Another Chart on the Desk

I recommend you to take care of the minutes, for the hours will take care of themselves.
-Lord Chesterfield (1694-1773)

It was quite busy in the office today; in fact, I'm still here as I type this at 1710 hours CDT, and must go back to the hospital as soon as I'm finished writing. Not to confuse me with a real doctor (read: surgeon), "quite busy" for me usually means one of the following:

1. Had to attend a meeting designed to test my powers of wakefulness.
2. One or more patients presented with a complicated development that required the mental powers of an Einstein to solve.
3. No lunch. (Just kidding - the doctor always eats something, even if it is at 3:30 PM).
4. Had to drive to a peripheral hospital to do a consult.
5. Was trapped in examination room with a patient demonstrating the "DIGFAST" mnemonic.

Actually, today all of the above happened, but when I lay me down to sleep tonight I won't remember any of them, because right in the middle of trying to simultaneously dictate a note and read about the gene expression signature of basal-type breast carcinoma and how it correlates with chemotherapy outcomes for metaplastic breast cancer, something happened that stopped me cold.

My nurse came in and laid a chart on my desk with the freshly written word "Expired" on it.

It is difficult to express the sorrow that washed over me when I saw that cruel word. Whenever I see a chart like this I feel as if another little piece of me has been carved out, like a tree under the woodman's ax. The rest of the day's importunate demands soured the air, leaving me feeling less valiant, less forgiving, afraid to walk out into the street and call for men and women to rally. My contribution to this case, however little or much, is over.

No amount of sympathy can remove the grief the family is feeling now, so all I can say is, "Goodbye, my patient. May you sleep well tonight, finally free from pain and worry."


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It would be very difficult to care for people and see them pass away. ehr gives the doctor a lot of power in keeping up with how the patient is doing. I have seen a lot of doctors put this technology to good use.

We are all in dept to the men and women that care for the sick and elderly.

Hey I came across all of your blogs when I was searching a bunch of stuff about oncology. I am a senior in high school and have always wanted to go into Pediatric Oncology, but never have known much about the schooling for it. If there is any chance you wouldn't mind kind of explaining to me what schooling you've gone through that'd be great. I'm guessing it's the normal two years of medical school and then two years of some kind of graduate school??? I really don't know what, but this has always been what I've really wanted to do. Please email me at if you can. Thank you soo much!

Your ability to care and continue to care in a field of medicine rife with emotion is the quality that sets you apart, the quality that makes you the fine doctor you are.

"I feel as if another little piece of me has been carved out..."

Take heart in that both patient and family benefit, more than you can know, from your willingness to share their pain. It is a priceless gift that you give just when it is needed most.

Great post. Timely, as has happened to me twice this week.

I feel so fortunate to be invited into the lives of patients at their most vulnerable and intense moments. A death brings some of that intensity back to my mind.

We have a long list of things to accomplish each day. The added moments recalling a life brings the rest of the list into perspective.

How timely for me to read this post... I had been wondering how you can be "Cheerful" in the face of oncology. But of course, you can't be cheerful without benefit of experiencing the downside. Thank you for your words.