Finding Faith
Abstract
In most professions, how “good” someone is at their job is determined by the amount of income that they earn or their position. Yet, when you think of medicine and healthcare workers, “goodness” is much more vague. Being a “good” doctor is more than just diagnosing and treating illness, but also about being able to understand and build meaningful relationships with your patients. In this course, we explored what happens when the humane side of medicine is separated from the technical side, such as in Dr. Ricardo Nuila’s “I Am a Rock.” In this story, I wanted to follow the journey of a young oncologist, as she struggles to find the balance between these two elements of medicine, learning through failures before she can succeed.
My protagonist, Dr. Justice Lee, is by no means perfect. She battles an internal “savior complex,” desperately trying to save her patient and struggles with her wishes to refuse treatment. Justice’s own traumatic past with her mother’s cancer comes into play throughout the narrative, greatly shaping her decisions and outlook, emphasizing the ideas represented in Ian Williams’ Bad Doctor. The title of the story, “Finding Faith,” is a play on her patient’s name, but also the faith that she must uncover in her own abilities as a doctor and in her patient’s decisions.
To craft her tale, I looked at studies about trust between doctors, especially oncologists, and their patients. I also drew inspiration from real stories written and told by oncologists about their experiences.
“Finding Faith” is a reminder of the humanity in medicine: physicians should treat their patients as humans, and physicians themselves are human. In the modern setting of medicine, which is overwhelmed by the complexity of new scientific discoveries, health insurance, and more, I think that this is much needed.
Seventy days.
It had been seventy days since Justice Lee’s lifelong dream had become a reality. She’d spent twenty nine years in Houston, but somehow, the inside of Houston Methodist Hospital felt like a completely different place. Here she was, a full-fledged, practicing oncologist, like she had wanted her entire life, yet it didn’t quite seem like reality.
She started every one of those seventy days the same way, with the excitement of living her dream, and the knot in her stomach that reminded her of the overwhelming responsibility of her new position. This morning, these unremitting thoughts flowed through her mind, accompanied by the loud pattering of the Houston rain outside the windows as she walked across the skybridge on her way to her patient rounds. Arriving outside the first room, Justice picked up the flimsy plastic chart outside the door, glancing quickly at the first page to remind herself about her patient.
Mary: forty year old female, who had just undergone her final round of chemotherapy using Ellence for her HER2+ breast cancer.
She knocked twice before entering. Mary sat propped up in the hospital bed, her eyes downturned as she gazed adoringly at the young boy that slept by her. His arms and head rested on the bed and his golden locks caught the light, as his soft breathing sounds drifted across the room.
“Oh,” Justice whispered, “I can come back later if you’d like?”
Mary shook her head, laughing softly.
“It’s alright,” she said, “Jimmy sleeps like a rock, come on in.”
So she did, still cautiously light-footed as she tiptoed in. She stopped maybe a few feet away from the bed, hesitant to get any closer in case she woke the boy.
“So, how have you been?” she asked Mary quietly, looking down at her charts to see how her tests had been and how she had been responding to her last round of chemo.
“I’ve been good,” Mary exclaimed brightly, “I haven’t felt this good since before I got the news about my cancer. I’ve been a little sore and numb…”
“Mmm hmm,” Justice nodded absentmindedly, her eyes still focused on the charts in front of her.
.”..but otherwise great. I’m really looking forward to being able to go to my son’s soccer games soon, it’s been a while since I’ve been…”
As Mary continued to talk, Justice’s mind drifted away, as she was struck by the words that Mary had uttered so casually a couple seconds before: sore and numb. These were both symptoms of breast cancer recurrence, she realized, thinking through the treatment plan that she had provided Mary with, and wondering where she might have, if she did, messed up.
“… he’s friends with all the other boys on the soccer team and he –”
“I’m sorry,” Justice cut in, “did you say sore and numb? Could you point me to where exactly you’ve been feeling that way, and could you give me an estimate of how bad your discomfort is?”
Mary looked slightly startled at Justice’s interruption. “Oh, it’s not bad,” she responded, beginning to brush her fingers through her son’s golden hair, as she glanced down at him, “it’s nothing like it was the first time, probably just me getting older.” She grinned, and Justice offered her an awkward smile.
“Ah okay,” Justice acknowledged, “that’s good!”
She looked down at her charts once more, making sure that Mary was in fact in the clear. Everything looked great.
