An earlier version of this post was originally published on KevenMD
My brother wears a scar around his neck. It is a permanent reminder of his second surgery for papillary thyroid cancer. The first started off the same way. Ugly, red and angry. Curving like an ominous smile around his neck. Like a noose. That’s how it felt, too, – the lump in his throat growing as he sat quietly, alone in a doctor’s office. It’s interesting how physical scars can be a visual manifestation of the emotional ones left behind by disease and illness.
The month was February and the ice that lined the windowsill reflected the chill in the room when the doctor read him the pathology report. “Papillary thyroid cancer,” he had said. Or he imagined he did. He knew it was coming and in those moments very little is really heard because the knowing sets it. That’s the moment when it becomes real.
The following months were a blur. There was the surgery a week later. Waking up bandaged, with part of his body now gone. His fingers grazed the ragged edge of his sutures to the spot where his thyroid had been. An organ he had never really considered had become all he could think about in a matter of weeks. Ever since he felt that lump, he knew something was wrong.
After the surgery, came the radiation. He waited three long months for it. While the cold winter brought news of his cancer, the warming of the summer brought the heat of radiation, and with the radiation came the isolation. For several days he stayed alone in his home. Unable to reach out to his friends and family as the treatment had made him literally toxic to those he loved. He disposed of his waste in plastic bags because it was too dangerous to be discarded alongside the rest of the sewage – a not so gentle reminder of the ravages and reality of radiation.
But then there was hope. “This is the best type of cancer you could have,” they said. That’s what everyone said, and slowly the panic began to settle with the falling of the leaves in autumn as his scar began to fade to a gentle pink. He gained weight and started to remember what “normal” felt like. He received follow-up blood work and took Synthroid to replace the hormones that his now-absent thyroid could no longer produce. For almost two years, the seasons changed with their usual lovely languor, but then the cold winter set back in.
It was February again. Two years had passed since that first appointment and we all expected the doctor to declare him officially “in remission.” This was the appointment that everyone assumed would happen, but then the truth that no one had dared whisper aloud suddenly became deafening.
“You have six enlarged, fixed lymph nodes.”
My brother called me from that same office. I was now a third year medical student and was rotating through internal medicine. I was in the resident room writing patient notes when I saw his number flash across my screen and the panic immediately engulfed me. He never calls me at work, and I knew what was coming before I even said, “Hello.”
I excused myself and went into the hall to talk, keeping my voice steady as I told him everything would be ok. “This happens a lot… and besides, studies haven’t shown that lymph node metastasis necessarily increases mortality with papillary thyroid cancer,” I said, not sure who I was trying to convince. I slipped into the bathroom where I let myself fall against the wall and sink to the floor. For two full minutes, I let the shock and pain and fear set in, and I sobbed. Two minutes I told myself. That’s all you get and then you have to pull yourself together and go back to work. So I watched the clock and after two minutes, I stood up, straightened my suit, wiped the tears from my cheeks and went back to work.
The next patient I saw had metastatic breast cancer. “Of course,” I thought, “But they are not the same,” I reminded myself. I forced my brother out of my mind for the moment and focused on my patient completely. I asked her every question I would normally ask any other patient on any other day. I consciously rested my hand on her shoulder as I listened to her heart and lungs.
I had learned from both standardized and real patients that this simple gesture, this gentle touch, made them feel more at ease and connected and cared for. I wanted that for her as much as I wanted it for my brother – to be cared for. They were not the same but then again, they were. Because she was also someone’s mother, someone’s sister, someone’s wife, and she too deserved my full attention. While my world felt like it was crumbling, hers already had.
Life does not stop the day you decide to become a doctor. Someone you love may get sick or even die. Friends will get married. Siblings will have babies and there will be times when you will feel pulled in a hundred different directions. Even as a medical student, you will take on this enormous privilege and responsibility of caring for others. This ability to connect with people and share in their lives is what inspired many of us to pursue medicine in the first place.
However, finding the balance between your professional and personal life is never an easy task. We spend so much of our day caring for others. Yet, as a profession, we often forget to care for ourselves. Learn to say, “No” and mean it. Recognize when you need help and don’t be afraid to ask for it. Adversity will make you a better doctor and a better friend so embrace the things that scare you the most and know that your team, attendings, mentors and advisors are there to support you when you need it.
About Sarah Mongiello Bernstein
Sarah is a fourth year medical student at Emory University School of Medicine. She graduated with a B.S. and Masters in Health Administration (M.H.A.) from Cornell University and has worked as a healthcare consultant in the population management division. She is passionate about global health and enjoys working with high acuity patients in resource-limited settings. At Cornell, Sarah served on the Public Service Center’s Leadership Council and as founder and president of Cover Africa, an organization dedicated to eradicating malaria in Humjibre, Ghana. Today, Cover Africa has over 800 members and has donated over $100,000 to the fight against malaria.
Throughout medical school, she has sustained this passion for global health – serving as Vice-President of Public Relations for Emory Health Against Human Trafficking (EHAHT) and a researcher with Operation Smile in Guwahati, India where she helped to develop and validate a new tool that would allow physicians to objectively assess the severity of pre-surgical cleft lips and palates internationally. Long term, Sarah hopes to combine her passion for global health with the skills she has developed as a patient, consultant and clinician to improve patient access and eliminate costly inefficiencies in healthcare systems worldwide. In her free time, she enjoys acting, drawing and exploring new cities and cultures with her husband, Gehrig.