COMMENTARY

When a Patient Turns Into a Friend

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

Disclosures

September 07, 2018

Hello. I'm David Kerr, professor of cancer medicine, from the University of Oxford. I thought I'd talk with you about the practice of medicine when a patient becomes a friend.

Clearly, all of us do our very best to look after our patients as best we can. All of the interactions in medicine are predicated by love—not romantic love, but the love of our brother, sister, mother, father—and clearly, patients want us to love them because if we do, we will do more for them.

Years ago, I was a young fellow in Glasgow and became very friendly with a patient who was the same age as me. She also had a family of about the same size; therefore, there was an element of self-identification. She had advanced hepatocellular cancer and received a liver transplant, but it recurred. This was in the 1980s, so I treated her with doxorubicin (that's all that we had then) and I put her into phase 1 trials, believing that the preclinical rationale implied that the drug would work. I was eternally optimistic.

Throughout the 2 years I looked after her, I was friendly with her husband and her family, who came with her from her village in Ayrshire. Two incidents stick out in my memory. One was her funeral. I have only ever been to four of my patients' funerals. It is not a thing I make a habit of, but Heather was special; she was a friend. That is what delineated her.

She lived in a mining village on the west coast of Scotland. It was a wet, miserable day and the whole village came to her funeral. It was very traditional and her coffin was carried by her husband, her father, her brothers, and me, for a while, up a long, dreary hill to a graveyard with a wonderful view of the surrounding hills and glens. The priest was moving in the words that he said. The whole village turned out for her, and that really counted. That was memorable.

Also, I did a strange thing, [as] I have no faith. I was sent to Sunday school when I was young. I was in the Boys' Brigade, sure and steadfast, but decided when I was 12 or 13 that it just did not make sense to me. In the midst of looking after Heather, I had to go to Paris to give some talks, and I went to Notre Dame—a wonderful Gothic cathedral which is extraordinarily beautiful. I am not of faith—if anything, I am slightly Protestant; Heather was Catholic—but I was awfully moved to light a candle in Notre Dame and think about her, even as a heathen. I offered up a prayer, a plea.

Some months later I happened to be flying back from New York, and I was sitting beside (then Archbishop, later to be Cardinal) Thomas Winning, who was a very clever, very personable man of the people. We were chatting and I asked him if there was any possibility that I could have caused any offense as an ex-Protestant heathen by lighting the candle for Heather in Notre Dame.

He said, "Don't be daft, son. How could the power of prayer be anything negative? Even if you're pointing heavenwards, words on behalf of somebody else and looking for help—what could possibly be wrong with that?" I never forgot that.

There are two elements when a patient becomes a friend. First, do the best you can, leaving no stone unturned. We do that for all patients, but lighting a candle in Notre Dame and helping to carry her coffin to her last resting place [was for my friend]. Patients can become friends and perhaps we pay an extra homage to them.

Thanks for listening. I'm happy [to read] any comments that you make. For the time being, Medscapers, over and out. Thank you.

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