“Well then, Mary, you should be good! I’ll come back in tomorrow just to check up before we discuss discharging you.”
And with that, Justice held the chart to her chest, leaving the room as quietly as she had entered.
She was almost halfway back to her office, when she realized that she had forgotten to return the plastic chart to its holder outside the patient room. And so she rushed back, praying that another doctor hadn’t made their rounds there yet. But as she approached the room, the door was slightly ajar. From the small opening, Mary’s voice and another voice, presumably a nurse’s, drifted through.
“How has your day been, Mary?” the nurse asked.
“It’s been pretty good!” Mary exclaimed, “it’s been really nice being able to have Jimmy stay over with me.”
“Ah, yes, I’m sure!” the nurse responded, “especially since his game’s coming up soon, isn’t it?”
“It is!” Then Mary hesitated slightly, “I actually have to ask you,” she said quietly all of a sudden, “does my oncologist, Dr. Lee, hate me or something? She’s just so cold and impersonal.”
The words felt like piercing knives embedding themselves in Justice’s chest. So cold and impersonal. They echoed around in her head, resounding chaotically. She reflected on this morning and their interaction. Sure, she hadn’t wanted to talk about Mary’s son’s soccer game, but that was only because she wanted to make sure that Mary’s cancer wasn’t recurring. Was that such a bad thing? Was she a bad doctor?
Tears began to sting at Justice’s eyes as she thought about the words she had just heard. She quickly scampered away from the room before she could hear the nurse’s response. It was bad enough to hear her patient utter those words, and she didn’t want to deal with the possibility that the nurse might agree.
As the tears began to slide down her face, collecting, salty, on the corner of the mouth, Justice held her head down, her thin figure weaving easily through the busy halls of the hospital to the quiet solace of her office. She almost made it there, except, in her hurry, she collided with someone else. Looking up, Justice’s teary eyes met a pair of familiar ones.
“Oh my god, Dr. Andersen, I’m so sorry. I wasn’t looking where I was going!” she exclaimed.
Her heart thumped in her chest as she thought about the world of trouble that she was in. What a morning this was turning out to be: first, her patient had been so offended by her bedside manner, and now, she had physically assaulted her personal hero and one of the hospital’s oldest and most respected oncologists.
But Dr. Andersen just bent over calmly to pick up the file that he had dropped during their collision, before straightening up to look at her with kind, warm eyes. They narrowed slightly as he glanced over Justice’s tearstained face.
“Dr. Lee, are you quite alright?” he asked.
All Justice could do in that moment, weighed down by her embarrassment and despair, was shake her head lightly. In response, Dr. Abraham gestured for her to enter his office, only a few steps away. She walked in timidly, uncertain about how to explain herself.
He waited until she had settled into the chair across from him at his desk before opening his mouth again.
“So, Dr. Lee, tell me, what’s wrong?”
Justice had considered making up some random story about sleeping poorly the previous night or relationship troubles at home, but realized that she wanted, no she needed, to confide in someone. Years ago, when she had resolved to become a doctor, she had promised herself that she would be a great one, and help save patient lives. Yet, this one interaction had been enough to erase what little faith in her ability that she had gained over the past seventy days.
“I met with this patient this morning, and I thought it went great, but I went back to the room after to return something to the room and I heard her talking with a nurse…” she trailed off with uncertainty, looking at his face to gauge his reaction. He just smiled, nodding for her to go on. She tucked a piece of hair carefully behind her ear, swallowing gently before continuing.
“She called me cold and impersonal but I couldn’t think of anything that I had done to make her feel that way? I just wanted to make sure that she was in the best physical state possible and that the cancer wasn’t recurring” she said, slightly breathless.
It felt as though a heavy weight had been unloaded from her chest, yet at the same time, her small hands trembled in her lap as she waited for Dr. Anderson’s response.
He simply nodded his head in understanding, his brown eyes warm as they held hers in a steady gaze.
“That’s okay,” he reassured her, “this a chance to learn.”
She nodded in understanding, though her hands continued to shake.
“Caring for a patient isn’t just about making sure that they’re physically healthy. You need to be there for them, to make them feel like you’re supporting them and like you care” he told her.
“It’s a privilege to be someone’s doctor. Show them that you trust them and respect them as much as they trust you.”
