It is dangerously hot but he has chosen to attend his appointment when others have rescheduled. His cancer is gone, and his life has resumed a normality that once felt permanently threatened. His return to the factory line was like an ascension to a throne, a reminder of his family’s dependence on his meagre income.
Our visit is short and reassuring. As he leaves he carefully removes a box cocooned by an ice pack and says in halting English: “Doctor, I made for you.” He opens the box to reveal a sparkling creation of multi-layered jelly, the shimmering surface too perfect to break. He has prepared it out of concern for my welfare on a fire-prone day because he thought I might not stop for hydration. Touched, I tell him that thank you doesn’t seem enough, but he simply beams and says: “You are good to me.”
Months later it’s nearly Christmas, a day that I had not expected my elderly patient to see after being felled by a single dose of chemotherapy. Tears rolled down her eyes when I apologetically explained that I hadn’t anticipated such a dramatic reaction. Her expression that accused me of being negligent stung more than any words. Despite my grave fears, she recovered.
She is famous for pastries made from a recipe in her head. For years she has brought them in, but now after her near-death even the thought of the delights seems heretical. But she has made a special appointment to deliver a mound of goods that must have taken all day to bake. Her back aches but her eyes are smiling. I can barely believe it when she says Christmas wouldn’t be the same if she didn’t thank me. We nearly lost you, I splutter. But I lived, she shrugs. The sugar hit is exquisite but sweetest of all is her forgiveness.
No matter who you ask, it has been a difficult year in medicine. Pressures are high, morale low. Aside from the usual demands of seeing more patients with fewer resources and distinguishing honest patient care from administrative doublespeak, doctors have grappled with refugee policy and climate change.
The “death spiral” of Australian private health insurance has somehow been twisted into a verdict about the failings of the public hospital system. Violent patients and disgruntled relatives have seen it fit to flog doctors for systemic failures. The gap between expectation and reality has often seemed unbridgeable, but amid all this we have repeated a constant theme: our patients keep us going.
Patients help us sharpen our focus, hone our humanism, and find the best of ourselves. Ironically, the greater the bureaucratic hardships the more we circle back to the great privilege and deep consolations of patient care. Therefore, for my final column of the year, I would like to say thank you to the patients who have eased our lives in untold ways.
Let me begin with the patients in the waiting room. We know that many of you are sick, jittery or both and that you carry a 1,000-page novel to pass the time. We know that your appointment time must feel like a “recommended retail price” with an unclear relationship to reality. The staff don’t know how long the doctor will be. The parking meter is expiring. You are frustrated but helpless.
While you wait, we want you to know that we are seeing the patient who brings up “one more thing”, which turns out to be the most urgent symptom of all. Or we are navigating a delicate conversation with a woman who suspects but doesn’t want to know that she is cognitively impaired. Or seeing a new patient who has burst into tears at the 14-minute mark and it would be unthinkable to say at 15 minutes that his allocated time is up. No doctor is proud of keeping patients waiting but to all the patients who tolerate the delay with grace and understanding, we say thank you for biting your tongue. Thank you for not making us feel worse or for simply acknowledging that we are busy. Let me also suggest that if you want the waiting times to go down, doctors can sympathise but elected politicians can effect change.
Next I want to say thank you to inpatients. Acutely dependent on us, you are reluctant to protest against the many indignities of your situation. Sometimes every minute of delayed treatment matters. Other times communication is lacking. Or the environment is inimical to recovery – the nurse is slow, the tea is cold, your fellow patients are disruptive. To be clear, we want you to announce your chest pain and defy rude conduct, but if the 8pm pills were a little late, or your elective gastroscopy was bumped by a bleeding emergency, or your nurse spent more time on another patient, thank you for not losing your temper. All patients are needy, but some are needier. Your understanding that it’s rarely our direct fault when things don’t go according to plan is like a collective balm. It doesn’t make us complacent; instead we appreciate the special resolve it must take to consider the big picture and not complain.
Thank you to every patient who has stopped to talk to our cleaners, porters, tray-bearers, chaplains and volunteers. They are hidden in plain sight and they’re an integral part of our workforce. Doctors and nurses are often thanked but your kindness to them means more than a mass-printed certificate because they come to work for you, and they are some of the staunchest defenders of your dignity.
I have saved the best for last. It’s no secret that the rewards of being a doctor exact a price. My children know that patients typically take precedence over performances although this is increasingly common in many households. But on many days the job of being an oncologist continues beyond the hospital with ethical dilemmas and heartbreaking situations, none of which can wait until tomorrow. The time given to patients is taken from family, and it can be difficult for young minds to understand their place in a parent’s world that is meant to place the child at its centre.
Recently at the shops a former patient saw me with my daughter and hurried to catch us. Addressing my daughter, she said: “I want you to know that I used to be very sick once and your mum and others took amazing care of me for many years. You should be very proud of your mum – I know I am.”
“Wow, that’s so nice of you!” my clearly thrilled daughter replied.
But it wasn’t merely nice. It was a profound act of generosity that made an impression on my child and her siblings in a way that none of my reasoned explanations could.
Doctors are regularly lauded for helping patients but we should stop to acknowledge all the ways in which our patients help us. You may not even know that you were the best thing that happened to us today, but thank you for accompanying us on the journey.
I would like to wish you a happy holiday season and look forward to sharing more news and views next year.
• Ranjana Srivastava is an Australian oncologist, award-winning author and Fulbright scholar. Her latest book is called A Better Death
