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A Complex State of Mind: “Is this going to cure me?”

Stephen J. Lirette, PharmD, BCPS, BCOP
Hematology/Oncology Clinical Pharmacist
UAB Medicine, The Kirklin Clinic of UAB Hospital
Birmingham, AL

I was in the clinic room with a patient while the oncologist ex­plained that the recommended therapy was not a cure but a way to prolong life. After a week, the patient’s oral oncolytic was approved and I was doing the initial counseling when he asked me, “Is this going to cure me?” I repeated what the oncologist explained at the prior visit. This example was my first experience with this scenario, and it has happened various times since. It never gets easier and sits heavy on my mind every time.

Upon first hearing the news of incurable disease, patients may find themselves not fully comprehending what is happening. It’s not a failure to deliver the news; it’s also the shock that the patient has to come to grips with his or her own mortality.

We Have All Had These Days
We have all had these days, and worse. I had one of those worse days a week ago, where I said goodbye to one of my favorite families because the patient was transitioning to hospice. The oncologist had to deliver similar news to the next three patients. It takes a toll.

Death is the natural order of life. We will all reach it one day, but we never want to think about it. Yet, as oncology pharmacists, we come face-to-face with it on a daily basis, which bodes the question: how do we cope with this?

One of my greatest fears working as an oncology pharmacist is that I will become desensitized to death and the struggles that the families are going through. They are losing a father, mother, son, daughter, or friend. It hurts… a lot. We care deeply about these people and want to see them at peace. Often in our quest to heal others, we forget to care for ourselves.

When One of Those Days Becomes Burnout
In an American Society of Clinical Oncology professional develop­ment article by McFarland DC and colleagues, burnout was found to be prevalent amongst oncologists: 25%–35% among medical oncol­ogists, 28%–36% among surgical oncologists, and 28% among radi­ation oncologists.1 I venture to believe that these statistics are sim­ilar for oncology pharmacists and also other medical professional colleagues who practice in oncology. Often this burnout is related to situations like the ones listed previously. If left unchecked, burnout can lead to more serious issues, mainly depression and in some un­fortunate cases, suicide. To prevent these, we have to become more adept at recognizing and addressing these feelings and thoughts, whether it be in ourselves or those with whom we work closely.

It is difficult to talk about. It is awkward at times. It is draped in stigma. Some feel it makes them weak. I, personally, struggle with my mental health regularly. I often do not talk about it because of the aforementioned perceptions; however, I have learned that in order to live a full, healthy life I have to have an outlet to express my emotions. Mine is writing my emotions and thoughts on paper so that I have a physically tangible copy of something that was previously an abstract thought.

The question I struggle with most that reverberates in my mind when I am speaking with my cancer patients and their family members is why is this happening to them and not me? I feel guilty that I am currently getting to live a healthy, wonderful life while the ones I’m helping are living a physical and emotional nightmare.

We Need Outlets for Coping
When this question reappears, I look to the words of an oncologist with whom I work closely that I have pinned to my desk: “I know it is often hard to understand what can seem futile when it comes to what therapy we have available for cancer, a lot of what we are do­ing is trying to shepherd people along this path. I am thankful and very proud of all.” These words allow me to reset and focus on what drives me on a daily basis: helping others less fortunate.

I write this in hopes that if you are struggling with these issues such as I am, you will reach out for help; you are not alone. I encourage you to find an outlet, an oasis where you can regularly go for help. Because we are the ones trained in providing care, we can often feel extra stress by thinking we are burdening others because we cannot “fix” ourselves. We do not need fixing because we are not broken. We are human, and we need to lean on one another at time.

Find your peace whatever it may be. As I mentioned before, mine is writing, so I will leave you with this poem:
Challenging it is
My own complex state of mind
Yet, we will prevail

REFERENCE

  1. McFarland DC, et al. Addressing Depression, Burnout, and Suicide in Oncology Physicians. American Society of Clinical Oncology Educational Book 2019 :39, 590-598
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