Sunday, August 28, 2016

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 (::cough::oftensurgeons::ahem::) 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.

No comments:

Post a Comment

Your comments let me know that I am not just releasing these thoughts into the Ether...