Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

“Both And”


As the only oncologist in a small rural town, I must often care for patients who are also my friends.

“Go, go, go!” At the swim meet, the parent beside me and I chanted in unison for our children’s relay team. No matter that the swimmers couldn’t hear us with their heads in the water. Swept up in the spectator frenzy, we clapped and hooted as the team took one of the top places.


Then the thought I’d been trying to keep my brain from consciously acknowledging wormed its way to the forefront. Some of these parents wouldn’t have many of these moments left. Here, we might be sports parents. But on Monday, I would again be their oncologist, and they, my patient. Have I talked with them about the balance between reality and hope? 


I’ve been a rural oncologist in the U.S. for almost a decade. Before that, I practiced in an urban metro area, where running into one of my patients was rare outside the office or hospital. In cities, people usually don’t know their oncologist personally. In our small town, I was, for a number of years, the only oncologist. 


I attended our childen’s “Back to School Night” shortly after moving to the countryside. The fourth graders had hung “About Me” posters in the halls, and to my surprise, my child had included the following: “My mom is a cancer doctor. She helps people who are sick.” Then I read the poster below hers, with a last name I recognized as one of my new patients. Their child had written, “My mom has cancer and it sucks. I hate cancer.” Our children would become friends. 


I soon learned that being a rural community oncologist meant practicing without the geographic and population barriers that inherently exist in metro practice. I ran into patients not only at school events but at the grocery store, restaurants, and even the hair salon. One time, a patient in the clinic mentioned they’d seen me recently at the shoe store with my youngest child. My face went hot as I recalled my then-preschooler’s meltdown when they couldn’t find shoes that fit just right. It wasn’t, shall we say, my proudest parenting moment. 


But as embarrassing as those moments of being seen outside of my protective “doctor shell” were at first, worse was when I worried that for my patients or their family members, seeing me outside the office was difficult. Of course, to respect privacy, I never speak to a patient or their family member in public unless that person approaches me first. And often, they do. I’ll never forget volunteering with my daughter at the Girl Scout cookie table outside the grocery store, and one of my patients came up to loudly consult me about their new gastrointestinal symptoms. But as uncomfortable as that interaction may have made the Girl Scout troop leader, worse was the time one of my recently deceased patient’s family members spotted me in the grocery store. Our eyes met, and after a brief glint of recognition, they walked on. Who could blame them? Who wants to run into their deceased loved one’s oncologist in the canned soup aisle and be reminded of the worst conversation of their life?  


I thought of the parent at the swim meet. I imagined that their oncologist was the last person they wanted to see when they were out enjoying time with their child. Even though I knew it was irrational, I wondered if I had a right to attend these events. Did my presence cause them pain? 


But sometimes, I spot a former patient from afar and get to glimpse patients in their everyday life, doing mundane things like shopping or dropping their kids off at school. It hits differently than seeing them for an annual clinic appointment, this direct witnessing of the living of life. I’m overcome with awe at having had a part in saving that life. 


And for those whose cancers aren’t curable, it’s both harder and easier when it comes time to have the toughest of tough conversations. When I say to that fellow parent that I don’t want their kids to see them die in a hospital bed, unconscious and attached to various tubes and machines, they know I mean it both as their doctor and their friend. It is devastating, and it is an honor. 


I remind myself that I’m a human being as well as a doctor and that it’s ok to let down my “armor.” The losses may hit harder, but so do the wins.  











This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.