When You're a Resident and Your Husband Has Cancer

Editor's note: Here is a follow-up post to one from this spring about being a medical student and wife of a newly diagnosed cancer patient. Both are cross-posted from Dear Husband's CaringBridge page.

Back in April I wrote about the bewildering experience of navigating healthcare as a wife/partner rather than as a medical student/insider. Several months and transitions later, I thought it mete to follow that up with a reflection on being a physician-in-training with a spouse who is also a cancer patient. Because we have moved to a new place and are establishing ourselves in a new community, there has been a constant internal tug of war between over- and under-sharing, between controlling how we are perceived and sharing information on a need-to-know basis.

I have not disclosed Dear Husband's diagnosis to many people involved in my training programs (Med-Peds, Internal Medicine, and Pediatrics). In part this is for his privacy among people he has not met and might not meet, which is also why we have posted nothing on Facebook, where it could be visible to mere acquaintances and to friends of friends. In part this is because I do not want "cancer" to be the first thing people think of when they hear his name or do eventually meet him. I did tell the Med-Peds program leadership as soon as I Matched in March--even before we knew the histological diagnosis--because whatever it was, the treatment was probably going to overlap with the beginning of residency and possibly impact my ability to do my job. The first time we got together in person, I also told the other three Med-Peds interns, because they are going to be my closest friends and colleagues for the next 4 years.

When anyone else has asked if I am married, I tell them I have a talented and funny husband who is looking for work, but I omit to mention that DH has been sick. During Peds orientation, I almost revealed our story during a session when one of the program directors asked us to share good and bad doctor encounters. I was screwing my courage to the sticking place to tell the room about his oncologist in Champaign going above and beyond for us—when the session came to a close. So I kept my mouth shut. Ever the optimist, I hoped that DH would have recuperated enough by picnic time to meet my colleagues, and if not, it would soon be a distant memory, something that happened the year I graduated from medical school.

DH's last chemo infusion fell on my first full day of residency. I had arranged for new friends in town to drive him to and from the cancer center, and to check in on him during the day while I was gone. That all went out the window in the evening, when I got a text message at a residents' potluck that he was throwing up and feverish. When I brought him to the ER, I was still in my scrubs from the NICU. Knowing the workflow of an ER, I called the Med-Peds chief resident to tell him that I expected to spend all night there and doubted I could show up for work at 6am the next day. He instructed me to call jeopardy* for my second-ever day as a resident. This meant I had to tell the Peds program leadership what was happening (Hi, I’m a new intern, my husband has cancer, and can you find someone else to work for me tomorrow, please?), as well as my co-interns. Needless to say it meant for an awkward third day of residency, when I showed up again apparently well. During a quiet moment, the attending commended me “for your dedication to your boyfriend”—and I had to tell her it was actually my husband of almost 11 years.

Having opened myself up to the issue, however, I did have a really moving conversation with my teammate about her father, who died of cancer when she was young, and how we wished others would respond to us as loved ones of cancer patients. When she encounters people who worked with her father, they perseverate on the tragedy of his short career and early death, whereas she would like them to tell her stories about the man she barely knew, about his personality, practical jokes, and little quirks. I also want people to know this thing about DH without making it the most important part of him.

On a recent Saturday at the hospital, my senior resident asked what I was going to do with my Sunday off. I mentioned that I wanted to work on a couple of projects, one being my #TeachingRounds posts. She wondered what the other project was, and since we two Med-Peds residents were alone, I told her it was this essay. She was shocked to hear that an otherwise healthy 44-year-old marathon runner developed a massive tumor in his chest and underwent four rounds of chemotherapy in two states, while friends and family got us moved, and I started residency. Whether because we have had five months to absorb the information, or because we have largely overcome this experience, I am no longer shocked—but maybe I should be.

I have noticed already that working in an environment in which bodies, patients, parents, and doctors misbehave, a treatment complication or an object in a body cavity is rarely unusual enough to register on the geiger counters of our OMG meters. Our thresholds for shock have increased, and the astonishing, even the traumatic, has become the currency of our watercooler conversations. This was demonstrated for DH last night at another potluck dinner, as we traded stories with subtle one-upmanship. Perhaps not coincidentally, the Peds program is holding a communications course this coming week for all residents; interns will practice breaking bad news—like a cancer diagnosis—with sensitivity.