Justice’s hands were finally still in her lap, as Dr. Anderson’s words brought forth a faded memory from years ago, when she was only a scared fifteen year old in the hospital with her mother. She remembered the cacophony of sounds: the noisy beeping of the strange machines in the room, her mother’s ragged breathing, and the not so hushed arguing of two doctors outside the room of the best treatment plan. Throughout the entirety of her time there, she had simply wanted someone to save her — to take her away from the chaos, and to tell her that everything was going to be okay.
And yet, she realized, all these years later, she had forgotten what it was like to be that scared girl, and had instead become the insensitive doctor, too focused on treatment plans to properly care for her patient and their family.
“I understand,” she replied to Dr. Anderson, “thank you, I will make sure to do exactly that,” she assured him.
With this piercing realization fresh in her mind, Justice walked towards her next appointment of the day, a consultation with a patient who had recently been admitted. She quickly grabbed the plastic chart outside the door, before knocking twice.
Entering the room, she found herself looking at a young woman who couldn’t have been that far from her own age, sitting on the hospital bed. She was perched at the very edge of the mattress, her wiry figure tensed, as if she was a wounded animal ready to run at the first sign of danger. Upon realizing her entry, the woman attempted to compose herself, raising the sides of her mouth in a feeble smile.
Justice glanced down at the first page of the charts before looking back at the woman. “Hi Faith,” she greeted her, “how are you today?”
“I’m doing okay, doc,” Faith responded, lowering her gaze to her lap and fiddling with her fingers, “can’t say that I feel too great though.”
Looking back down at her patient forms again, Justice noticed the symptoms that she had reported upon entry: nausea, vomiting, severe headaches, severe memory issues, fatigue, left side weakness… The list seemed to stretch on, alarmingly long.
“I’m sure,” she told Faith, “with all these symptoms that you described, I can’t see how you could be feeling great.” Faith grimaced noticeably.
“Why didn’t you come in earlier?” she asked.
Faith’s gaze remained on her fiddling hands as she responded.
“Oh, I was busy with some other stuff I guess.”
She spoke quietly, her composure as tense and hesitant as when Justice had first entered. She was holding back, Justice realized. She grasped at the edge of the charts, tempted to move on and to attempt to diagnose Faith, but Dr. Anderson’s earlier advice rang through her head: Make them feel like you’re supporting them and like you care.
“Tell me,” she encouraged Faith, gazing earnestly at her.
Faith finally looked up from her lap, her eyes widening slightly, as if surprised that Justice actually cared.
“I was going through some stuff at home…” she started hesitantly, as Justice nodded softly for her to continue.
“My mom got a terminal lung cancer diagnosis about a year ago, and I had to move back to Houston to take care of her. I started getting the symptoms a while ago, but I thought it wasn’t anything too big. Plus, she had so little time left that I thought it was better to spend what time she had left with her.”
By now, Faith’s gaze had finally met Justice’s completely.
“And did she get any better?” Justice asked.
Faith shook her head lightly, her pale lips pursing slightly.
“No, she passed away a month ago.”
“Oh, I’m so sorry,” Justice responded, “do you know any other people in Houston that you can stay with or that can take care of you?”
Hearing the question, Faith sighed softly before shaking her head again.
“No, I left all my friends and my dream job back in Chicago to come here.I really don’t have anyone or anything in Houston anymore…” she sighed again, “but I thought maybe I should get myself checked before I try and figure out what to do from here.”
Justice nodded respectfully, feeling a pang of sadness and sympathy. The image from earlier that day floated back into her mind: of herself at age fifteen, when she had lost her own mother to glioblastoma. Though she was in a city full of people, she had never felt quite so alone. It was a situation she could not wish on her worst enemy, but perfectly parallel to the one that Faith was in now.
“You’ll make it through,” she promised Faith, “my mom passed away from brain cancer when I was younger, and I thought I’d never feel whole again, but it does get better.”
She pushed down the tears that threatened to escape her eyes for the second time that day and coughed lightly, finally looking at the charts again to distract herself.
The loud pitter-patter of the continuing rain outside the hospital window and the beeping of the hospital machines in the room melted away as she examined Faith’s head CTs, MRIs, and symptoms. A wave of nausea surged over her.
Looking at the scan, the familiar shape was all that she could see, a bullet like tumor with wings spread across both hemispheres, lodged irretrievably deep in the skull and alighting on the corpus callosum. She recognized it from years ago, when she had asked to see her mother’s case files: a butterfly-like omen of death.
