Matthew Matasar, MD, is a medical oncologist specializing in lymphoma and is chief of the Division of Blood Disorders at Rutgers Cancer Institute of New Jersey and RWJBarnabas Health.
I’ve been thinking about illness a lot these days. Hardly shocking, no doubt is your reply. Professional hazard! True enough, but to be more specific, I’ve been thinking about when physicians become ill, especially when oncologists get cancer. There’s something uniquely terrible about being diagnosed with the very condition you’ve dedicated your life to treating, fighting, and curing. And seeing all the ways in which an oncologist’s cancer diagnosis impacts our practice — as a patient, as a treating physician, and as a colleague and program leader — has prompted some reflection.
My own cancer diagnosis was early on in my journey as an oncologist. As a first-year fellow, I self-diagnosed my own appendicitis, woke up my wife and mother of our infant, and told her not to worry, I was just going to hop across the street to the ER and get my appendix out, I’d be home by dinner, no need to fuss. The ER doc that night was a friend, who, much to my chagrin, insisted on a CT scan to confirm the obvious appendicitis. And hey, it was appendicitis (it’s not rocket science, folks!), but there was also an incidental renal mass: high-grade renal cell carcinoma. Well, a couple months later, and that had been taken care of. Taking my post-op laps in my own hospital, giving my co-fellow (who was leading rounds on the genitourinary medical oncology service) low-fives as I got my steps in, was both comforting and surreal. I was back to work in a month and none the worse for the wear, but the lessons learned — having to sit in those appointments with my wife, holding her and my own fear and uncertainties in hand alongside realistic hopes and expectations, having to abandon my own pursuit of control to trust in my doctors and in the process — have undoubtedly helped shape my own care of my patients.
Those lessons I learned are never truer than when caring for another oncologist. I have always taught fellows and colleagues that there is no greater honor than caring for another physician facing their own health challenge. Yes, we physicians can be tough patients. We know a lot, often too much, may be reluctant to take on the sick role in lieu of the caregiver role, want and expect clear communication, but at the same time want to just be “the patient” and not “the doctor.” It’s also true that physicians are not monolithic in our reaction to illness, just as our “lay” patients respond uniquely to their individual challenges. But the grace with which an oncologist can approach a cancer diagnosis has been cast in sharp relief by one current patient. Let’s call them “Dr. A” — a physician from a regional practice with whom I’ve had a friendly and collegial relationship. Dr. A refers cases to me that are challenging and is generous in calling me on occasion to solicit advice. When Dr. A then called me asking for such advice, not for a patient but for themselves, as they had recently been diagnosed with bulky follicular lymphoma, I was flattered but also anxious. Would I be able to be the kind of doctor they need? Could I remain objective and, as I say, call the balls and strikes fairly? But as Dr. A’s treatment has gone on, and as we’ve hit complications and faced uncertainty, their ability to balance their identity as a medical oncologist and their role as a patient has been exemplary, and their trust in me is a reminder of the unique potency of the doctor-patient relationship as a force of healing.
At the same time, as an administrator and colleague, I’ve been alongside another much-loved and deeply respected colleague, a bone marrow transplant expert par excellence, facing their own treatment for acute leukemia. Here, my role becomes more nuanced yet. There’s no real playbook for how to handle such challenges. It wasn’t covered in my “Welcome to Being a Chief” orientation because, don’t be silly, there is no such thing. So, here’s what I’ve learned in having the privilege of navigating and supporting my friend through this journey so far:
- Protect the patients. Work with your partners and administrators to make sure that patients have a covering provider during an extended absence and that this is communicated clearly to each and every patient without jeopardizing confidentiality.
- Protect the doctor. Work with human resources and administrators to ensure that you’re doing everything possible to protect your colleague. This includes determining rules for medical leave versus reduced work/work-from-home arrangements, evaluating if coworkers can donate banked sick time, and making sure that personal and home needs are being met by offering, for example, babysitting, meals, rides, elder care support, or whatever can be done to relieve burdens. Pass the hat — people will want to be generous in support of an ill colleague, and this gives them a tangible way to make an impact. And get them signed out of Epic and email with a forwarding message to the covering provider.
- Protect the team. Create opportunities to discuss in a safe, confidential manner the impact this has on the team. Coworkers and team members will be hurting and will benefit from resources that are readily available (including formal counseling and on-site social workers who can help them process the developments). Discuss openly what coverage looks like and take stock of what, if any, additional resources are needed to do so safely. Attend to mentees who may feel threatened, and create backup mentorship structures. And of course, reward generosity and selflessness whenever possible.
- Protect the program. Identify any professional or administrative responsibilities that need to be reallocated, and communicate with referring providers to clarify how support will be provided during the absence.
One final reflection here, reinforced by my experiences as patient, doctor, and colleague, is on redundancy. Modern teams are built around efficiency. “Lean” is the goal — do the most with the least, as it may be less generously defined. But lean teams have, by definition, very little padding, so what happens when there’s an unexpected illness? Suddenly a team with no redundancy has to achieve the same with less. This of course can stress a system, and if there is not enough give, that stress can lead to fracture, which resonates for me, given the challenges my program is navigating as well as my own personal health right now … as I write this from home nursing a post-operative ankle because of a nasty trimalleolar fracture I earned while hiking abroad with my daughter. So, when we think about the care of the physician — ourselves as patients, as providers, or as colleagues — remember that flexibility, that ineffable quality of bending under stress, is invaluable.
Matthew Matasar, MD
Associate Editor
The content of the Editor’s Corner is the opinion of the author and does not represent the official position of the American Society of Hematology unless so stated.
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