If I were being less cautious and more attention-seeking, it would be easy to win that game: My husband was diagnosed with cancer the week after The Match. His tumor was 17 centimeters across. He developed rare and scary side effects. He spent 2 nights in the Surgical ICU with blood pressures so low no floor nurse would take care of him. His oncologist has never seen such a large tumor shrink so much. The man around that lump of metabolically inactive scar tissue remains as funny, caring, and talented as ever. It was in the center of him but never was the center of him. If and when I share DH’s diagnosis with my residency colleagues, that is what I want them to know about my husband.


*Some (most?) residencies require you to work exactly the number of days in your contract, and if you need a sick day, you have to “pay it back” by giving up a day of vacation later. My residency has a “jeopardy” system, where senior residents spend a week or two covering for all the other residents who get sick or have a family emergency.

That's So Pittsburgh: A Love as Strong as Steel

Ever the romantic, Dear Husband has tried to mark many of our anniversaries with a theme gift. The 1st wedding anniversary is supposed to be "paper," so he bought me a book (Eugene Peterson's The Message). For our 5th dating anniversary, he sent me five wooden roses that now live in a vase on his bureau with the three more he received while hospitalized for his first three rounds of chemotherapy.

Strong as Steel
(click for the original music video by British pop group Five Star, 1987)

This love is as strong as steel
Can't break it up or break it down
It's always gonna be around
This love is a love that's real
It's as deep as any ocean goes
It's gonna last, don't you know?
This love's strong as steel.

Even through the times when times were hard for us
Any rain we came through shining
Oh, I knew we'd make it all it takes is trust

A few days before our recent 11th wedding anniversary, it suddenly occurred to me that I should get DH a gift. I gave up an evening of studying to search the web for a suitable present made out of steel: cuff links, bottle openers, and dog tags just did not appeal to me and don't sound like him at all. Finally I stumbled upon Cut Maps, a company that cuts city maps out of shiny steel plates and frames them in modern, black frames. The finished pieces look like abstract art. I decided to buy one map of Baltimore, where we met, fell in love, and got married, as well as one map of Pittsburgh, the city where we will (hopefully) establish ourselves and live many years.

How appropriate to be celebrating our "steel" anniversary in the Steel City!
We had dinner at a restaurant called Eleven, naturally.

DH's card concludes, "...I'm glad we never let go." This was taped to the envelope:

Bill Watterson, Calvin and Hobbes, December 20, 1985

Available Immediately: Spacious Single Room

Enjoy the 6th-floor views from this spacious single room with 1.25 baths, available immediately and waiting for you! Comes fully furnished with an adjustable bed, tray table, corner table, wheeled sleeper recliner, and a couch that seats three and folds into a bed for one. The large vestibule is separated from the main room by a stylish privacy curtain, while the main, handicapped-accessible bathroom has a zero-entry shower, toilet, and sink. There is a cabinet with hangers for your convenience, and two kinds of black-out shades for the large picture window. Room is sequestered at the end of a hallway to give you all the peace and quiet you need. Fresh linens changed daily. Room service available for occupants and guests. It looks even better in person, so call to schedule your visit today!

***
In other news, I have been apartment hunting in Pittsburgh, and Dear Husband has finally been released from the hospital after 8 days of chemotherapy and/or fluids. He is tired from all the anti-nausea medications, but he is feeling better. The cards friends and family sent lined the entire windowsill! Find him on Caring Bridge. For more details about "the temerity of a tumor," click here.

When You're a Medical Student and Your Husband Has Cancer

DH drinks "berry-flavored" oral contrast
for a CT scan the first day in the hospital.
I asked him to let me taste it, so I know
what to tell my future patients. It's less
"berry" than "fake-grape" flavored.

Editor's Note: For those of you whose spam boxes ate the email I sent--we are keeping the news off Facebook--Dear Husband has been diagnosed with a large mediastinal seminoma and was admitted to the hospital last week for a work-up and to start treatment. Cross-posted on Caring Bridge. 

Now that the chemotherapy is catching up with him, Dear Husband has been either nauseous or fatigued. Our oncologist has been very understanding about keeping him in the hospital, where he can get IV fluids and anti-nausea medication even while he sleeps. Until he feels well enough to write again, I thought I would tell you a little bit about what it is like to be a medical student whose significant other is being worked up and treated for cancer.

