There’s an old tree in the backyard of my childhood home. It was there when we first moved in. It still stands there now. Every year it’s a family affair to trim back its branches and gather up all the orange and brown leaves that it has strewn across the yard. By the end of the afternoon, it sits there with its new haircut, looking a bare and forlorn for the winter.
I like the Emergency Department a lot. It might be busy and chaotic at times, but things are always moving and progressing towards a goal. A lot of problems we can fix. Urinary tract infections or ear infections get antibiotics. Sprains might get splinted. Fractures get a colorful cast from orthopedics. These kids feel better and go home.
Then there are others. A tired child has leukemia. A headache turns out to be a brain tumor. Whether the universe knows or word spreads across the ED staff, time seems to stop. My phone is silent for the first time the entire shift. I walk with the parents to a private room and draw the curtains. We sit down, and I prepare to deliver the news. In those moments, even the most stoic of parents shake uncontrollably with emotion. Sometimes there are a lot of questions, and sometimes there is only shock.
I think it’s disingenuous for me to pretend like I can even come close to fathoming what it feels like to be told that your child has cancer, but I can speak a little about the impact of these moments on a physician. There are times when I feel like our job is inhuman. After disclosing earth-shattering diagnoses like this, we sit with the family to offer comfort and support but after that we are expected to immediately get back to work. There is no time to process the gravity of what we just did so we spend the rest of the shift in a daze. The daze can extend into the next few days. We find ourselves crying on the way home from work in the car or sobbing randomly at dinner the following day. Fuck Cancer.
I asked a senior physician, “Does this get any easier?” He replied, “We went into medicine because we care about our patients and their families. You learn to develop your approach to delivering the bad news so in that sense it gets easier. But otherwise, it doesn’t. And it shouldn’t.”
A few years ago as I scaled the tree in the backyard for its annual trimming, I noticed something. The main branches were covered in knots and gnarls. Remnants from when we had trimmed in the past. The trunk had also literally grown around and past where we had tied a laundry line to it when we had first moved in. Despite everything, it was still finding ways to grow, to thrive, and to shoot out its branches and leaves and reach for the sun.