Issue 13 / 8 April 2019

THERE are many challenges to face in your first year as a junior doctor: learning how to prioritise jobs, developing procedural skills, managing deteriorating patients, all of which medical schools do their best to prepare us for through years of placement and practice.

One of the integral parts of being of doctor is learning how to deliver bad news. Unfortunately, this is a skill unable to be practised in vivo until that title appears in front of your name. I anticipated having difficult conversations with patients and their families and went through the motions of scenarios set for us by our tutors and our peers, unaware of how important this skill would become to me.

Ten weeks into my internship, I had the first of many heartbreaking conversations throughout that year – I had to call my little sister and tell her that our father had just been diagnosed with pancreatic cancer.

My father is also a doctor, a paediatrician, and my mother is a neurosurgeon, so the wave of impending doom that comes with a diagnosis such as pancreatic cancer hit us all immediately. Between us, we navigated informing family members and friends, trying to convey the seriousness of the situation without being too fatalistic. I tried to fall back on the lines I had said so many times in practice but soon realised how much harder they were to say about my own father.

In the weeks that followed, my family and I had many long discussions about life and death, about cancer and about karma – and one thing that we had all experienced in our careers, although mine was so short in comparison, was that there’s no fairness in cancer. Gender, race, religion, socio-economic status, doctor or not; cancer doesn’t discriminate.

Although it’s easy to see this ugliness and unfairness in the pain and the tragedy of cancer, something beautiful did come of it. Too often in medicine, we see loved ones going too soon, too suddenly, to appreciate how truly cared about they were. But a diagnosis such as pancreatic cancer walks this line; and it became quickly apparent just how many people cared about my father. From day one, when our house resembled a flower shop, and every day after, we were completely overwhelmed by the love and support of our family and friends, and particularly by that of the medical community. It was their small actions; the kind things we as doctors do without a second thought that made the most difference to me and my family and too often it is these actions that go without thanks.

So, thank you:

  • to my medical team whose eyes welled with mine as I received that first phone call and covered me without question for as long as I needed;
  • to every colleague I told who nodded with grave eyes and knowing silence as I choked up saying “pancreatic” and offered their endless support;
  • to the general surgeon who gave us clarity and direction while we sat in his office for our first experience on the other side of that desk;
  • to the specialist surgeon who answered a work call on his family holiday and cleared his schedule to assist with the Whipple procedure;
  • to the oncologists, radiologists, pathologists and surgeons who met at a day’s notice to discuss his case, offer their expertise and assist in any way they could;
  • to the intensive care doctors who let us come in past visiting hours while Dad was still intubated just so we could hold his hand;
  • to every nurse who cared for him at his weakest and every physiotherapist who walked patiently by his side holding his drains;
  • to every colleague and friend who stopped by his room after their own long days working at the hospital just to sit and chat and take his mind off the pain for a while; to the junior doctor on my first weekend back who pretended to arbitrarily assign the patients we would each see, while clearly assigning the four patients dying of pancreatic cancer on the ward to himself, and the one who was thriving to me;
  • to my father’s dear friend, a cardiologist, who drove 2 hours to see him every week during his chemotherapy to offer a small silver lining as it got harder and harder to drag himself to each session;
  • to my mother, who guided us through all of this and still had the strength to support her own patients through the devastating diagnosis of brain cancer; who continued to perform life-saving surgeries to give her patients and their families the gift of time, all while having to watch the love of her life suffer through the same fate.

And finally, thank you to the kindest, strongest doctor I’ll ever know: my father. Your dignity and humility as a doctor, and now, as a patient, is inspiring to everyone you meet. Thank you for studying with me late into the night, for practising OSCE stations, for discussing interesting diagnostic dilemmas, for debriefing with me after tragic cases, but mostly, for supporting me and countless others to achieve our dreams.

Thank you to all of you. What I have seen in the past 12 months is the shining light that we can provide when patients and families are in their darkest times, and what we as professionals, as doctors, as carers, daughters, sons, fathers and mothers need to be reminded of.

Being surrounded by your passion for medicine and for helping others has fostered my own love for this profession, this community, of which I now couldn’t be more proud to be a part.

Dr Caitlyn Withers graduated from the University of Queensland Medical School in 2017 and is currently completing her residency at the Sunshine Coast University Hospital.

 

 

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.

13 thoughts on “Thank you: a letter from the heart

  1. Kay Dunkley says:

    Thank you for sharing your personal story in a public forum. It is heart warming to read of all the support you and your family received. This is compassionate care at its best and is very inspiring to read.

  2. Anonymous says:

    Thanks Caitlyn. It is why we are called to medicine, but reading your beautiful article reminds me of a flower in the desert.

