COMMENTARY

'I Wonder if I Betrayed Him': When the Patient Is a Colleague

David J. Kerr, CBE, MD, DSc, FRCP, FMedSci

Disclosures

September 07, 2018

Hello. I'm David Kerr, professor of cancer medicine from Oxford. I thought I would talk a little about the practice of medicine and my own experience of it. I have been a cancer doctor for almost 35 years.

I thought I'd talk about when a patient is a friend. Clearly, when you get on in the world like me, when you've been around for a while, you gather patients from all over, especially if you work in a university town. It's not at all surprising that people who are friends or colleagues that we work closely with sometimes cross our path because they have cancer.

It is so fresh in my memory. We just lost a good friend. A friend of some 20 years I had worked closely with. He was in my department; we published together. He was an extraordinary person, somebody who was loved and respected around the world for the contribution that he made.

He presented with advanced colorectal cancer, primary in situ. It was right-sided disease with hepatic metastasis and peritoneal metastasis. That was 2.5 years ago and we kept him going so well with judicious use of chemotherapy, with chemotherapy holidays, and by varying the dose intensity. We kept him well with a good quality of life and with responsive disease, and working almost full-time, traveling, and lecturing. It was great.

It was always interesting that despite some of this deep insight of the disease, somehow he still managed to suspend reality. It couldn't be him, even though we had written, thought, and discussed on the subject, the prognosis, etc. It couldn't be him.

At 3.5 years, I knew that we were getting to that period in which the wheels would start to come off. We'd been through multiple rounds of chemotherapy, etc. My great friend was so impervious to it until the very end. Things happened really quickly. The peritoneal disease progressed rapidly and he had lymphangitis. He went from cycling to work to dying within 2 or 3 weeks. One might consider that a mercy rather than it being a slow, protracted thing, but it was so quick.

It doesn't make a difference having a patient who is a close friend. There is nothing different that we would've done. There is no drug that we wouldn't have given and there isn't a different pattern of treatment [we would have used]. There's nothing that I would have done differently in terms of treatment.

It's just that when we had our last conversation during which, at last, we talked about his dying, that felt different. That was real loss. Of course, it always is, regardless of who our patients are, but this is somebody that I was fond of.

I guess you betray yourself in different ways. Your voice tightens. Your throat tightens. When I was explaining that he was going home to die with palliative support and that I would be coming to visit him at home rather than him coming to visit me at the hospital, I could see how that immediately shocked and frightened him and how, at last, there was a sudden moment of realization that this was it, despite me letting him down gently. Trying to guide him towards this discussion, he just pushed away.

Other than the tightening of voice that men do, I had to quickly wipe a tear away from the corner of my eye. I wondered if I'd betrayed him in that moment of emotion that we shared between us. But in retrospect, no; it is what friends do. That's what friends do.

When you have a patient who is a friend, nothing is different, apart from saying goodbye at the end.

I'd really be interested in your own views, your own experience, and what you think. When the patient is a friend, does it make a difference in any material way to any of your clinical practice? If you've had family or anybody who's been looked after by someone who's a friend, does it make a difference? Does it make things better or worse? I don't know.

Thanks for listening, as always. For the time being, Medscapers, over and out.

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