I entered the exam room and the nearness of death permeated the air — an all-but-visible persona, like a depiction from classic literature, a dense and overwhelming presence. The visceral knowledge inundated me, and matched the intellectual understanding that there was nothing I could do.

I faced the family. My heart skidded to a near stop. Not six months earlier, I’d referred this patient’s grandparent to hospice. 

This young adult patient, refractory disease – failed clinical trial, failed everything – sent home from Big University Hospital, to my community clinic, to arrange hospice services.

But the family was desperate for something more.

I can’t do this, I thought.

You must, the clinician in me said.

But I couldn’t force myself to meet the eyes of the patient’s mother. 

What kind of person am I? First, I told this woman her parent will die. Now, within the same year, I will tell her that she will lose her child?

Yes, the clinician in me said. You are an oncologist. This is what you must do.

I hesitated.

But the specter of death insisted. Impatient. Inexorable.

Only a monster could deliver this kind of news. Twice to the same family.

My mind flashed on the alternate pathway if I didn’t. The drips and machines that we would wield in a battle doomed from the start. The tubes and lines that would bind only a body to the hospital bed.

That is not the way, the clinician in me said. You are an oncologist. You will tell them.

I went to that place inside. The one that we physicians have all created for ourselves — that place of no feeling that lets us speak the unspeakable. And I met the mother’s eyes. And my patient did not get readmitted to the hospital. And for the second time in the same year within the same family a hospice referral was accepted.

For a long time afterward, despite my head telling me I’d done the right thing, my heart considered myself to be that monster. I thought of myself in the way others have perhaps perceived oncologists to be, but I never had before—the grim reapers of medicine.

I clung to anger and bitterness at the fate that had delivered them to my practice. I hadn’t asked to be this family’s oncologist for a second time. I didn’t want or deserve their trust in me. I wanted them to be angry. To yell, to rage, to curse, to refuse. To loathe me. 

I continued in my practice as an automaton. I carried out my job, but corralled off any emotion.

Sometime later, another patient, stable with stage IV disease, called me her angel.

I inwardly rejected her gratitude.

If you only knew, I thought.

Because deep down, I feared the monster I thought I’d become. And that fear kept me trapped in the place of no feeling.

I had lost my calling. Without calling, there was only duty. A duty that I resented. The privilege of being let into someone’s life as their oncologist had gone missing.

I’d forgotten the most important part of the oncologist’s duty. It is sacred.

It was an email, of all things, that brought me back. An out-of-the-blue message from a former colleague. A link to a past blog post by Rachel Naomi Remen, from the year 2000, “Glimpse of a Deeper Order.”

In her post, Dr. Remen relates how, exhausted from her schedule of speaking engagements and teaching others, she neglected to purchase her traditional angel ornament, a ritual she had done every year for over thirty years in symbolic remembrance of her patients.

On a flight to yet another appearance, she spends the five hours in-flight writing her speech and ignoring her seat mate, a young woman in military uniform. At the end of the flight, the young woman, a total stranger, tells Dr. Remen she feels compelled to speak to her, and to give her something that her grandmother gave her to provide solace at a tough time in her life.

It is an angel ornament.

Dr. Remen calls this a moment of synchronicity. When “events cluster in particular ways that give us a glimpse of the deeper structures of reality, and suggest that time and linear causality may not be the ultimate way in which the world is ordered.”1

If you are a skeptic you will call it a mere coincidence. If you experience enough of these moments in your practice however, you might, like Dr. Remen, believe them to be glimpses of a deeper order.

Dr. Remen wrote, “synchronicity often takes us unaware and may restore us to ourselves.”1

I hadn’t before been open to the possibility that the experiences with my patient’s family encompassed such synchronicity. I had instead begrudged the forces, whether coincidental or other, that had thrust me in front of them a second time, demanding of me to dredge the deepest fabric of my soul, to find a way to say the unsayable.

The email from my colleague that pointed me to Dr. Remen’s words was, I believe, an act of synchronicity in itself. I have no idea why she sent it to me, on that particular day. Only that I am glad she did.

I examined the possibility that a deeper order had put me with this family. I let go of my selfish resentment. I found my way back from that bitter place of no feeling.

I was not the monster. Cancer is the monster.

To be the messenger of the unspeakable is a burden. But it is the burden we choose to accept as oncologists. We are not the grim reapers. We are not angels or monsters. But we are the doctors who do not turn away from their presence. 

I have not seen my patient’s family since that day. But I hold them in my heart. As we all, no matter our specialty, remember each loss alongside the victories.

Last weekend, I found myself hurrying through the store to finish my errands, when something in the bargain aisle caught my eye. A bin of holiday ornaments, marked down for the off season. An angel ornament poked up out of the jumble. At first, I ignored it and rushed onward to the next aisle.

I thought of Dr. Remen’s story. Two aisles down, I turned back.

Dr. Jennifer Lycette, MD is a medical oncologist in community practice for 11 years. She works and resides on the North Oregon Coast, where she lives with her husband and 3 children. Her personal blog, The Hopeful Cancer Doc, includes her writings on practicing oncology, maintaining hope in medicine, work-life balance, and various other musings.

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