Rethinking the Patient Experience
A radiology resident recounts his journey undergoing cancer treatment — and its impact on him as a physician.
In 2016, at the age of 32, I was diagnosed with peritoneal mesothelioma. I’ve since had two exploratory laparotomies, a thoracotomy, multiple organ and bowel resections, a kidney injury necessitating three months of dialysis, subclavian and internal jugular deep vein thromboses, a fascial dehiscence, a port that eroded through my abdominal wall, at least four separate admissions for bowel obstructions, eight cycles of intraperitoneal chemotherapy, and ten cycles of intravenous chemotherapy. I think it’s fair to say that I know a thing or two about the patient experience.
I could describe at length the various ways in which being a patient is a tedious, painful, humiliating, and dehumanizing ordeal. But lately, I’ve been thinking about how I could make my experience relevant to my fellow radiologists. One of the things that first struck me about this entire affair was the disconnect between the imaging findings and my clinical symptoms.
I had been having mild and vague abdominal pain on and off for a few years, and that was pretty much it. I thought I had a bad case of subacute nothingness, and I chalked it up to the stress of radiology residency hurting my delicate feelings. On the day I finally went to the ER, the pain was slightly more focal in the right lower quadrant but still quite tolerable. I thought that my CT would show maybe a bit of inflammatory change in the fat around my appendix or colon. But it was a metaphorical disaster — the right colon wall was enormously enlarged, there was ascites everywhere, and there were multiple enhancing masses around the peritoneum. In addition to being completely unnerved, I was struck by the fact that my pain was actually pretty minimal. They kept asking me if I wanted hydromorphone in the ER, and I politely declined each time.
Conversely, a couple of the bowel obstructions I’d had were exquisitely painful, to the point where I literally could not sit still in the waiting room. But when we finally got the CT, the findings were underwhelming to say the least. The bowel was just barely dilated, the “transition point” looked more like a bowel that was just non-distended, and there was only trace ascites and a bit of inflammation. Until I had the personal pleasure of a bowel obstruction, I would have been quite dubious as to the severity of the patient’s illness given such “insignificant” findings.
These experiences have really driven home the limitations of our tests and the fact that imaging findings and clinical presentation can differ enormously. As a radiologist, I now give all my patients and clinical colleagues the benefit of the doubt. When a patient presents to the ER believing there is something wrong, it’s our job as physicians to find it, even if it is quite subtle.
There are a thousand other ways in which this ordeal has been a blessing and a curse, both personally and professionally. The downsides are obvious. The upsides, much less so. People have opened their hearts to me and have shown me the true meaning of “love thy neighbor.” I relate to my patients in a way that I never did before, and I believe it has made me a better physician. I understand now what they go through. Little things matter to them. It’s nice when the radiology department makes sure your scan and your appointment are on the same day, especially when you’re driving 1–2 hours (or more) to get to the hospital.
As a physician, I’ve learned that I need to go out of my way to introduce myself to my patients before I do a procedure on them. Oftentimes, in a training hospital, the lower-level residents do pre-procedure paperwork and the upper-level residents operate or do cases all day. Someone you have never met, whose name you don’t know, may be sticking their hand (or at least a wire) into your body while you’re unconscious. I met the surgical oncology fellow, for instance, as I was counting backwards from ten falling asleep from the anesthesia. I decided at that moment that I would never do a procedure on someone who didn’t know my name and whose hand I hadn’t shaken.
Above all, I’ve discovered that how you approach problems in your life — even extraordinarily serious ones — is almost entirely within your own control. You can become a helpless pile of self-pity, of benefit neither to yourself nor anyone else — or you can tackle what life throws at you head on and assume the burdens of existence with acquiescence. Like any other skill, it’s hard at first, but if you practice at it, you’ll improve. It all comes down to a simple choice, really: what kind of person do you want to be?
Christopher Graham, MD, is a radiology resident at the Ohio State University’s Wexner Medical Center.