Dear patient, I hope this letter finds you well. It seems foolish to ask if you remember me. I’m sure you couldn’t forget me if you tried. I’m the centrepiece of the worst memory of your life. I was the doctor who broke the news you were dreading, that you had cancer. Stage 4 cancer, incurable cancer. I’m sure you’d recognise me if you saw me in a crowded room. My face was the last thing you saw before you lost hope. My face destroyed your world. When you’re a doctor, telling a patient they are dying gets easier. It does. In fact, with time some doctors seem to forget that even though this is the hundredth or the thousandth cancer for them, it’s their patients first cancer. You didn’t know this then, but your cancer was my first cancer as well. Since that conversation I’ve diagnosed many more cancers, and I’ve told many more patients they are dying, but your story has stayed with me. Your story, I’m sure, will stay with me for the rest of my life. I first met you in a busy emergency department. You’d come in with a cough. (Just a cough!) But something wasn’t quite right. I had an uncomfortable feeling from the moment I met you. Two years later I’ve learnt that that feeling- that sinking, nauseating feeling in the pit of my stomach that a patient is much sicker than they look- rarely lets me down. You taught me that. Your X-ray showed pneumonia and I admitted you, but after two days of antibiotics you weren’t getting better. Then the lab called and said your pneumonia was caused by a odd bug. A bug sick people get. But you weren’t a sick person. You were 37 and fit. Why did you have this bug? I came back and asked you the same questions I’d asked you in the ED again, but this time you told me different answers. You told me about the weight loss, the sweating at night, the blood when you coughed. The next day we scanned your whole body, but really we already knew what the answer was. There was cancer everywhere. We think it started in your lung but it was now in your liver, your bones and your brain. Inoperable. Incurable. You probably only had weeks left. I remember breaking the news to you like it was yesterday. We were both terrified but I was pretending I wasn’t. I told you that I was sorry, and I truly was. I hope my voice didn’t shake. I hope my face was kind. You cried and my heart broke for you. I wanted to hug you and tell you things would be alright. But I couldn’t, and they weren’t going to be. I hope you didn’t realise that when I left your room an hour later I was crying too. I took your cancer so personally. I felt that I had failed you by not being able to offer a cure. I cried myself to sleep for many, many nights and tormented myself that if I’d seen the signs the second I met you, or that if I’d taken a better history you could have been saved. I know now there is nothing anyone could have done. You accepted you were dying long before I did. In fact, I didn’t accept your death until long after you’d gone. You weren’t the first patient of mine to die, but your death left me broken. I felt like I wasn’t worthy to be a doctor. That I should have been able to save you. You were only with me for 4 short weeks, but in that time you taught me more than many of the professors and teachers I’ve known have taught me in years. You taught me to be empathetic but wise, compassionate but brave and that being vulnerable and emotional were both my best and worst qualities as a doctor and a human. You taught me that I couldn’t save everyone, but that saving people wasn’t always what mattered. There were more important things in life – dignity, kindness, being at peace with yourself… I knew back then that my face was the one that changed your world forever, of what a huge role my character played in the story of your life. You didn’t know then, what a huge role you played in mine. I hope this letter finds you well. I hope you found the peace I couldn’t give you. Yours most sincerely, Your doctor.

Medical Exam Prep would like to thank Dr. Ashleigh Witt for this guest blog post. About Dr Ashleigh Witt Dr Witt is a medical resident and physician trainee at Western health in Australia. You can read more posts from her at the following blog: http://ashleighwitt.blogspot.co.uk