Remember

(I'm writing this not so much for the blog as for myself, in an effort to remember.)

When you're interviewing for residency people often ask you to describe a memorable patient, someone who made an impression on you and changed the way you thought. When I was interviewing, I had Salma, a plucky eight year old I took care of in one of Karachi's inner city clinics. She used to wet her bed and every morning would be predictably beaten by her mother for it. We did some tests and found out she had recurrent urinary tract infections. There was a pro bono referral to a specialist, some antibiotics and the bed wetting and beatings ceased. It was almost mathematical in its progress from diagnosis to cure.

As you progress through your career, your list of these patients grows. You may remember someone for their resilience, how they fought and recovered. Or for their kindness, their patience with you as the fledgling physician. Or even for your failure, how you were unable to help someone. The practise of medicine isn't as mathematical as all our algorithms would suggest. There are, of course, guidelines and standards of care but the patients, or diseases, don't read textbooks and there are times when a diagnosis is elusive and difficult to make. Sometimes you can make the diagnosis and the pathology doesn't respond to the treatment. Other times the disease is so widespread that treatment is redundant. The new age of genetics and molecular biology may make our knowledge of science cutting edge but the practise of medicine, and more importantly, the care of patients, still remains for the most part an adaptible combination of both knowledge and humanity, or the art of medicine as people like to call it. To dissect one out from the other is to do the patients a great disservice.

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I was on the Hematology Oncology service last month. The general perception people have of cancer medicine is that it is a very depressing field. How can anyone spend their days watching children die. In truth, it's not actually like that. Pediatric cancers are, for the most part, a different species from adult cancers and a lot of them respond very favorably to treatment. Acute Lymphoblastic Leukemia, for instance, has a cure rate of more than 80% and most children are expected to survive. In the month that I spent on the service, there were no fatalities.

And yet, throughout the month, I found my eyes uncomfortably moist. It is difficult watching children suffer and a lot of that comes from the treatment of the cancer itself, the chemotherapy. I'm not going to describe the individual details but it's an experience that, even as observer, takes you outside of yourself and sharply puts things in perspective. Often I would sit and talk with the parents and the specialists, trying to cull, for my own consolation, perhaps, stories of their experience with the disease. It is those stories, more than anything else, that both humble and embolden you as a physician. Like the boy who didn't have hair. Or the family who, after the death of their teenage son, adopted the clinic and made sure that all new patients receive a basket of toys or anything else they might need. Or the man who, even when he found out at the time of transplant that he wasn't the father of his daughter, still took care of her. Her own mother abandoned the child but this man stayed with her, steadfast until the very end. The girl died in his arms.

It is humbling to be around such people. I cannot say how I would react were I to be placed in their situation and, frankly, I am grateful that I am not. But having met them and having been acquainted with their example, I think that I am a better physician and a better person. They set a precedent for me for how to behave under what can only be excruciating circumstances and for that invisible gift I am grateful.