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time I accompanied her to medical appointments or chemotherapy infusions. I became increasingly stressed by and frustrated with my inability to make her better.
As many of us know, the interventions we put our patients through can be worse than their disease. Maria underwent mastectomy and reconstructive surgeries and had been receiving chemotherapy for about a year when my diagnosis required me to share that misery. Chemotherapy is evil. Maria and I called Adriamycin the “red devil.” Maria’s stomach proved tougher than mine.
I became so ill that every time I received the drug I developed anticipatory nausea; I would retch as soon
as my port was disinfected with alcohol. Can you imagine an anesthesiologist troubled by the smell
of an alcohol wipe?
The red devil worked for me. It didn’t work for Maria. Another chemotherapy, Taxotere, caused her severe, searing bone pain. She would go on to suffer three addi- tional chemotherapeutic agents, including those she received during her participation in the PARP inhibitor trial. For that trial, Maria had initially been randomized out of the treatment, but then was given the experimental treatment as compassionate care. It was during that regimen that we learned she had not responded; the cancer had been found in her brain, her lungs, and her liver.
FAMILY
Physicians can become annoyed by and critical of seemingly needy patients and their families. Not only did I need to deal with my own emotions while watching my sister wither away, I also acted as go-between with my family. This meant that each day during Maria’s illness, my father would ask me the same question he asked
me every day, “Maria is going to be alright, isn’t she?” One day, I just could not bear the burden of his sadness anymore. I blurted, “Dad, stop asking me a question you know the answer to. Do you want me to lie to you?”
The look on his face caused me to immediately regret my harsh response. Now, when patients and family press me for answers to difficult questions, I remember the look on my father’s face that day and I strive to be as compassionate as possible.
Chronic neuropathic pain leaves the best of us open
to depression and opiate dependency. My husband, a practicing neonatologist, was no exception. The central C5-C6 cord injury he sustained four months before Maria died had initially resulted in full quadriplegia. Over time, however, he was fortunate enough to regain his ability to walk and partial use of his arms and hands. Unfortunate- ly, he also suffered spasticity and neuropathic pain. He came home from his eight-week rehabilitation stay with a dependence on OxyContin. His mood was often dark as he mourned the loss of his career and the use of his hands. Even my work with patients in my chronic pain practice did not prepare me for what he faced following his injury. Hospitalization and an addiction specialist helped wean him from OxyContin. His spasticity and pain, however, will remain a lifetime challenge. Realizing
this, I have learned to be much more aware of his daily ups and downs. Most days we joke, and I try to keep things light. But Brian’s frustration can easily ignite when I need to assist him with simple task such as tying his tie or buttoning his shirt, or changing a light bulb or when he mourns the loss of his career. We are well aware that going forward, each day will test us.
My family and I were at my sister’s side when she passed away in February 2011. As an anesthesiologist,
I typically don’t see death in this way. I am now, however, acutely aware that every time I anesthetize a patient,
I hold a precious life is in my hands. This realization has, I think, made me a better physician. I only wish the cost of this lesson had not been so enormous.
Rosalie Tocco-Bradley ’88 is CMO/VPMA of St. Joseph Mercy Health System Ann Arbor and Livingston. She previously served for 10 years as the Chair and medical director of the Department of Anesthesiology and Pain Medicine for St. Joseph Mercy Health System and is currently a member of the Michigan Board of Medicine.
This essay was adapted from “Becoming a Better Physician ...
at a Cost,”ASA Newsletter 78(7): 33-34 of the American Society of Anesthesiologists.A copy of that text can be obtained from ASA, 520 N. Northwest Highway, Park Ridge, IL 60069-2573.
The article first appeared in the Winter 2015 issue of the Harvard Medicine Magazine.
Volume 69 • Number 1 Washtenaw County Medical Society BULLETIN 9


































































































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