Justice struggled to open up her mouth to speak, her diagnosis heavy on her tongue.
The sounds of the room flooded back into focus, and as she glanced outside the window by Faith’s bed, she noticed the storm clouds for the first time, crowding ominously on the horizon.
“Faith…” she turned her glance to meet Faith’s entirely as she spoke, “I’m afraid I have some unfortunate news for you, I believe you have Stage IV glioblastoma.”
Justice composed herself, bracing for Faith’s reaction.
“Ha–Haa–Haaaa..” Laughter poured from Faith’s lips, almost hysterical, and Justice flinched, her eyebrows lifting in surprise.
“I’m so-oo-rry,” she managed to get out between her laughter, as she tried to compose herself, “it’s just with everything that’s been happening on me, it feels like the universe is playing some major prank on me. Like my life is just a joke.”
But just like that, the laughter faded away as quickly as it had come. She seemed to collapse in on herself, sobbing as her tears stained her blue hospital gown. With her head down, and her long mousy brown hair engulfing her small figure, Faith looked like a young girl again, and unconsciously, the image of herself at fifteen flashed before Justice’s eyes again.
She battled the urge to respond to her in the way that she had been trained: to remain calm and level and to propose a treatment plan. Reminded of the scared girl that she had once been, and the overwhelming swarm of emotions and thoughts that had raced through her mind when she had heard her mother’s diagnosis, Justice realized how insincere that approach was. Faith didn’t need a doctor at that moment, she grasped, but a friend.
So against the “professional” instincts that had been ingrained in her over twelve years of research and medical training, Justice stepped forward, closing the distance between her and Faith, kneeling on the ground in front of her and placing her hands on the bed next to her.
“Faith,” she said earnestly, “you’re going to be okay, I promise.”
Faith looked up at her, her tears still free flowing. “Can I have a hug, please?” she asked.
Justice nodded, and for a moment, she just held Faith as she cried, running her hand in soothing strokes along her back.
Eventually, once Faith’s tears had dried, Justice explained to her what it meant to have stage IV glioblastoma, and the options of care that were available. Though she knew the chance of resecting the tumor completely and safely were small, she couldn’t help but recommend it.
Faith’s doe eyes seemed to grow larger as she took in the information, but she nodded along and asked for some time to weigh her options. Justice told her to take her time, and that she would come back tomorrow to check on her.
Walking out of the hospital room, Justice caught a quick glance of Faith through the clear window of the door. She sat completely motionless in the center of the bed, her back to the door as she gazed out the window at the pouring rain, her figure thin and small. And in that moment, Justice made up her mind to do whatever she could to save Faith.
She owed that much to her mother and to her fifteen year old self.
Justice didn’t notice the downpour as she trudged her way to the car that night, already brainstorming a mental list of possible treatments. Of course, Faith would need chemotherapy, but would procarbazine or temozolomide be better for her? Justice wondered, slotting her key into the car ignition.
Even as she drove home, her mind ran wild with thoughts of treatment. And the rest of her night was no different. It was like she was a medical student again, pouring through her textbooks, Pubmed, and countless journals through the night, desperate for a miracle cure for Faith. As the first few rays of sunlight of the day broke through the clouds, with the ink smudged messily on the side of her hand from her incessant writing and the dark circles around her eyes striking against her pale skin, Justice smiled.
Sure, she hadn’t found her miracle cure, but she was satisfied with the list of ideas that she had compiled. One of these would save Faith, Justice thought to herself, one of them would surely work.
Her mother would be proud.
Grasping onto her list, Justice drove hastily to the hospital, too wrapped up in her thoughts to notice the sun peeking through the clouds for the first time in days. It was with the same mindset that she knocked on Faith’s door, barely waiting for her gentle “Come in!” before entering.
“So, Faith…” Justice greeted her patient, almost buzzing in excitement, “I looked into it and I might be able to get you into a clinical trial for glioblastoma, they usually don’t take patients with such progressed cancer, but I can see what I can do…” She continued on, “I just need you to approve a tumor biopsy and we can talk together about the best treatment to extend your survival, whether that’s chemo or radiotherapy, or immunotherapy.”
