Of all the services, the cancer ward is the most difficult one to stay sane on, especially if there are young patients on service. On other services, a hospital stay is a blip in the road, a temporizing measure, a small bit to include in future Past Medical History reviews, but not a defining condition. Not part of your identity. A single episode of gallstone pancreatitis doesn’t end up in your ID. In three days one can go from “64 y/o generally healthy male presents for easy bruising” to “64 y/o male with recent dx AML,” and “previously healthy” is gone, and AML has won a spot in the first sentence in every medical note to come.
Yes, I know other conditions end up with similar prominence. “Brittle diabetes” “COPD w/ mult intubation” “Ulcerative colitis” “ASCVD s/p 3v CABG” “chronic pancreatitis” “seizure d/o” “SLE” “HIV+” “schizophrenia” etc etc etc. But these are background canvases. They (often) aren’t a picture themselves. They don’t clue you into how a person is going to plan the next year of his or her life, trying to squeeze it into the cracks between neoadjuvant options and radiation fractions and breast-conserving operations, 7+3s and lymph node biopsies and diverting colostomies, surveillance CTs and bone marrow biopsies.
There was this one young girl with who I’d flirt a little. Not too much; I was still her doctor. But she was so sick, and she was so scared, and her chances of recovery were so slim that often I felt like all I had to offer was a humanizing interaction. Anything to bring a little life into her sterile, neutropenic hospital room.
I’m sitting here and feeling a little bad about it. Outside of that hospital (no, outside of that gown), I would never have paid her any attention. Even before treatment made her puffy and bald and lethargic she was chubby and plain and boring. Or maybe she was blonde and curvy and loved animals. Either way, I’d be similarly disinterested. Part of me thinks the lesson of this is to be friendlier, say to that LNA who’s kinda frumpy/dumpy but is awfully sweet to patients. But the ego-centrist in me warns that if I do this, I’ll probably give her osteosarcoma. Nah she’s too old for that. Hodgkin’s lymphoma then.