest threads-respect, love, mercy, and understanding. It can never be unraveled by human hands-only the tolling bell can rip it asunder.