The mother of identical twin boys sent me this story by Ranjava Srivastava.
“Losing my twin baby boys for ever changed the way I treat my patients.
I will never know the kind of doctor I would have become without the searing experience of being a patient, but I like to think my loss wasn’t in vain.
‘My obstetrician’s tears stunned me but also provided immediate comfort. They normalised the mad grief that had begun to set inside me.’
Around this time 10 years ago, I was poised to start my first job as an oncologist when personal tragedy visited in a way that would forever change the way I would practice medicine.
I had returned from my Fulbright year at the University of Chicago, blessed with only the joys and none of the irritations of being pregnant with twins. Landing in Melbourne, I went for a routine ultrasound as a beaming, expectant parent. I came out a grieving patient. The twins were dying in utero, unsuspectedly and unobtrusively, from some rare condition that I had never heard of. Two days later, I was induced into labour to deliver the two little boys whom we would never see grow. Then I went home.
If all this sounds a little detached it is because 10 years later I still have no words to describe the total bewilderment, the depth of sorrow and the intensity of loss that I experienced during those days. Some days, I really thought my heart would break into pieces. Ten years later, the din of happy children fills our house. But what I have found myself frequently reflecting on is how the behaviour of my doctors in those days profoundly altered the way in which I would treat my patients.
An experienced obstetrician was performing my ultrasound that morning. Everything was going well and we chatted away about my new job until he frowned. Then he grimaced, pushed and prodded with the probe, and rushed out before I could utter a word. He then took me into his office and offered me his comfortable seat. Not too many pregnant women need a consultation at a routine ultrasound.
“I am afraid I have bad news,” he said before sketching a picture to describe the extent of the trouble. I thought for a fleeting moment that my medical brain would kick in and I would present him with sophisticated questions to test his assertion that the twins were gravely ill. But of course, I was like every other patient, simultaneously bursting with questions while rendered mute by shock.
I was well aware that doctors sometimes sidestepped the truth, usually with the intent of protecting the patient. I knew he could easily get away with not telling me any more until he had more information but I also knew that he knew. I read it in his face and I desperately wanted him to tell me.
I asked the only question that mattered.
“Will they die?”
“Yes,” he said, simply holding my gaze until his tears started.
As I took in the framed photos of children around his office he probably wished he could hide them all away.
“I don’t know what to say,” he murmured, his eyes still wet.
Until then, in 13 years of medical training, I had never seen a doctor cry. I had participated in every drama that life in bustling public hospitals offers but never once had I seen a doctor cry.
My obstetrician’s tears stunned me but also provided immediate comfort. They normalised the mad grief that had begun to set inside me. Yes, the doctor’s expression said, this is truly awful and I feel sad too.
“You are sure?”
“There is a faint chance that one lives but if you ask me, things look bad. You know I will do everything I can to confirm this,” he said.
The obstetrician had told the unflinching truth and in doing so almost surgically displaced uncertainty with the knowledge that I needed to prepare myself for what lay ahead. I had test after test that day, each specialist confirming the worst. I think I coped better because the first doctor had told the truth.
Two other notable things happened that week. Among the wishes that flowed, another doctor wrote me an atypical condolence note. His letter began with the various tragedies that had taken place that week, some on home soil and others involving complete strangers. “I ask myself why,” he wrote, “and of course there is no answer to why anyone must suffer.”
Until then, everyone had commiserated only at my loss – and I was enormously grateful – but here was someone gently reminding me that in life we are all visited by tragedy. All the support and love in the world won’t make you immune to misfortune, he was saying, but it will help ease the pain.
Finally, there was the grieving. I lost count of the pamphlets that were left at our door to attend support groups, counselling sessions and bereavement seminars but we were resolutely having none of it. My midwife called me out of the blue – it was a moving exchange that taught me how deeply nurses are affected too. But I didn’t need counselling, I needed time. I valued the offers but I knew that my catharsis lay in writing. I wrote myself out of suffocating grief, which eventually turned to deep sadness and then a hollow pain, which eventually receded enough to allow me to take up my job as a brand new oncologist. How I would interpret the needs of my patients was fundamentally altered now that I had been one myself.