She turned to Faith now, eager to hear her response to her proposal. As she properly looked at Faith for the first time today, she couldn’t help but notice that something was different. Faith’s slim figure was tucked comfortably into the bed, and she held herself up with a certain poise and energy. Her round, brown eyes peered sweetly over at Justice, her gaze warm.
Faith smiled gently. “I don’t want any treatment,” she said, “I’d like for you to discharge me.”
For a moment, the words made no sense to Justice, and she might as well have spoken in another language. Standing in the middle of the room, her list in one hand and Faith’s charts in the other, Justice’s eyes widened in surprise, a heavy feeling settling in her stomach.
It was insane to her: This girl, who hadn’t had the full chance yet to live, was choosing to just die? Not to mention, as a doctor, she had taken an oath: do no harm. Letting a patient die with no form of care sure felt like doing harm.
“You can’t!” Justice blurted out, her facial expression switching to one of shock as she realized what she had said.
Faith’s expression wasn’t that far from her own, her eyes narrowing in confusion.
“Excuse me, doc?” she asked, her voice still soft, but now undeniably cold.
“I mean… “ Justice struggled to choose the right words to say. More than anything she wanted to tell Faith to fight, to take the chance with a surgical resection or a clinical trial. Like she wished her mother had so many years ago.
“You shouldn’t just give up.” she finally said.
Faith’s facial response was completely unexpected for Justice: she looked furious. She sat up completely straight in her hospital bed, staring almost menacingly.
“Excuse me, what?!” she said, “I’m not giving up.”
Her complexion, once pallid, was now flushed red, as she continued.
“My mother followed through with chemo, and radiation, and surgery, and sure her body died a few months later than it would have otherwise, but as far as I’m concerned, she died months earlier. Those last couple of months she wasn’t living anymore. She was either in constant pain or high on as much painkiller as we could possibly give her. And that last month, she couldn’t even remember who I was anymore. Her own daughter, a stranger.”
As she finished talking, Faith simply turned around, facing away from Justice.
“Please leave,” she requested.
And so Justice did, letting the door swing closed, as the loud thudding of her racing heart filled her ears. Her cheeks began to flush with heat, as Faith’s had but a few moments ago, and her mouth felt inexplicably dry.
What was wrong with her?! She thought, how could Faith just give up and choose to die?
She made her way to the bathroom to splash water on her overheating face, letting the coolness and the rhythmic gurgling of the running faucet distract her from her emotions. But as she looked up at the mirror to wipe her face dry, she saw something that she wasn’t expecting.
Gazing at her reflection, Justice recognized the emotion that had rooted itself so deeply in her through this experience. As the facade and her denial fell away, it was replaced by a familiar sensation of dizziness and goosebumps pricking its way along her arms. Rubbing her tired, bloodshot eyes, the figure before her transformed into one she knew so well: fifteen year old Justine, cowering under the comfort of her mother’s worn cardigan, as she waited for the doctors to resuscitate her mother.
Oh, Justice thought.
All along, she had been thinking of Faith as the frightened fifteen year old, needing someone to save her, but really, she was seeing not Faith, but herself. And as she let herself feel properly again, and her emotions churned in her stomach, she raised a white lab-coat clad sleeve to wipe the tears that unwittingly streamed down her face. Glancing at her lab coat, Justice finally understood the words that Dr. Anderson had gifted her yesterday.
It’s a privilege to be someone’s doctor. Show them that you trust them and respect them as much as they trust you.
As those words ran through her mind, they were accompanied by a wave of clarity, clearing away Justice’s uncertainty and confusion. With her sudden burst of energy, she scrambled quickly to fix her composure and rushed as fast as her feet could carry her back to Faith’s room. And as she reached the door, she flung it open with no hesitation.
In the few moments that she had been gone, Faith had already moved, now standing in the corner of the room and packing her things into a small duffel. She turned around briefly when Justice entered the room, but moved back quickly to continue packing her stuff to leave.
“You can’t stop me,” she said, “I’m going.”
“I’m not going to,” Justice replied.
Faith turned around fully now, a look of surprise registering on her face.
“It was never my place to tell you what to do,” Justice continued, “it’s your decision, and yours only. I’m so sorry about how I acted…”
She was cut off abruptly as Faith wrapped her arms around her in a hug. And as Justice pulled away, she noticed Faith’s eyes, misty with some emotion.
It was only as she smiled, waving goodbye, that Justice realized what it was: peace.
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