In anticipation of our upcoming Women in Medicine Summit where Dr. Lucy Kalanithi will be one of our keynote speakers, I am re-reading the book written by her late husband Dr. Paul Kalanithi, When Breath Becomes Air. I could quote the entire book when sharing sections that stay with me. Here are the two I chose. The first is when Dr. Kalinithi’s oncologist makes this powerful statement:
“I’m totally happy for us to make your medical plan together; obviously you’re a doctor, you know what you’re talking about, and it’s your life. But if you ever want me to just be the doctor, I’m happy to do that too.”
Different patients desire a different level of involvement in their own care. Some prefer a physician to make all their decisions, while others prefer a team based approach where decision making is done with physician and patient discussing and weighing the options together.
As a patient who is also a physician, the burden of trying to manage and understand one’s own diagnosis, and make decisions based on what the science says, and what is in line with one’s own personal goals and desires, can be a difficult internal struggle. Objectivity in taking care of the patient can go right out the window when the patient requiring treatment is you.
This statement from Dr. Kalanithi’s oncologist is so powerful and so important. Sometimes, giving the patient the power to BE the patient by saying out loud these simple words, especially when the patient is in healthcare, can be exactly what they need to hear.
They may not want to abdicate that role, but giving them the choice to just be the patient may allow them to traverse the diagnosis with more peace of mind, regardless of the way they choose to move forward. And in the future, if they decide to just be the patent, mentally they have been given the permission to do just that.
Another section that sticks out comes from the epilogue:
“This book carries the urgency of racing against time, of having important things to say. Paul confronted death-examined it, wrestled with it, accepted it- as a physician and a patient. He wanted to help people understand death and face their mortality. Dying in one’s fourth decade is unusual now, but dying is not.”
As an oncologist, I walk patients through death and dying on a regular basis. Simply seeing a visit with me on their calendar can elicit high levels of anxiety and stress for my patients and their families. With each visit, phone call, conversation, my patients and their families worry if this will be the time I tell them the cancer has recurred, or if we have run out of treatment options.
That humanity, remembering that each person has a family, a job, a life, outside of the walls of our clinic, of our hospital, is what makes me more dedicated to providing each patient care personalized to their lives.
Allowing my patients to not just exist with cancer, but live with cancer, get the most of their time on earth and feel some control, when they often feel they have lost any decision making in their lives, that is what continues to drive me forward as an oncologist.
This book, and Drs. Paul and Lucy Kalinithi’s story, is a beautiful, poignant, and sometimes painful reminder of what our patients experience when they leave the doors of our clinics.
I am also reading Why So Slow? The Advancement of Women by Virgina Valian.
Several sections in this book bring up questions and solutions posed in unique ways that I think get to the heart of why gender inequities are so pervasive in our society. One such example is this section:
“Two different questions can be posed. The first is, why have women advanced as much as they have? The second is, Why have they advanced so slowly? The second question is easier to answer than the first. Schemas change slowly, especially if people do not know how schemas operate. Even when they do know, they may require frequent reminders…Unless we- women and men alike- understand how gender schemas disadvantage women professionally, women will not receive the positive evaluations their work merits, women will get less than their fair share, and women’s advancement will continue to be slow.”
This book also provides some powerful solutions on how to work towards a more equitable society including more accurate evaluations, challenging our own underlying biases, conducting thought experiments by switching the sexes and seeing if your conclusions remain, awareness training, institutional policy changes, and more objective performance evaluation criteria, to name a few. Many of these types of interventions can all make an impact and are just a few of the solutions described in this objective, well-written, thoughtful scholarly book.