Cancer patients are very particular about how much truth they want to know and when. I don’t decide for them but if they ask me I always tell the truth. A wife brings in her husband and his horrendous scans trigger a gasp of astonishment among even the non-oncologists.
“Doctor, will he die from this?” she asks me.
“I am afraid so,” I answer gently, “but I will do everything in my power to keep him well for as long as I can.”
It is the only truthful promise I can make and although she is distressed she returns to thank me for giving her clarity. Sometimes honesty backfires, when the patient or family later say they wanted to talk but not really hear bad news. I find these encounters particularly upsetting but they are rare and I don’t let them sway me from telling the truth.
Oncology is emotionally charged and I have never been afraid of admitting this to the very people who imbue my work with emotion. I don’t cry easily in front of patients but I have had my share of tears and tissues in clinic and contrary to my fears, this has been an odd source of comfort to patients. In his Christmas card, a widower wrote that when my voice broke at the news that his wife had died he felt consoled that the world shared his heartbreak.
It can be tricky but I try to put my patients’ grief into perspective without being insensitive. It’s extraordinary how many of them really appreciate knowing that I, and others, have seen thousands of people who are frightened, sad, philosophical, resigned, angry, brave and puzzled, sometimes all together, just like them. It doesn’t diminish their own suffering but helps them peek into the library of human experiences that are catalogued by oncologists. It prompts many patients to say that they are lucky to feel as well as they do despite a life-threatening illness, which is a positive and helpful way of viewing the world.
I will never know what kind of a doctor I might have become without the searing experience of being a patient. The twins would have been 10 soon. As I usher the next patient into my room to deliver bad news, I like to think that my loss was not entirely in vain.”
I read this story with alarm. It made me feel anxious because I have and love a pair of identical twin boys. I felt involved because, like the writer’s doctor, I am a doctor who cries; and like the writer, Dr Srivastava, I am a doctor who writes. Finally we two are products of the same medical school (Monash) – Dr Srivastava graduated at the top of her class, in the present century, I graduated at the opposite end of my class, in antiquity (1969).
A final point of commonality was her reassuring remark that ten years after her doctor wept her home is full of the noise of happy living children.
I found the piece helpful. Dr Srivastava identifies and untangles the strands of her experiences with surgical deftness. Her doctor weeps, her colleagues show support and care and empathy and she heals. As a trained observer, the writer dissects her experience of grief, lays out its anatomy and reflects upon its organs and parts.
Like the writer, I find relief and understanding in the act of writing. I suspect that a part of this relief results from word search. The writer is obliged to seek the precise word for the experience. In my case this forces me to test and taste a number of words. Perhaps a dozen words might work more or less passably, but the acts of searching, of choosing, of trialling, help me to clarify what my feelings were not quite like. I mean I discover what I mean. Perhaps this functions as a working through, a self-conversation, something between analysis of an experience and re-imagining it. In my case too, the pleasure of words is an aesthetic joy that comforts me.
Medicine is a pursuit conducted with the living in the shadow of death. It is a pursuit packed with anxious questions: what is wrong with me, will I die, what can be done, will it hurt, how much, how will I know the answers, when will I know? This crying doctor feels the patient’s fear and his own and has to know the border that divides the two. My fears are for the patient, of the patient, of failure, of failing a person of flesh and feeling. My fears include the terror that strikes me when I see my patient slipping away, the knowledge of my mortal inadequacy.
The writer who lost her twins precisely names the elements in her emotional experience. With remarkable poise she traces the costs and the benefits of the loss. So coherent are her reflections I could feel myself learning as I read. I learned about her life and her work, how the two are not the same but never severable. I learned more of how a doctor feels, who she is, who I am.