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Coping With Death

Discussion in 'Radiation Oncology' started by Narmerguy, Nov 3, 2009.

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  1. Narmerguy

    Narmerguy Member Moderator

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    How do you cope with the stress of a patient population that is dying? I've heard that over half of patients diagnosed with cancer ultimately die. I've been considering a career in oncology but I'm pretty sure that I would struggle with dealing with patients that would die or that I couldn't help. I'm really interested in radiation oncology but I'm also really worried that I'll commit to a field that I'll end up being miserable in because I can't cope with death.

    How hard is it to deal with that stress? It's really hard for me to determine how hard it'll be to determine without actually doing it but it could be too late by then. Haha, sorry that was really long winded but you know...it's my future.
  2. GoodmanBrown

    GoodmanBrown is walking down the path.

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    Really? I would guess that ultimately, every patient diagnosed with cancer will die. As will every patient not diagnosed with cancer...

    Not to be rude or prying, but what level of medical training are you at? Death and dying is an issue with all specialties of medicine (as it's an issue with medicine itself). Family medicine doctors see many older patients who may die in the next couple of years, neurologists watch patients slowly succumb to incurable diseases, and even pediatricians watch little kids have their life cut short.

    I can't speak for the other folks on this forum, but from my time working in hospice (end of life care), it's all about helping people live a life that's as happy and pain-free as possible for as long as possible. Regardless of terminal illness status, that's all a doctor can be expected to do after a certain age or after certain illnesses arrive. I don't think it ever gets easy per se, but I think you work off the hope that you made someone's passing a bit easier for them and for the family.

    Have you thought about volunteering at hospice or an oncology ward? It might bring you some insight into how you feel about death and spending time with those who are dying.
    Last edited: Nov 4, 2009
  3. Narmerguy

    Narmerguy Member Moderator

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    Hmm, I'm not really sure why you responded the way you did. In a survey of radiation oncologists, dealing with the constant death of patients was ranked as the #1 drawback from the career. I find it odd that you compare the experience a family care physician has with death to that of a radiation oncologist.

    You cite pediatricians and other doctors who too must watch patients die...for them these are all the type of stories they remember. Particular cases in a vast career of other cases. For cancer, they're all dying, and usually fast. A significant amount of the care patients will receive and pay for is in the final year of life.

    As for the quoted section of my original post, forgive my careless use of words. What I meant was that over half of the patients will die from the cancer, not of natural or other causes. I hope this is more clear. I also hope it is clear why I expect the experience of death with this specialty to be different from that experienced in most other professions.

    Thanks for the recommendation on the hospice volunteering. I think I'll look into finding some time to do that.
  4. Palex80

    Palex80 RAD ON

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    This is the good part.
    Other specialists (for example surgeons) probably complained more often about their crappy life style and working hours, while family doctors probably complained about their bad payment.
    So in radiation oncologist you have the major drawback, that everything else simply rocks so that the biggest drawback is seeing patients die.
    So your life is basically fine, but what bugs you the most are your patients' fortunes.
    Now this is what I call a true doctor!
    One that worries more about his/her patients than himself/herself.

    I agree with you on that.
    As a family care physician you care patients for decades, get to know them well, perhaps even get friends with them and then have to see how they miserably die with multiple brain metastasis from NSCLC. And then it strikes you, that you may have taken care of these patients for decades, but you never managed to persuade them stop smoking. FAILURE!
    That's an exaggerated example here, but not all of our patients in radiation oncology die. The key point is being "prepared". In radiation oncology you know, that every single one of your patients (excluding the 5% treated for benign diseases) can potentially die because of cancer.
    So you know what you are dealing with.
    It's a new way of thinking.
    As a colleague of mine once said concerning a patient with breast cancer and negative staging for metastatic disease: "We cannot saythat the patient has no metastases. We can simply say, that her metastases are too small to be detected by imaging."
    This is how you learn to think in radiation oncology. Every patient, regardless of how small his/her primary tumour is and how good his/her prognosis is, has the potential to die of cancer.
    You simply know what you have to deal with. Every single day.

    And that's the bad part about it. Because they are all unprepared.

    Not everyone dies of cancer. We do cure a sizable portion of our patients.
    And it is our job to make that final year as comfortable as we can for the patients. Comforting pain, avoiding complications and often extending survival in the palliative setting is a major task for radiation oncologists.
    And we can be proud of fulfilling that task, whenever we can.
  5. clintpark

    clintpark Member

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    Being able to cope with frequent deaths of your patients is a BIG part of have a fulfilling career as a (medical or radiation) oncologist. I presume you can still have a (financially or academically) successful career even if you can't cope, but I wouldn't want it that way.

    It certainly is different from a family practice doc's or a pediatrician's experience of having occasional (but, probably very traumatic in the case of pediatricians) deaths.

    This is a quotable phrase that summarizes my approach very well. "To cure sometimes, to relieve often, to comfort always -- this is our work." If you go in thinking this is a competition between you and the disease (cure vs. death), you are going to lose a lot --- maybe not all the time, but a lot.

    I don't mean to sound all corny/interviewy, but it really is about the relationship with your patients and looking out for their interests that keep me going. I would be lying if I say that each death nowadays hits me as hard as the death of a young girl during my pre-med, volunteering years. You kind of learn to say "Well, that's too bad", think about the surviving family for a few seconds, have your staff send a card, give them a phone call if you really connected with them, then put it behind you and move on. I still have hard time dealing with pediatric patients. I didn't before, but having a child of my own really changed that. That's why I don't like treating peds cases, as do many other radiation oncologists. Thankfully, I have a partner who took on these children as her own and take a really, literally agonizingly, good care of them.

    Let me add: Deaths and dying are NOT part of all medicine fields. Many diagnosticians and procedure oriented fields never have to deal with deaths as routine part of their practice. Radiology (diagnostic/interventional), nuclear medicine, pathology, GI (endoscopists) and dermatology, would be some of them.
    Last edited: Nov 5, 2009
  6. ghgi8

    ghgi8 Senior Member

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  7. Narmerguy

    Narmerguy Member Moderator

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    I really appreciate everyone's responses. Thanks a lot, especially for the link to the older thread.

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