By Young Kwang Chae, MD
Translated by Grace Lee
It has been over 15 years since I came to the U.S. following my service as a public health doctor in Korea. If I were to describe my life until now using one word, what would that word be? As someone who has been a medical student, a researcher, and now a medical school professor in the U.S., I believe that the one key word for my life would be ‘humility.’ I met a myriad of people and had many unique experiences during my time in Baltimore, Philadelphia, Houston, and Chicago. Reflecting back, however, I realize how narrow my vision and how superficial my knowledge had been in the past; I confess that I still have a long way to go as a son, a husband, a father, and as a physician.
The more I learn about humility, the more I look forward to growth. It’s quite paradoxical.
Especially as an oncologist who specializes in cancer therapy, I spend a lot of time with patients walking the thin line between life and death, so working in the clinic always humbles me. The clinic is where I constantly realize that my troubles and complaints are incomparable to the suffering and pain that my patients experience. Interestingly, however, the more I am humbled, the more I discover there is to learn. The more I learn about humility, the more I look forward to growth. It’s quite paradoxical. As I grow older, my expectations for the following year grows, as well. With each year, I look forward to growing more as a person as I discover and learn more about humility. The more I learn about humility, the better I can see how I can grow Among my patients is a middle-aged woman with lung cancer who has the EGFR mutation and does not have a history of smoking. Cases like these generally have a good prognosis, as patients tend to respond well to targeted therapy. However, this patient was not responding to any of the targeted therapies, traditional chemotherapies, or immunotherapies prescribed to her. Eventually, this patient took part in a clinical trial that involved an antibody-drug conjugate targeting the EGFR mutation, but she unfortunately still failed to respond. During this time, the patient experienced extreme fatigue and had difficulty breathing, and she ended up being hospitalized. My team and I were all worried for the patient, who herself seemed to be disappointed and tired from the fact that she was not doing better despite going through five different therapies. After a long conversation with the patient, we decided to try a slightly different combination of immunotherapies and chemotherapy reagents before she left for the hospice. Medically speaking, the probability that this combination therapy would work was very low, but I prayed for a good outcome regardless. After being discharged from the hospital, the patient received outpatient chemotherapy and came back the following week for the next cycle. When I saw her that following week, I was blown away by her improved condition. The patient told us that she no longer had difficulty breathing. She also felt rejuvenated and ended up going on a trip with her family from Chicago to Michigan for a couple of days. Even more surprising was the fact that the metastatic tumor that was present on the skin of her left chest was completely gone.
The day that patient came in, the clinic had been extremely busy, and the team was exhausted from a morning filled with difficult decisions. However, seeing the progress this patient made, all our exhaustion melted away. My team and I high-fived, reveling in the happy news brought to us by our patient. The patient and her family expressed how happy they were that the treatment seemed to be working and shared their thanks with us. Within the grueling journey of cancer treatment, it was relieving and refreshing to see how the patient, the patient’s caregivers, and our medical team united as one, going through both happy and sad times together. Response to treatment is a blessing that should never be taken for granted and instead be celebrated at every step. It is also a blessing to be able to share happy moments together with patients. That week was one filled with learning, during which I was able to deeper understand ‘humility.’
I would like to add, however, that a later CT scan showed that the patient’s cancer had actually progressed. I was devastated when I first heard this news. I had been so caught up in celebrating the happy news with the patient and her family that this development hit me twice as hard. However, as I reflected on the situation, I came upon the realization that I don’t only have to celebrate the “successes” in a patient’s journey throughout treatment — that a patient’s attitude, spirit, and endurance are still worth celebrating. With this realization, I started to envision an environment in which my team and I could celebrate and encourage patients and their caregivers for their endurance and perseverance — for being troopers who can tolerate and not lose hope during trying times. My team and I started coming up with creative awards to present to patients and their caregivers: “best smile award,” “best attitude award,” “sunshine award,” … The effects of the awards were immediate; I would see patients and their caregivers light up with smiles on their faces as they became recognized for things that are often overlooked. As I witnessed the positive effects of the awards taking shape in the clinic, I began to dream about how wonderful it would be if more healthcare professionals engaged in such meaningful celebrations, becoming “pacemakers” for patients and their caregivers in the marathon of cancer treatment. With this vision in mind, I founded a movement called Pacemakers, an organization dedicated to cultivating creative encouragement and companionship for patients and caregivers on their treatment journey.
