On Regret

What I regret most in my life are failures of kindness. - George Saunders

Like all oncologists, I walk with ghosts.

One of the ghosts who is most often by my side was a middle-aged Jamaican woman. I don’t remember much about her, except that she was a gentle person who faced her rapidly progressing disease with faith and equanimity. As I recall, she did not have family in the area. She was admitted for an escalating pain crisis and liver failure while I was away giving a talk. When I came back, the office gave me a message that she would like to see me. Monday, I had to catch up from the trip. Tuesday and Wednesday were clinic days. Thursday, she was dead. She died alone. I did not get by to see her.

Her ghost arrives whenever I have a patient in the hospital. And whenever she comes, I reflect on her lessons. The obvious one is that tomorrow is not promised, and one needs to get by to see one’s patient in case they die before morning. But the lesson that is more important is that I am a hypocrite. Or at least, I always have the potential to be one.

I know people who were born to be physicians. I was not one of them. I decided that I was going to pursue medicine as far back as 10th grade, but it was not out of any deep-seated desire to serve humanity. It was because I was a smart kid who was science-oriented, and medicine was what smart kids did. I turned out to be very good at hitting the milestones required to become a doctor. Looking back, my journey in medicine was one of focused pursuit of external validation. Initially, it was test scores and grades, then papers and presentations, and ultimately positions. I achieved these things at great cost to my family, my relationships, and my mental health. And the relentless pursuit of more and more traditional academic rewards eventually no longer motivated me. There was no more external validation to pursue. But that left me without a driving force. I drifted.

One day, I was in clinic, seeing a very kind young woman for a routine follow-up. As we were talking, she asked me, “Why do you do this?”

I was taken aback - “Do what?”

“This. Oncology.”

And the answer came to me.

“Because it’s a privilege.”

As I get older, I have come to believe ever more deeply in this truth. People come to us in what is more than likely the worst time of their lives. They are terrified, confused, in dire need of information. They have many stories running through their heads, most of which end with their deaths. They have never met you but they are placing their trust in you to save them, or their wife, or their child. And, if you cannot save them, they are trusting you to walk with them through the dark wood, to guide them as they approach the abyss. I am not a believer, but to me this offering of trust is as sacred as anything gets in this world. It is not just a privilege to receive that offering. It imposes a duty.

But I can be a hypocrite. My Jamaican friend reminds me of that all the time. Reminds me that I am fully capable of recognizing my duty and yet failing to fulfil it. Admittedly, I met her quite a long time ago, while I was in my external validation phase. If I was capable of neglecting my family, I was perfectly capable of neglecting my patient. But I let her cross over alone. I failed to show kindness and compassion. And it is one of the biggest regrets of my life.

The world still pulls us away. Meetings, clinic, family demands, travel. I still find excuses for why I have not responded, have not gone to visit. But it doesn’t take long before she materializes to remind me. I’d like to think that she forgives me. I’d like to think that she knows that I hear her often, and that I am still trying to walk my sister home.