Hematologist and Oncologist
Sugar Land, Texas
This essay is part of our series, Flattened By the Curve, which features the voices of doctors, nurses, healthcare workers, and others on the front lines against COVID-19. For information on how to submit, click here.
As an oncologist during this time, I face choices that are of a different nature than those faced by my colleagues in intensive care units and emergency rooms. Instead of rapid triage and immediate decisions on who should receive care and how much, I am challenged by more subtle dilemmas no less wrenching in their implications.
I now meet with my clinic patients through a videoconferencing application, discussing their treatments, any side effects, and what they are doing to stay safe. It’s a necessary precaution, but still isolating, tethering me yet further to a computer that already demanded so much of my daily attention. Telemedicine is draining in a way that in-person visits are not, and in between patients, I half-heartedly read the latest research papers before I refresh my e-mail yet again. My partners are doing their own telemedicine visits, so our office is nearly empty. All of us have lost long-time patients to this virus. Camaraderie is difficult to maintain these days, but we encourage each other when we can.
I struggle with how to counsel my patients. Having graduated medical school nearly nine years ago, I was taught the primacy of evidence-based medicine, a systematic approach to providing care that emphasizes the incorporation of objective research data into every clinical decision. The pandemic has thrown this sober system into chaos, shattering its illusions of certainty. What are the risks of chemotherapy for a patient who is in an assisted living home with a half-dozen other residents who have COVID-19? What are the risks of delaying surgery for a younger patient with a small breast mass that we know is cancerous? What treatments can be modified? What treatments should be modified? What tests can be delayed? What tests should be delayed?
As the answers to these questions change daily, I am comforted in my uncertainty by the generosity and understanding of my patients. Occasionally I still see them in person, typically when they are admitted to the hospital. I hope these visits mean as much to them as they do to me.
In 1891, the British painter Luke Fildes completed The Doctor, his most famous work. In it, a physician sits next to a critically ill child sometime late at night, her parents helpless in the background, a table lamp burning in silence. Fildes depicts that difficult moment when everything that can be done has been done and everything that can be said has been said, and the only task left to the physician is his most basic, that of bearing witness to another’s suffering.
I recently said goodbye to a patient whose cancer I could no longer treat. Before we sent him home on hospice, I came by his room one last time, and after we had said what we wanted to say, I reflexively shook his hand. He told me I was the first physician to touch him in a day.
Kirtan Nautiyal is a practicing hematologist and oncologist in Sugar Land, TX, a suburb of Houston. His non-fiction is published or upcoming in The Southern Review, Boulevard, Longreads, and elsewhere. He promises there is much more to oncology than goodbyes and tears.