Just as the dust of being slapped with Stage 3 breast cancer 24 hours ago was starting to settle another storm was percolating inside my head – this one ridden with anxiety, not just about me but also about others. The others that are an integral part of my daily life, helping whom is my calling. I am their guide to hope and recovery…my dear patients. I was constantly straining my mind with this question, “What will I say to them?” I had taken the day before off, I needed at least a day to regroup enough to show up at work.
I was seeing patients, but in the back of my mind, a small sign was flashing “Cancer, cancer, cancer.” I was nervously tapping on my desk and the little stack of appointment cards was sliding, little cards that describe me, “Uzma Yunus, MD, Psychiatry.”
The first mental hurdle to cross was to share or not to share….
Sharing this news was in direct contrast to what I had been taught during my psychiatric training. Excessive self disclosure is frowned upon in my line of work as an interference in the therapeutic process. Introducing personal details is said to influence the relationship. Moreover, the appointments are about the patient not the psychiatrist and her misfortunes.
It is pretty routine for doctors in other specialties to have family pictures in their offices but these are rare in a psychiatrists’ office. Our specialty pays a lot of attention to therapeutic boundaries – what does and doesn’t get shared, and if shared, then very importantly, how it gets shared. Patients can also perceive excessive sharing by the doctor as their neediness and using up their appointment time complaining about their own problems.
Not too long ago, a patient had quipped, “My last psychiatrist would tell me what medications she had taken and how they worked for her. I am telling you she was a nut.” I cringed, will they think, “Am I crazy to consider even sharing this very personal medical dilemma with them?”
Nervous and unsure, I started to ponder justifications for a disclosure, I wondered could self disclosure be therapeutic in certain situations. One of the reasons groups like AA function well is because everyone is a peer, a fellow in their common struggles. Could I be a peer with my patients…now that I have a serious illness too, one that will always be something that stays with me, will this information be useful in our encounters? But can the doctor be a fellow, a companion, rather than the hierarchical provider? The debate in my mind continued.
Most people, once diagnosed with cancer, share the news with friends and family move on to the next phase of their grief journey. As a physician, I had this additional bridge to cross. To share or not to share with my patients.
My health, my well being and my ability to work is tied intimately to the well being of my patients. People who rely on me being there for their emotional needs. People with whom I am building and reworking their life stories, people who keep me sane and I do the same for them. Those people, what do I say to them?
Suddenly the faces of my patients started to flip through my mind. Jackie is so depressed and her dad is dealing with cancer. Tony just got out of the hospital and needs close observation. Tim has such great phobia of death and dying. One by one, I started to evaluate in my mind whether they were well enough to deal with the news of their doctor being struck by cancer. Did they need to know? Will I burden them by sharing?
When I am facing the worst storm of my life, how will I shelter them from the wind? How will I keep my personal struggle and suffering outside the office? How will I ask them how they are and not give them the equal chance to ask about my well being. What if I don’t tell them, will they assume the worst? Cancer isn’t like high blood pressure…only seen with a sphygmomanometer. It is seen in the bald head, absent eye brows, ashen skin tone, in fatigue, in the steroid related moon-face, in the spirit and energy. You can’t have cancer secretly. You can develop it secretly but you can’t get it treated secretly.
How am I supposed to go through surgery, chemotherapy and radiation spread over the course of a year without saying anything to my patients? Wouldn’t it be provoking more anxiety if I take few weeks off without explanation and then show up one day in a wig? Wouldn’t that be insulting to the intelligence of my patients about whom I care about so much? Would that be denying them the human interaction and connection that they deserve being associated with my life? I did not consider taking a prolonged leave of absence since I couldn’t fathom taking that much time off and interrupt my patients’ treatment.
The thoughts kept spinning in my head. What is it about being a doctor that even in the thick of early cancer diagnosis I was obsessing about my patient’s well-being and how they would feel about MY illness. Why are we trained to be so responsible and ethical? How will I be a patient and the doctor for the next year? I thought about who I am as a doctor. What do I take pride in? My answer was my honest effort to do the best I can with the knowledge I have and the responsibility I hold. To do good by my patients, treating them ethically and respectfully as an equal.
Just as these thoughts narrowed in my mind, I found my answer. When two people interact in any capacity, it’s a mutually effective relationship. I am delusional to think that they don’t affect me or I am not who I am today without my patients. The humbling moment happened. Yes, I am a human first, a doctor later. They are my peers in this universe, as strong as me and as vulnerable as myself. I cannot shield them from life and its misfortunes just as I couldn’t do it for myself. They needed to know, their doctor has cancer and she will be alright. I heal them and they will help heal me through this journey. For there is no better way to heal than by healing others.