I don't like Dr. Kent Sepkowitz

Perhaps it's just my prejudice against Memorial Sloan Kettering Cancer Center -- or, as I have often called them during our frequent and acrimonious billing disputes, the Memorial Sloan Kettering Cancer Pirates -- but Kent Sepkowitz's essay about his failure to write the families of his dead patients condolence notes made me mad.

He starts off comparing his efforts unfavorably to those of his vet's, who sent a heartfelt note after his dog died. Not a promising comparison from where I sit, and it gets worse from there. 

He goes on -- and I know he's just being honest, and you shouldn't get mad at someone for being honest, because where would we be without self-serving honesty anyway? -- to float and discard some theories about his reticence, finally cutting to the chase: it's really disappointing when patients die, especially when he's just getting going with them. 

Here's the good doctor:

...I think doctors have a strange way of grieving their patients.

Probably no one cares about our feelings when a patient dies, and that’s as it should be. Our personal loss, after all, is trivial — most patients we know only as patients. But we do have feelings, a confusing mishmash that includes disappointment and embarrassment, but is mostly a sinking emptiness.

It’s like this: caring for very sick patients is exciting, probably because doctors, like everyone else, become swept away by human drama and possibilities. Managing a patient places us in the middle of hard decisions, bitter truths and sudden hallway conversations. We become futuristic acrobats of the high tech and the extreme, rather than yesterday’s stodgy pillars of the community, dispensing advice and lozenges, a silver-haired presence to steady any uncertainty.

But then the patient dies and bam! it’s over, just when we had so much to say, so many plans. We are left alone with our hectic thoughts ricocheting left and right and nowhere to point them.

Then, within hours after the death, a new patient is installed in the same room. You look in and see a stranger with darker hair and different clothes, reading a newspaper from somewhere else. And with the new patient comes a new set of visitors, in ones or twos or crowded at the door.

It's about him! Those plans, those thoughts -- all for naught! And now he has to deal with another patient, some drone "with darker hair and different clothes," another faceless object of his doctorly care. He feels too much, his cup runneth over!

Keep your unwritten note, a-hole. And in the spirit of honesty, let me add this: I teeter between seeing doctors as heroes and resenting them mightily. I resent their detachment. I resent the fact that (so far) they are well, and I am sick. I resent that they can go home from the hospital while I, in so many ways, cannot. I resent their money. I resent the thousand small deaths of waiting for their phone calls. I resent that they understand intimately how this disease works, and I do not. 

Ranting aside, I understand why oncologists have to deal with death differently than people in other lines of work. My family doesn't need a note (though it would be nice...). But I do wish they could treat me in ways that make me feel little more special now, while I'm living, less like a guy with dark hair and a magazine and an occasional joke and more like someone precious, with my own unique dreams and aspirations. 

In a lot of ways, I feel like my current doctor filed me away in a rusty mental filing cabinet labeled "Doomed" from the very beginning of our relationship. That may make her work easier, but it's a hard thing for me to live with.