The first thing to note is that cancer was not on the long list of differential diagnoses I had developed for DH's progressive and months-long chronic cough. We had discussed whether he should see a doctor for weeks before he finally got fed up enough to go. Could be post-viral cough, I thought--we have symptomatic treatment for that. If it were bronchitis, then he needed antibiotics. He couldn't remember whether he'd ever gotten a booster shot, so it could be pertussis, though I doubted that was treatable this late in the game. Could be allergies, I supposed--we had a freaky early spring here, and over-the-counter allergy medication seemed to help a little. Or, since he was coughing at night, his childhood asthma could be making a reappearance, although I didn't detect any wheezing with my stethoscope. A mediastinal mass compressing his trachea was not anywhere on my radar, so I was surprised when he sat me down after dinner one night to announce that he had gone to convenient care, had an abnormal chest x-ray, and the doctor thought it might be lymphoma.

Naturally the first thing I did was ask him more history questions (loss of weight or appetite, fatigue, night sweats?). Then I walked him through the print-out of laboratory values he had been given, explaining what each one measured and noting only a single, slightly elevated result, which might or might not mean anything. Lymphoma didn't seem to fit his clinical picture. So the second thing I did was consult the interwebs. Yes, medical students and doctors research things on the internet! I skipped Wikipedia and went straight for my favorite online medical encyclopedia, Medscape, where I researched the causes of antero(superior) mediastinal masses. A mnemonic holds that there are 5 Ts: thoracic aortic aneurysm, cancer of the thymus, cancer of the thyroid, teratoma, and "terrible" lymphoma. Given his symptoms (mostly just cough and inability to run anymore) and the CT scan results the next week, I decided it sounded like a thymoma and started reaching out to medical colleagues for recommendations for a chest surgeon.

Meanwhile DH was scheduled for a CT-guided biopsy at one of the hospitals at which I have rotated. We arrived early on the morning of the procedure, and since there was no volunteer at the info desk, we proceeded upstairs to the OR, where we were told we needed to register downstairs. What? I had no idea what office the woman was talking about. Medical students never see patients that early in the process. So we went back downstairs and figured out how to register for a same-day procedure with interventional radiology. They don't teach us these things in medical school.

After the biopsy came the waiting. And the speculating. And the wondering how much this was going to throw off my clinical schedule. Thankfully my attending physicians have been eminently understanding, encouraging me to focus on DH first and school second. Because I have already Matched, and class ranks and honors have already been decided, the rest is just formality. There is nothing to keep me from graduating, although we are anxious that DH feel and be well enough to attend the ceremony. As Doctor of Musical Arts and Loyal Spouse, he has the long-awaited honor of bestowing upon me my green velvet hood as Doctor of Medicine.

Once the diagnosis came, the research and anticipation changed, of course, to chemotherapy, which is better and worse than surgery to open his chest and scoop out the tumor from among so many important structures: heart, lungs, the nerves that let him breathe. Chemotherapy means months of nursing and running him back and forth across town for appointments. Thank goodness we have so many willing friends in town! I also realized is that T for "teratoma" is really shorthand for "germ-cell tumor," which includes seminomas (what DH has) and non-seminomas (which have a worse prognosis).

Being a medical student means that the doctors and nurses have talked to me with a little more medical jargon. They have let me manipulate the scans on the computer. One even let me scrub up to access the port in his chest for the first time. Dear Husband delights in the ways in which he has contributed to my medical education over the years. When I was learning how to do a physical exam as a second-year student, and my student-partner came down with mononucleosis, he graciously let me listen to his lungs, tap his reflexes, and feel the pulses in his feet, over and over again, until the routine seemed a little less foreign to me. He joked that he must have been the healthiest guy, since he'd just had ten physicals. Now I've done my first port access, and it wasn't terrible for either of us.

Although I understand the vocabulary and am familiar with many of the drugs DH is getting, I do not have any experience with oncology treatment, so this is a learning experience for both of us. Particularly with this first round of chemotherapy, we wonder what each day will be like. Today's nurse assures us that succeeding rounds will be less physically demanding, as his body accommodates to the rigors of the chemotherapy. So that's all we know for now. We will keep you updated.

Here is a follow-up post about being a resident in a new city with a husband with a cancer diagnosis.