Emotional detachment

You asked me whether I had breakdowns taking care of cancer patients. You said it would seem to be quite depressing and frustrating at times.

Nope, I had not. I haven't been overwhelmed by those negative emotions thus far. Perhaps I was subconsciously resistant to those thoughts or maybe I was too busy working to ponder things over.

Dunno. We're all taught to be empathetic toward those who suffer. Nevertheless, working where tears and death are almost always around the corner, one can not survive without some level of emotional detachment. In health care, if one takes everything personally, sooner or later one may explode.

Still, I'm not iron-hearted. Delivering bad news to patients and/or their family remains daunting to me.

Stan* has cholangiocarcinoma, cancer of the bile ducts, which is notorious for its resistance to chemotherapy. Once the disease progresses, there is virtually nothing in the current medical armamentarium that can help. Stan's cancer has gone beyond control. Time to stop. I told him so, but he, probably too shocked or frightened to absorb the fact, desperately asked for therapeutical trial of the latest chemotherapy/targeted therapy regardless of the effectiveness, the side-effects or the cost. I insisted on 'do no harm' and somehow refused his requests mercilessly. Yet, I actually felt a bit shaken behind the professional facade. I felt as if I'd become one who deprives poor people of their last hope.

A patient collapsed unexpectedly this past weekend. The intern, who took care of this patient, cried the whole morning, blaming herself for not being preemptive enough. Seeing her lose her composure, I feel a great sense of loss. I can't think of the last time I cryed over a dying patient. I feel the emotion no more.

Am I too nonchalant or too business-like? Hopefully not. There aren’t any checklists for us to follow on how to maintain boundaries when faced with the emotional demands of others.

I'm still trying to find balance.


* the name has been modified.

Love is a losing game

For you I was a flame
Love is a losing game
Five story fire as you came
Love is a losing game

One I wish I never played
Oh, what a mess we made
And now the final frame
Love is a losing game

Played out by the band
Love is a losing hand
More than I could stand
Love is a losing hand

Self professed profound
Till the chips were down
Know you’re a gambling man
Love is a losing hand

Though I battle blind
Love is a fate resigned
Memories mar my mind
Love is a fate resigned

Over futile odds
And laughed at by the Gods
And now the final frame
Love is a losing game

Go upstream

尋夢？ 撐一支長篙 向青草更青處漫溯，
滿載一船星輝， 在星輝斑爛裡放歌。

The Chinese poem written one century earlier is my first impression about punting in River Cam. Although the scenario was not exactly the same as what he described gracefully in his poem, I still enjoyed the afternoon breeze and sunshine when I lazily dozed off in the boat.

We went punting a couple of times throughout the 3 weeks in Cambridge. The River Cam was always crowded with tourists, bantering and laughing. It's said that we could enjoy some peace and quiet if we go upstream. So, by the end of the summer school, we decided to escape form the crowds and organized an upstream punting excursion.

It takes a bit strenuous work if you'd like to try punting in the upstream. Yeah, you have to drag the boat offshore and upward along the slope as the picture shows.

Thanks to our inexperience, we've caused a traffic jam when the boat stuck in the middle of the road for a few minutes. Those people who were waiting to cross the road shot nasty looks at us unceremoniously. I thought we'd win some applause as we pushed the boat back to the water successfully and relieved the traffic jam, but there's none. lol

The upstream was apparently more primordial. It felt like the scenario in a B-movie where there's a python lurking around somewhere and we're the would-be victims. lol. Fortunately, nothing surrealistic happened that day.

We spent the whole afternoon there until we were almost running late for the closing dinner of the summer school.

Mr L

Mr L used to be a high-ranking IC engineer in Silicon Valley. I wouldn''t have gotten to know him if he was not inflicted with lung cancer.

He did not smoke and only had minor health problems previously. However, he began to suffer from lower back pain during the summer's peak a couple years ago. Mr L took painkillers and underwent rehab after seeing his family physician. Yet, the pain did not go away. A spine MRI was thus undertaken, right before the Christmas Holidays that year, and reportedly showed multiple metastatic lesions along his vertebrae. He was diagnosed as having adenocarcinoma of the lung and started the latest targeted therapy available.

A miracle did not happen. By the time I saw Mr L, he was undergoing another cycle of palliative radiotherapy for the agonizing metastatic bone pain in both of his shoulders.

Mr L appeared depressed; his wife, Mrs L, on the other hand, was anxious and sometimes a bit demanding. Even though that was understandable, it was cumbersome for myself and nurses, to some degree, to take care of such a patient and his family.

I'm not good at encouraging others, let alone those who are dying chronically. I've tried a couple of times to comfort Mr L. Yet, it sounded awkward and lacked genuineness, especially when the medications I gave him did not work while he was suffering from intractable pain, or instead rendered him nauseated.

In the context of taking care of terminally ill patients such dilemmas are not uncommon. For example, using morphine to ease pain may cause severe, distressing constipation. Palliative paracentesis, if not undertaken judiciously, may jeopardize a patient's renal function. As patients lose their physical capabilities, and must obtain nutrition via a nasogastric tube for example, they sometimes become very depressed and even lose the faith and strength they had to stay alive. Some even become indignant and refuse treatment even when suffering from severe symptoms. As you can imagine this can be quite problematic for us as their care-givers.

Luckily enough, Mr L's pain was relieved and his nausea and constipation were more tolerable after several rounds of morphine titration, along with administration of antiemetics and laxatives. Toward the end of that month, he received another course of chemotherapy with a different regimen.

Sometime later after I rotated to a different ward, I met Mrs L down the corridor. She said that Mr L is going to be discharged home in a few days. Although the effectiveness of the new regimen is yet to know, she told me that Mr L's general well-being is now good and she attributed this to my meticulous care the previous month.

"That's what we are supposed to do," I insisted but could not help smiling.