DR RODRIGUEZ: I really appreciated the questions — the input from the oncologists on how it affects the oncologist at the end when people die. And there’s a lot of data about burnout. I’m young, and I already feel that it is very draining, emotionally, and it takes a lot of time that is not compensated.

Some of these patients that you bond with and you get to know — for me, they have my cell phone number. I know their families. So it’s very personal, like you lose a friend at the end of this path. And so it is good to collect this data because I think doctors need it. They need reinforcement that they’re not alone going through this experience. So I thought it was very powerful to read that.

DR LOVE: Any thoughts, Maria?

DR PICTON: Well, I think that doing this project really helped me look back and learn a lot of things from my patients and from me and rethink that — many of the decisions that I made. Taking care of a cancer patient is not very easy. We all know that.

And whenever we are faced day to day making decisions about what to do for this patient, a part of us goes into it and a lot of stress and a lot of learning from previous patients. I think that participating in this project really helped me.

DR LOVE: Before I ask Heather for your thoughts on this — and then we’ll get to the cases — I’ve got to tell you about this that I saw in the Miami Herald this morning. Okay? Article in the Miami Herald this morning: “Caring for my dying husband was the best time of my life.” This is from a woman whose husband died 10 years ago. It sounds like it was a solid tumor. She didn’t say which one. And I just want to read you two parts of this, because I wonder if you can relate to this as an oncologist, Heather. “Ten years ago, my world as I knew it ended. My husband of 19 years, the father of my two sons, was diagnosed with terminal cancer. Over the course of seven months, Bill went from beating me silly on the tennis court to needing my help to go to the bathroom and bathe. It was the best seven years of my life. Maybe I don’t actually mean that.” But what she was trying to get into — I want to read the conclusion of what she said. And it kind of reminds me of things that oncologists have said to me.

So she’s reflecting back now. This is 10 years ago that her husband died. “Ten years later, I haven’t started a foundation to cure cancer. I haven’t left the news business to get a medical degree” — she’s a news editor — “I work. I pay the bills. I try to be there for my sons. I will never again be as good a person as I was when I cared for Bill. I will never again have that high a purpose, but every day I also try to find and put into practice the person I became during those seven months. I try to be a little bit less judgmental, a little bit more forgiving, a little bit more generous, and a little bit more grateful for the small moments in life. I’m a better person for having been Bill’s caregiver. It was his last best gift to me.”

And it kind of made me think a lot about what I hear from oncologists. Any thoughts?

DR WAKELEE: Yes. When I was a medical student, one of the reasons that I was drawn to oncology was that sort of a sense of purpose that people living with cancer and the people caring for them develop. And it was this ability to stop and pause, and think, and really live even if it’s in the process of dying. And that’s something that’s continued to really be an amazing part of being an oncologist, because you’re let into someone’s life at that time when they really are struggling.

And I think that one of our most important jobs that we play as oncologists is really helping people to find that, to really step back and say, “You really have to live for the time that you’re living, because it does have a more finite point to it than you might have thought otherwise.” And I think too much of current life is just rush, rush, rush, rush, rush. And you look back, and what happened? So that was really well written.

This year has been a lot of reflection for me on that. One of my patients wrote a best-selling book, When Breath Becomes Air. That was Dr Paul Kalanithi. And that has really brought a lot of these discussions forward into the more general public. And I felt that with his voice of describing his journey — and, unfortunately, he lost his life to lung cancer. But he was able to really explore a lot of these questions about what does it mean to have cancer at a young age, what does it mean to be facing death when you’re just starting life, because he was just finishing his training as a neurosurgeon.

And he did a really amazing job of capturing our interactions, as well, and I think gave people an insight into what it means to be an oncologist and have those patient interactions. So that’s been a really challenging part of this year because it’s made me reflect back on it, but also really amazing to see the response, that his book has resonated with so many people, and his widow, Lucy, who’s done a lot of book tours and really been able to express that and have those sorts of discussions.

And it’s a part of our medical education that doesn’t always get emphasized enough. So I was really fascinated by that aspect of this project, having people really reflect back on it. It’s also one of the things I try to emphasize when I’m teaching. I just came off of 2 weeks being in the hospital attending, so working with the residents who are getting younger all the time — but really kind of helping them as they grappled with young people dying with cancer and trying to help them see, well, yes, this is a terrible thing that’s happening to this person, and you need to be able to give and help them see how they’re still living.

But then you also need to figure out ways not to have that come home with you and not to have that pull everything out of you. And you need to kind of — it’s different for each person, but how do you find ways to regenerate your own energy so that you can continue to be giving in that way? And how do you learn from our patients how to live more yourself? So I mean there’s a lot in that. And I’m really happy that you shared that article because I think she was voicing that so well, also.

DR LOVE: And the other thing we asked about was emotional attachment to that particular patient. And we saw a lot of docs, anywhere, either very attached or somewhat attached.

But the thing that was interesting, kind of getting back to this issue of being an oncologist, is that, again, we asked, “To what extent did you find it satisfying to take care of this particular patient?” A lot of gratification. I mean you look at the downhill course that a lot of these patients have, particularly lung cancer: Median 13 months’ survival of the patients, these 78 patients. Where does the gratification come from?

DR RODRIGUEZ: I think it’s the bond and how you build this relationship. And I also kind of find that the caregivers, you’re the person who they look to, to guide them through this process, because you have been there before. You had other patients who died. And they’re looking at you: “I’ve never done this before.”

You asked the question about “Have you gone to a funeral?” And sometimes I have. I’ve gone a few times. But I have gone because I have a bond with the caretaker, and I want to be there for them because it is really that satisfying that it is not only the patient that you helped but also the family that you helped through this time.

Metastatic wild-type nonsquamous non-small cell lung cancer (NSCLC)

Metastatic colorectal cancer (mCRC)

Metastatic epithelial ovarian cancer (OC)