Happiness from forming relationships with patients
Happiness in life stems not from material possessions, but within interpersonal relationships. For me and my team, forming meaningful relationships with our patients in the clinic is a significant source of happiness. How beautiful it is, to be able to help and support people through tough times. Whether sharing good news with patients and celebrating milestones in treatment together or recommending the hospice to patients and assuring them that they’ve worked hard throughout the difficult marathon of cancer treatment, the conversations that take place in the clinic are like art; they are the result of the relationships and trust built through time. I always ponder how to best create these artful relationships, as I wish to become a physician who can better express my feelings. Often, I notice that patients and their caregivers do not know when or how they should express relief or be sad. It is often because they do not know whether their progress is “good” or “bad” relative to other patients. I often tell my patients that I am happy to see them persevering so well through therapy or showing a good response to the therapy they receive. It is after hearing such words that patients begin to crack a smile. When I ask patients how they’ve been, I sometimes ask the same to their caregivers. I even hug some of the caregivers, knowing how difficult the journey must have been for them, too. This often causes them to start shedding tears, perhaps because they feel they are finally being recognized for their efforts behind the scenes. Consoling the families of the deceased and reminiscing about relationships From a certain point in my life, it occurred to me that I should, to the best of my ability, call and follow up with the families of my patients after they pass away. I wanted to start doing this in order to feel a mutual comfort in remembering and cherishing past relationships. I often find myself having to wipe tears from my face as I talk with my late patients’ families and share memories of their loved ones. Recently, I ended up crying with a group of my patients’ caregivers as I spoke to them over the phone, and I was pretty surprised to see how emotional I had become. Once, a late patient’s wife and son came into the clinic with teary eyes to ask me to attend the patient’s funeral. I had been prepared to tell them that I could not attend due to my busy schedule and to apologize, but I just could not bring myself to say those words once I saw their tears. Eventually, my team and I all attended the funeral, which took place in a church located in the South Side of Chicago. Many people, including myself, shared stories and memories in remembrance of the late patient. Attending this service helped me realize how meaningful it is to reminisce about the deceased and simultaneously console one another through such remembrance.
In the past, I was more interested in treatments and their mechanism of action than the patients themselves. I thought more about patients’ symptoms than I did their emotional distress and the toll their illnesses had on their relationships with their families. It was as if I considered my patients’ hardships as somebody else’s business. However, more recently, this has not been the case. Especially after witnessing firsthand my close friends and family suffering from cancer, I have been feeling more and more as if my patients’ hardships were mine as well. There are always some patients and/or caregivers who ask how I am doing when they come into the clinic, not just out of courtesy but because they genuinely want to know if I’ve been well or had a nice vacation. There are even some who tell me that they pray for me and my family’s health every day. Small interactions like these never fail to brighten my day, even on a particularly rough day. There have been times when I felt my throat closing up from emotions as I closed the door to my clinic room. It is in these ways that my patients and I support and console each other, especially as we continue to become poorer in spirit. Hoping to support and encourage patients I can now see what I could not in the past: the hardships that my patients face and the tears that they shed. Now, even amidst my busy schedule, I want to offer as much help as I can to my patients. I want to give them sincere words of encouragement and consolation. This is evidence that I am growing as a person. I am becoming humbler and poorer in spirit. One of my biggest hopes is to live a life in which I can laugh and cry together with the people around me. Especially as an oncologist, I hope to live a life in which I share my happiness and sadness with my patients. Of course, I need to make sure I don’t get too emotionally invested to prevent myself from experiencing burn-out. I need to always maintain objectivity, as well. However, the Romans 12:15 verse, “Rejoice with those who rejoice; mourn with those who mourn,” keeps speaking to me. Like this Bible verse, I wish to live a life in which I can celebrate and mourn with patients and their families. From time to time, I recall when, during my residency, I cried in the emergency room of a Philadelphia hospital while filling out the admission order for a leukemia patient because I felt so sorry for the patient’s suffering.
In the past, I had ambitious aspirations to run towards recognition and fly towards success. But now, I know that happiness can come even from crawling slowly towards the finish line, so long as I am with people who I can laugh and cry with together.
Healthcare professionals must always think about their patients; once they begin to think that they have bigger fish to fry, they lose space in their hearts for patients to dwell. At least in the clinic, I want to treat my patients like they are the only ones that matter in this world. I want to celebrate anything and everything there is to celebrate about them. My team and I started a tradition in which we celebrate our patients by awarding them certificates for small milestones in their treatment journeys — for example, for completing four rounds of adjuvant chemotherapy after surgery, for successfully completing 100 cycles of immunotherapy, etc. My heart is full just thinking about planning a celebration for the lung cancer patient who began responding to the combination therapy I mentioned earlier. I cannot overstate how thankful I am to work with my colleagues, who genuinely love and care about our patients. It is because of my patients, my colleagues, and the beautiful relationships that form between them that my life continues to improve towards complete humility. In the past, I had ambitious aspirations to run towards recognition and fly towards success. But now, I know that happiness can come even from crawling slowly towards the finish line, so long as I am with people who I can laugh and cry with together. My aspirations are ongoing and simple: to just become a humble man.
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Translated by Grace Lee
Originally published in the SIGETOP
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