The Fragile Bonds of Cancer

I went to another wake today: A 50-year-old woman, in the prime of life, struck down by cancer. I was her oncologist. I went to pay homage to her life, to hug her family once again, to walk the final leg together of what was an intense two-year journey. All that needed to be said had been said many times before. I shed my tears a month ago when her condition took a dramatic downward turn; I didn’t know if I would once more.

As I drove toward the funeral home, I encountered heavy traffic. I thought to myself, It couldn’t be…all for her, could it? I looked ahead and saw a police officer directing traffic. Cars were being diverted to the shopping center across the street; the funeral home parking lot was full. Of course, it was all for her, for Sue.

Sue had legions of friends. She was deeply caring and intelligent—someone who could see right through the fluff in life and insincerity in certain people. She survived a major car accident when her three children were young and prayed that she’d make it to see them grown. She survived a divorce and raised them on her own, her way. When the diagnosis of pancreatic cancer hit, she faced it with fierce inner strength and a focus on living as long as possible, in the context of her life, so that she could put the finishing touches on her children (now in their 20s). It was always about the children.

Keeping memories alive and maintaining a connectedness amongst those who will never forget the deceased is an essential part of feeling joined to humanity.

I can’t go to every wake, but I always either call the family or send a card of condolence. It’s not only proper but also cathartic. I tell them how much I cared about their loved one, mention the special traits that I came to appreciate and acknowledge how much I know their loved one will be missed. I find it very sad when the spark of a life goes out. I feel for those who need them. My own father died when I was 9, and my mother died four years ago. I lost my best friend to cancer—I know the fragility of life. Keeping memories alive and maintaining a connectedness amongst those who will never forget the deceased is an essential part of feeling joined to humanity. I reach for it again and again.

And so I sometimes go to wakes and funerals, even though they are difficult for “the doctor” to attend, for all the reasons imaginable. It doesn’t matter if it’s a small group or a large one. I imagine the eyes I’ve never seen peering at me, somehow knowing I’m the doctor who couldn’t save their friend or family member. When I stand in the receiving line, the air is thick and I hear murmurings about what people think actually happened to the person, medically speaking. Few know the details, the visits, the toll of treatment, the heavy conversations, the highs of good results, the misery of bad news. As a central figure in a cancer patient’s life, I am privileged to join the inner family circle, but it is only a temporary membership. The eyes can’t possibly know these things, I tell myself to bolster my nerve. A second later, all nerve evaporates with a thought—It’s as it should be; I am the outsider.

Inside the funeral parlor, I quietly join the line and estimate an hour until I get to the front. I know I’ll never make it. After five minutes, the eyes get to me and I bolt out in a sweat. I’ll come back later, when the crowd is thinner, I think. As I walk away, I run into one of Sue’s good friends and we embrace. Soon, Sue’s eldest son comes out to bring me in. Handsome, tall and mature, he’s totally in control. I see how well Sue did her job. I’m ushered straight to the front, and I join the inner circle one more time.

The main challenges to being an oncologist are humanistic, not medical. We struggle to show our humanity to our patients and to let their humanity touch us. We form special bonds with those we care for, wrought through a common struggle, increasingly over the course of years. When a life ends, our bonds usually end and we grieve. It’s not quite closure, but it is vital for us to reach out to families after their loved ones die. It means so much to them and, surprisingly, to us too.

—Richard C. Frank is a medical oncologist at Norwalk Hospital in Norwalk, Conn., and the author of Fighting Cancer with Knowledge and Hope.