Gown and Coat

“It’s just become overwhelming,” Mrs. Perez whispered.  Her daughter Jacinta wandered, wiggled and stomped around the exam room, peppering me with questions.

“What’s this?” “Where are the Band-Aids?”  “Does this sink work?”  

“It does, Jacinta.” I replied. “Why don’t you wash your hands?”  

She set to work with a large squirt of soap as her mother and I talked.

“Jacinta is just too much lately. Her preschool is always calling me, saying she won’t listen and she hits other kids.  They think she has ADHD, but I told them you already tested for that.”  Mrs. Perez sighed. “But I’m more concerned about Anton.”

Throughout the several years I had been Jacinta’s pediatrician, her teenage brother was in treatment for a rare type of lymphoma.  

“At least the chemo is over, and he’s in remission, thank God.  But he just mopes around the house.  He doesn’t really have friends anymore.  They scattered away after his diagnosis.  And he’s so angry. His temper flares at the smallest trigger.  He throws stuff, punches walls.  Sometimes Jacinta gets scared of him.”

Her tears welled.

“Have you talked to his oncologists about all of this?”  

“Not really.  We don’t see them much anymore. The social worker suggested some support groups. He went to one but it wasn’t his style – mostly rich kids.  And I think it would be better if he could talk in Spanish. I don’t know what to do. He can’t seem to stop the anger.”

Mrs. Perez gazed at the floor, wiping away the smudged mascara gathering under her eyes. Jacinta paused her handwashing, crept up and hugged her mother’s leg.

“I just thought once he was in remission it would all be over.”

Medical school had provided training for this situation – offer a tissue, put a hand on the patient’s shoulder, speak with quiet and firm sympathy.  Say gently, “I’m so sorry you’re going through this,” then suggest a meeting with the social worker to widen the circle of support.  

Though a well-intentioned template, I found these instructions hollow.  Certainly with our own patients we could be more genuine.  But we were warned not to become too emotionally involved.  It was the patient’s suffering to bear, not ours; we could only try to ease the burden.  As the doctors, we were not the sick ones.  We wore the white coats; patients wore the gowns.

“You know, Mrs. Perez, I had cancer as a young adult.”  The words came out before I could restrain them.

She looked up, her eyes now wider and softer.

“Really?  So you know.”  

The despondence in the room began to dissipate.  

“I was a little older than Anton, and I had a different kind of cancer.”

“But you went through it – you know what it can be like,” she urged.

“Well, I know a few things.  First it shatters you.  Confused and terrified, you scramble to reorder the pieces of your disrupted life.  Treatment ends, and you think you’ve put everything back together.  But cancer haunts you. You get through the pain, the nausea, the exhaustion.  What you don’t expect is how you become scared of being happy.  I kept waiting for the anvil to drop on my head again.  And my anxiety and anger affected all the people close to me.  Everyone else was planning their future while I thought only three months ahead, living at the mercy of the scans that searched for recurrence.”  

“Ugh, yes! Only the people who’ve gone through it seem to really get it,” she sighed.  “Doc, it’s so good to know you’ve walked the walk.”

I had never shared my own medical history so explicitly with a patient.  But in the moment, I felt my revelation was a healing act.  It dismantled the barrier of the white coat.  It brought deeper trust and broader healing.

I arranged play therapy for Jacinta, discussed the roots of her attention-seeking behavior with her teacher, and recommended a Spanish-speaking male therapist for Anton.  Mrs. Perez finally felt comfortable seeking therapy herself.  I showed her some online resources for young adults with cancer – those in which I had also found solace.    

I became a cancer patient as I became doctor; I wear both the white coat and the hospital gown.  I’ve scrubbed into surgeries and been operated on myself.  I’ve been told “I’m sorry, the mass is malignant” and given the same life-changing news to others.  

With this parallel education, I learned not just when to order an MRI, but how to describe its cramped warmth, loud bleeps and whirs. To understand not just the findings of a biopsy, but how to endure the endless time between a test and its result.  To decide not only which treatment is indicated, but to know the feelings of unbearable nausea, searing pain or existential despair.  To think beyond a diagnosis and consider how an illness may impact a psyche, a family, a career, a community.  I knew how to address the suffering that rippled out from Anton’s first tiny cancer cell because my family had been caught in a similar wake.  

Doctors are just as human as anyone. Our degrees give us knowledge, but they do not confer superhuman powers.  We too are vulnerable, we too suffer.  I can recite the cascade of proteins that make the blood clot, but I bleed no differently.  I can explain the genetic changes that cause cancer, but my genes still mutate.  I can discuss a disease’s survival rates, yet I can do little to lengthen my own life.

Our tailored white coats are not impregnable shields.  At any moment, they could be traded in for a hospital gown.  When we remember this – that our humanity is shared and our vulnerability can be a strength – truer healing can begin.  

 

*All names and identifying details of patients and their families have been changed to protect their privacy.