  3. Toby Commerford says:

    This is really beautiful. Thank YOU Caitlyn. It sounds as though the Sunshine Coast is very lucky to have you. I also totally agree with the comment above, that this brief message is like a flower in the desert. Medicine is so much in need of the positivity, optimism and gratitude you show abundantly in your writing.

  4. Maia Sales says:

    Caitlyn,
    It was such a heart warming reading
    It me my eyes water ..
    I am so proud of you.. we went to the same school
    You will be an amazing doctor
    … your story was such an eye opening I really enjoy your story …
    Good being a doctor in the future

  5. Cathy Walker says:

    Beautiful words Caitlyn. The strength of your parent’s is very inspiring. Lots of love

  6. William Withers says:

    Thanks for sharing this with us Caitlyn. It is a beautiful tribute with love and dedication. With love, Bill and Judy Withers.

  7. Sunshine coast doctor says:

    Thank you Caitlin. What you wrote reminded us again that we treat PEOPLE and not ‘diseases’

  8. Kerrie says:

    Thank you for sharing your story Caitlyn.
    Personal and professional, you will excel.

  9. Penny Parker says:

    Truly beautiful Caitlyn! The optimism and faultless positive, fighting spirit that you all, as a family, exude is so inspiring; not only as doctors but in everything you all do. Love you all x

  10. Cathy Day says:

    What a beautifully written piece by a loving daughter. Your grandfather, like your family, would have been very proud of this reflection.

  11. Bevan Slater - your great Uncle - Warwick says:

    Dear Caitlyn,
    Our families seem to have drifted apart over the years – I guess everyone tends to go their own way, but I always remember when your father was born and the many happy hours Johanna and I spent with him as a toddler during my visits to Brisbane. Your great great parents Bill and Verner Slater, were oh so proud of your father and his medical achievements, as we all are. We are all so pleased he has overcome this terrible event and your words above will give him huge support.

  12. Anonymous says:

    Firstly, I am glad that you can draw the positives from your experience as a daughter of a parent with an incurable cancer. I don’t wish to detract from your experience. Your experience however is in stark contrast to my own. I would like to speak a little of my lived experience with my mum’s renal cancer. She was 37, I was 19. My younger siblings were 11 and 12, when she died.

    I have a few memories of that time. The support that our family received from the hospital, was such that at the time my mum’s husband (my step dad) was so unhappy that he wrote to the premier regarding her experience. I have somewhere archived that letter, both in my memory bank and physically stored. In it I recall an incident my mum experienced in the presence of her parents-in-law, and a separate incident in which she was told to spend her last days at home, rather than in the hospital, because she was dying. My mother only wanted to shield her young children from her fragile cachetic state, hence her decision to die in hospital. That dying process took two weeks.

    The other “support” we received from the hospital following my mother’s death were two letters addressed to the deceased, asking for monetary support / donation to the hospital. Not even acknowledging she was dead.

    I have memory of spending an entire night at the hospital about a week before my mother’s death. No doctor spoke to me about my mother’s condition. A nurse did offer me a pillow to make it more comfortable to sleep in the chair. At that time, I didn’t even know my mum was dying. Her delirium, I thought was because of the morphine she was receiving, not her impending death. At 19, I didn’t realise you get to spend a night in a chair next to a patient, only because they were dying.

    Unfortunately my experience is not unique. When I asked another young motherless daughter about her experience with the medical profession during her mother’s treatment and death from leiomyosarcoma. Her words were that she had a number of negative experiences more so than positive ones.

    This young lady has gone on to form the Motherless Daughters Australia support group, and more recently enabled that group to gain deductible gift recipient status. Which apparently was difficult as ASIC and charity laws see death and bereavement as a normal part of life.

    The other aspect of my mother’s care that I would like to touch on, was that once treatment options were exhausted in Australia, my mum went on to have radiofrequency ablation in Germany (at the expense of our family). This was researched by an extended family member who was a GP. At the time, mum’s treating radiologist recommended against this treatment. I have a VHS of the procedure, and a few medical notes from Germany. My understanding is that the treatment did have considerable effect on the tumour burden.

    Now, some years later RFA is an option for treatment of renal cancer in Australia. I remember being humiliated by a peer during medical school for seeking (what was at the time) “alternative” treatment for cancer. This coincided with a period where we had patients with breast cancer visit the medical school to give their own lived experience with cancer. I recall the lady who spoke with our group saying that she was put on a trial during her treatment and that she was grateful for that.

    I came to study medicine to answer these questions for myself. To understand her death. To be at peace with everything that expired at that time, and the subsequent unfolding that occurred after. I hope that I have given some honour to mum in writing this.

  13. Anonymous says:

    Recommended reading: Chris O’Brien’s “Never say die”, which is a fine example of the tenacity of the human spirit.

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