The Fly

I was writing about oncologists and grief when a large fly caused me grief of a lesser form.

First the fly strafed my right ear en route to loudly smacking up against the window a few times. Then it disappeared a short while, to investigate my plants, dusty LP collection and ancestral tchotchkes, only to strafe me again and return to head-butting the window.

The subject of oncologist grief was hard enough to wrap my head around without the distraction this fly was intent on creating.

According to a study by a multidisciplinary Canadian team, oncologists experience grief in all the ways one might expect, along with forms unique to them. One of the latter is a grief born of holding the burden of bad news and knowing you must inform the patient.

This is a grief closely related to the death of hope and magnified by the pressure of knowing there is no known curative therapy left and wanting the truth to be otherwise. You’re a hero one minute, messenger for the Grim Reaper the next. And perhaps your own communication skills are not what they might be even in ideal circumstances.

This grief, the study said, sticks to oncologists like smoke, follows them to the next patient, follows them through interactions with other hospital staff, follows them home.

Honey, how was your day?

Oncologists are heroes. The degree of emotional difficulty in what they do is about as high as it gets.

Reading the study, and taking in its insights, I became conscious of something that had been bugging me about my bioethics blogging: my lack of real experience of the physician’s circumstances. I’ve been father of a patient on a hematology/oncology ward, but I’ve not been the one ordering the tests, reading the chart, assessing the chances, delivering the bad news.

I’ve read, heard and tried to write intelligently about the need for improved communication between doctor and patient so many times, especially related to end-of-life care, and increasingly have wondered what keeps it from happening? It’s harder than it should be.

But like Rudy Giuliani said of Mitt Romney, in his sort-of presidential endorsement, you don’t go looking for the best people skills in picking a surgeon. Same, I suppose, with an oncologist. Communicating well requires persistence, patience and clarity. And an ability to listen.

The fly stopped bumping the window and stood still. I saw my opportunity. No fly swatter available, I grabbed the next best thing, a brochure, folded it in half and WHACK WHACK WHACK! The fly strafed me no more.

I wiped a splotch from the brochure and unfolded it. I looked at the cover: Five Wishes.

The brochure had been sitting there on my desk, waiting for me to read it again and answer its questions ever since that workshop on the advance directive at my Unitarian church several months earlier. I emailed the minister who had led the workshop, and recommended completing it right away. She had to know what use I’d found for my neglected copy. Ministers need a laugh sometimes.

I think I’ll fill it out now. Maybe I’ll blog about it. My Five Wishes will be a fly’s legacy.

President Obama was recorded during an interview once killing a pesky fly with his bare hand. “I got the sucker,” the president said. The animal rights people sent a catch-and-release trap for flies, and scolded the president about humane treatment.

Animal rights people aren’t fond of some of the research that gives the oncologist something to go on in treating cancer. The research doesn’t always produce the magic, though, and when the options run out, the oncologist needs to let the patient know.

Grief clings to an oncologist like smoke, they say.

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