Letter to an oncologist: Do you remember my mum?

Ten years after I treated her dying mother, this aspiring doctor wants to meet me

Dear Dr Srivastava, you won’t remember me.

My eyes fly to the bottom of the page and I feel a thud in my chest. You couldn’t be more mistaken, I murmur.

You used to tuck yourself in next to the sink in my office, the one with the annoying water tap that would start gushing at the slightest movement and embarrass you until I gently suggested that I had the same problem and you should move your chair a little closer to my desk. I know you wanted to be anonymous, but that really wasn’t possible in those close confines or our precise circumstances. No one attends regular oncology consultations and stays anonymous, even if you were only 13 years old and there for the sake of your mum and dad.

I remember every bit of your innocent face, your pensive expression, the body language that spoke of your sadness but also your determination to make the journey with your parents because it was the right thing to do. Sometimes you came in your school uniform, sometimes not – it all depended on the vagaries of the appointment system that I am afraid wasn’t set up to cater to your needs. But you came nevertheless, part of a tight family unit that threatened to break before not too long. Sometimes I made small talk, hoping to pull you into the decidedly medical circle. How was school? Did the principal know? Could I call someone? You were quiet and courteous, determined to hold it together.

You have many patients, but I hope you recall treating my mum.

I do. To this day, I remember the cubicle in the emergency department where I told your parents that her back pain and weight loss were a result of advanced cancer. She was stunned. But I am young, she said, and I have never been sick in my life. Did they switch the scans, your dad puzzled. No, I replied gently. This happens. Bad luck just happens. I will do my best to treat you. At this, your mum politely asked if she could seek a second opinion. I told her I’d want to do the same. Days later, she returned. I am going to put my trust in your hands, she said.I feigned confidence and pushed my dread aside.

Thankfully, she felt better after the first round of treatment. Her pain diminished and her weight improved. Subsequent rounds brought more benefit, and for a period, your family discovered a newfound normality. I can’t tell you the relief it brought me.

When mum died, I interrupted my studies to get our lives in order.

One day your mum announced that further treatment for her progressive disease was traumatic and futile and she would rather spend her days at home than in my waiting room. I told her I agreed. Shortly afterwards, she slipped away. Your dad had showed enormous fortitude but now he said that he lacked the strength to continue on his own. He wanted to move to the city of your grandparents, and who could blame him? But I felt privately conflicted. I cared about your bereaved dad, but I had grown especially fond of you for your precocious dignity and composure through an unimaginably difficult time. With your mum gone, I wanted you to remain in the embrace of your old school, your good friends, the parents of those friends. But parenting is hard work, harder still when a single parent feels on shaky ground. So, when your dad and you came for a final time to say thank you and goodbye, I met your gaze and quietly said: “You’ll do well wherever you go. Get in touch if you ever need a hand.”

It took me time, but now I am a medical student.

I have often wondered if the experience of your childhood left you inspired or damaged. A dispassionate observer might say that it was biology and not medicine that failed your mum, but you had an insider’s view. You endured the long waits in clinic, the days of inadequate symptom relief, the times nothing would mitigate her suffering until her slow, sure, untimely decline. The end was quiet, but the journey was rocky.

Over the years, has the memory evoked your sympathy for the limitations of medicine or frustration at the slow pace of change in an era when so much is available at the touch of a button? There are newer drugs now, but the patient experience may not have changed that much. I can’t help wondering whether the image of your mum in every patient will spur you on or hold you back. However, I will say that some of the best doctors I know are people who have first-hand experience of the vicissitudes of life.

I know you must be very busy, but can I sit with you in clinic one day?

I was hoping you’d just want to talk to me about a life in medicine and we could get by on generalities. But actually, you are asking to walk through the same doors as your mum. Do you know that the chairs are still arranged in the same way? And the tap still gushes at the slightest movement? More patients are benefiting from advances in medicine that your mum didn’t live to see but still, this rarely dilutes their anxiety or vulnerability. Having cancer remains challenging, and suddenly, I feel protective of you that you should face your past all over again. What if I did you a disservice?

I am sorry for appearing out of the blue, but I had to ask.

People assume that a family’s relationship with an oncologist is fleeting and marked by sadness. Bereaved relatives are convinced that their loved one was only a number. To you, we must all be the same, a patient once said to me. But I told her she was wrong. Every patient conveys a lesson. Every patient leaves an impression. The way someone spoke, acted or faced mortality. Your mum’s diagnosis was common, but she was uncommon. She was always kind, gracious and calm. I also remember how proud she was of your character, of the same composure that I grew to admire because it should have belonged to someone older than 13. You anchored your family at a devastating time.

I understand if this is inconvenient, but I hope you say yes.

Part of me wants to say a polite no, the part that would have loved to save your mum so she could witness your accomplishments. Seeing you will mean remembering her and talking about her, for how could it be any other way? I sense from your letter that you want to tell me how you managed things in the aftermath. And I’d be curious to know how you chose the path to becoming a doctor.

What if we are undone by the occasion? But I feel that’s to not give you enough credit for the 10 years you have spent in reflection. So, if I can play a small role in your life, I shouldn’t flinch so easily.

Please let me know.

In two minds, I ask a nurse if she remembers you and her eyes light up. She used to treat your mum. And then I think how lovely it might be for you to feel our warmth again, to know that we never forgot you. My mind is made up. Ten years after we met, the best tribute I can pay your mum is to greet you as a colleague. She would be proud. I will be in touch.

Written by Ranjana Srivastava for The Guardian ~ August 22, 2019

Ranjana Srivastava is an Australian oncologist, award-winning author and Fulbright scholar. Her latest book is called A Better Death

Editor’s Note:  Photograph: ER Productions Limited/Getty Images