The day I received the call informing me that my husband had sustained a cervical spinal cord injury during his team’s play-off game in a local men’s hockey league was the same day I sat with my younger sister as the oncologist told her that years of treatment had failed to stop her breast cancer. It had metastasized widely, and she would likely not survive the year. Ten days later, I would hold my elderly, frightened mother-in-law in my arms as she died; her only son was lying in the Neuro Intensive Care Unit at the University of Michigan, and no other family members were present. As for me, my hair had just grown back following my own dance with chemotherapy for breast cancer.
That year, 2010, changed me for better and for worse. Better: I believe I became a more aware and empathetic physician. Worse: Losing my sister Maria was heartbreaking beyond consolation, not just for me, but also for the devoted husband and the 11- and 16-year-old children she left behind. Better: My husband, Brian, and I learned to navigate through his rehabilitation and the emotional challenges associated with a life-changing injury. Worse: My mother-in-law died without seeing her beloved son one last time. Better: I’m still here, although I can assure you, there is survivor guilt when your little sister is the one who dies first.
Although I would never wish pain and suffering on a physician colleague, I can tell you that hardship has provided me with perspective, empathy, and wisdom beyond anything I gained in medical school or on grand rounds. In 2008, in the calm before the storm, I thought I was a pretty good doctor. I loved what I did, I worked at keeping current with advances in anesthesiology, and I felt I was able to connect well with my patients. But after my year of heartache, I realized I really hadn’t known what personal anguish a patient experiences, or for that matter, the stress that family members undergo when their loved ones are ill or dying.
Let me step back and provide a little perspective on my road to medicine. According to family and tradition, I wasn’t supposed to become a doctor. As the eldest daughter in a highly traditional Sicilian family, I was expected to marry young—and to marry Sicilian. I’m not kidding. How many of your parents were disappointed that you chose a career in medicine over a career as a housewife? Thankfully, mine got over their disappointment and even came to respect my decision. It soon became clear that, as the only physician in a family of eight siblings, I had the responsibility of caring not only for my patients but also for my family. This, then, was the point of departure for my professional and personal journeys.
Pain and suffering, even that experienced by loved ones, wears you down. Before we learned of my sister’s diagnosis, I was happily immersed in a satisfying career as a clinical anesthesiologist and department chair. Then came the news that Maria, at the time only 40 years old, had triple-negative breast cancer. My controlled world turned into one of emotional upheaval driven by my care and concern for her well-being. Throughout her years of seeking treatments that might stem the disease, she and her family had intermittently lived with me and my husband and our three sons. On one occasion, Maria participated in a clinical trial that was administered through a cancer center near our home. Although I loved having Maria close by, I felt her anxiety and witnessed her struggle each time I accompanied her to medical appointments or chemotherapy infusions. I became increasingly stressed by and frustrated with my inability to make her better.
As many of us know, the interventions we put our patients through can be worse than their disease. Maria underwent mastectomy and reconstructive surgeries and had been receiving chemotherapy for about a year when my cancer diagnosis required me to share that misery.
Chemotherapy is evil. Maria and I called Adriamycin the “red devil.” Maria’s stomach proved tougher than mine. I became so ill that every time I received the drug I developed anticipatory nausea; I would retch as soon as my port was disinfected with alcohol. Can you imagine an anesthesiologist troubled by the smell of an alcohol wipe?
The red devil worked for me. It didn’t work for Maria. Another chemotherapy drug, Taxotere, caused her severe, searing bone pain. She would go on to suffer three additional chemotherapeutic agents, including those she received during her participation in the PARP inhibitor trial. For that trial, Maria had initially been randomized out of the treatment, but then was given the experimental treatment as compassionate care. It was during that regimen that we learned she had not responded; the cancer had been found in her brain, her lungs, and her liver.
Physicians can become annoyed by, and critical of, seemingly needy patients and their families. Not only did I need to deal with my own emotions while watching my sister wither away, I also acted as go-between with my family. This meant that each day during Maria’s illness, my father would ask me the same question, “Maria is going to be all right, isn’t she?” One day, I just could not bear the burden of his sadness anymore. I blurted, “Dad, stop asking me a question you know the answer to. Do you want me to lie to you?” The look on my father’s face caused me to immediately regret my harsh response. Now, when patients and families press me for answers to difficult questions, I remember the expression on his face that day, and I strive to be as compassionate as possible.
Chronic neuropathic pain leaves the best of us open to depression—and opiate dependency. My husband, a practicing neonatologist, was no exception. The central C5-C6 cord injury that Brian sustained four months before Maria died had initially resulted in full quadriplegia. Over time, however, he was fortunate enough to regain his ability to walk and the partial use of his arms and hands. Unfortunately, he also suffered spasticity and neuropathic pain. Brian came home from his eight-week rehabilitation stay with a dependence on oxycontin. His mood was often dark as he mourned the loss of his career and the use of his hands. Even my work with patients in my chronic pain practice did not prepare me for what he faced following his injury.
Hospitalization and an addiction specialist helped wean him from oxycontin. His spasticity and pain, however, will remain a lifetime challenge. Realizing this, I have learned to be much more aware of his daily ups and downs. Most days we joke, and I try to keep things light. But Brian’s frustration can easily ignite when I need to assist him with simple tasks, such as tying his tie, buttoning his shirt, or changing a lightbulb, or whenever he mourns the loss of his career. We are well aware that going forward, each day will test us.
My family and I were at my sister’s side when she passed away in February 2011. As an anesthesiologist, I typically don’t see death in this way. I am now, however, acutely aware that every time I anesthetize a patient, I hold a precious life in my hands. This realization has, I think, made me a better physician. I only wish the cost of this lesson had not been so enormous.
Rosalie Tocco-Bradley ’88 is regional chair and medical director of the Department of Anesthesiology and Pain Medicine for St. Joseph Mercy Health System (CHE-Trinity Healthcare); chief clinical officer of Anesthesia Associates of Ann Arbor; and a member of the Michigan Board of Medicine.
This essay was adapted from “Becoming a Better Physician … at a Cost,” ASA Newsletter 78(7): 33-34 of the American Society of Anesthesiologists.A copy of that text can be obtained from ASA, 520 N. Northwest Highway, Park Ridge, IL 60069-2573.