It was one of the only beautiful, sunny days during an otherwise rainy month of April in Seattle. The year was 1997. Flowers were blooming. I remember the sun coming through the conference room window. The space in the small room was taken up mostly by a large square table. I walked around the table and sat near the window to look outside and feel the warmth of the sun. My mother sat to my left. After we had waited for about 10 minutes, the doctor entered the room, accompanied by a nurse. They sat across the table. I’m not sure if it was the distance between us or the minimal eye contact from them, but I quickly sensed that the outlook was not good. Of course, any rationally thinking patient would have realized there was bad news coming. The signs were glaring, including the profound fatigue and the need for supplemental oxygen. But what 20-year-olds imagine that their treatment won’t work, that they will die of their illness? The doctor launched into the battery of testing that had been done and the evidence that the leukemia had not responded. She paused, “there is a 95% chance you would die from the transplant itself.” She had just told me that my only chance was no longer an option. A silence hung in the room and my throat felt tight. I was able to ask, “In your medical opinion, how long do I have to live?” She replied that I had only “months” left, and with her gaze dropping to the table, she added, “maybe weeks.” My mother asked if there were other options. The doctor mentioned more high-dose chemotherapy, but said that it would be unlikely to help. With the last sentence I could get utter, I turned to my mom and told her, “We need to go home.”
Three days later we were flying home. I replayed details of the events in the conference room over in my mind, the words that were spoken, how they were delivered. I replayed the nonverbal details, the setup of the room, the physical distance between myself the doctor, her facial expression, and her lack of sustained eye contact. With these images swirling in my head, a strange thought emerged. I considered ways that my doctor could have handled the situation better. I imagined her coming around to my side of the table and sitting next to me, looking me in the eye, maybe touching my shoulder. Heck, even as a 20-year-old guy, I might have been glad to get a hug. The pain of what was being said would not have changed, but the wounds would not have been as deep. I would not have left the cancer center feeling alone and isolated. On that plane ride home, I imagined that, perhaps if some miracle occurred to save my life, I would dedicate myself to pursuing medicine, becoming an oncologist, sharing these moments with other survivors, and doing a fine job of caring for patients with cancer.
Upon returning home I met with my hometown oncologist and relayed this story. He sat directly in front of me with no table between us, looked me directly in the eye, and said, “Gee, you don’t look that sick!” He found a realistic thread of hope in that moment and offered it to me with those simple words and his expression. He had spoken with the expert in LGL leukemia, and some promising results had been seen with low-dose methotrexate. Within 3 months of starting this treatment, I was in a hematologic remission! I finished college as the seed of the idea that came to me on the plane while returning home from Seattle began to germinate.
As a practicing oncologist more than 20 years later, my view of that April 1997 day in the conference room has taken on new perspective. I see the moment through the vantage point of my Seattle oncologist. Now, when I play it over again in my mind, I can literally feel her pain. She was probably afraid she would cry herself if she looked at me too long or sat too close to me, which I would like to tell her now would have been okay. I have developed a deep empathy for my Seattle oncologist. In my own practice over the years, I have felt viscerally just how difficult it is to deliver this kind of news. Despite my own experiences as a cancer patient, I still have had my own days when I leave the examination room thinking, “I could have done that better.” I am humbled on a daily basis to be with people battling these diseases, and I continue to try to grow as an oncologist.