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Pharmacy Practice in Focus: Oncology
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A pharmacist examines the intersection of medicine and humanity.
Image credit: C Davids/peopleimages.com | stock.adobe.com
Joseph A. Kalis, PharmD, BCOP, is an ambulatory oncology pharmacist at UCHealth in Colorado Springs, Colorado. Kalis writes from the Front Range of Colorado and enjoys climbing rocks and frozen water. He rages therapeutically at concerts of all sorts.
It was 20 minutes into our visit, and the patient’s stony face hadn’t wavered. I can usually get a smile out of someone in the first few seconds of meeting them, but Mr X remained unaffected. If you mix anger, frustration, unease, and a sprinkling of his “internalize and bear it” attitude, you’ll get a picture of Mr X.
At this point, I realized my approach needed to change. “I can see that something is bothering you, sir,” I said, gesturing with my hands. “What’s on your mind?”
Mr X is a veteran, having served in Vietnam, and his cancer was likely related to Agent Orange exposure. He had a lot to be frustrated about and a lot of life experiences no doubt still on the docket to process. What he said next didn’t surprise me in its words but in the opportunity it presented. “It all f-----g sucks, Doc. Cancer, the treatment, [adverse] effects—you name it. And not one of you here will come out and say that it just f----n’ sucks. I just need someone to admit to what I’m going through.”
I instantly had a gut reaction of the right thing to do. Visions of my future flashed in my head: patient complaints, human resources violations, sensitivity training. Suddenly, my path was clear. “Sir,” I said, “this f----n’ sucks. There’s no two ways about it.”
Initially, Mr X appeared surprised, but he quickly regained his composure. Grinning for the first time, he said, “You’re the first real person I’ve met here.” Our visit progressed from there, and we remain friends to this day. You might argue that what I did was unprofessional, risky, or not necessary. I encourage you to look deeper. At its core, my visit with Mr X was a discussion between 2 people. Two humans, complete with their own baggage, weaknesses, and common humanity. In other words, normal people. Normal humans.
The father of physicist Richard Feynman once showed young Richard a photograph of the Pope blessing a group of believers. Richard’s father asked him whether he knew the difference between the Pope and his followers, but before Richard could answer, he said, “The difference is the hat. He [the Pope] is wearing a hat.” Feynman’s point is that people are people, no matter what clothes their job dresses them in and no matter who they are or what they have accomplished. It’s a lesson that we can all learn from, because being human is consumed by internal and external dynamics: our relationship to ourselves, our relationships to other humans, and our relationship to our internal and external environments. How we navigate those relationships determines our impact on the world around us. Some call this emotional intelligence. Others call it a skill. The trouble is that relationships are neither of these things—they are the key component of being human.
You might be thinking you know this already. And you’re right. You do. Intrinsically, we all do. But in health care, it’s easy to forget. We’re all focused on the current problem we need to solve, the right thing to do in a given situation, or maybe just the next thing we need to do that day. Often, we may be focused on all these things simultaneously.
Here is my point: Health care professionals need to be better at relationships: understanding them, forming them, and tending to them. And we especially need to be better at relationships with those who rely on us for help: our patients.
You may ask why. Aren’t we already doing our jobs and optimizing pharmaceutical care and attempting to live up to whatever pithy mission statement our organization’s consultants have cooked up? Aren’t we doing enough?
Well, yes. In many senses, we are. But at the end of a life, the impact we have on the world around us won’t be measured by the number of orders we verified, how many dollar bucks we saved our health care system, or how many arbitrary metrics we met. It will be measured by the number of lives we affected. I pose these questions not to cajole but to illuminate and provoke. I provoke you to think what your “why” is: the answer that keeps you soldiering on in oncology pharmacy. For this burned-out, disillusioned, and cynical clinician, my why is my patients and the connections I have with them. I’m no different from my patients. I just happen to be on the other side of the table.
Where I differ from many health care professionals is that I’m willing to take the risk of being vulnerable and being human with patients. If patients are able to meet me halfway, I’ll go all the way for them. Yes, experts don’t advise this approach, because we can become too attached to patients.
Then again, I didn’t become the professional I am today by following all the rules I was told to follow. Diving deeper than the expected professional veneer and forming a real relationship with patients is part of what separates humans from automated machines. It requires risking something and exposing ourselves to social rejection, but it can make all the difference to patients who may be going through some of the worst days, weeks, or years of their lives.
I think back to another patient, Mr Y. He had terminal pancreatic cancer, and he knew it. Over the visits we shared, he also had an unassailable, emotionless mask. It wasn’t until I asked what he did for work one day that we were able to break through. “I’m a computer programmer,” he said flatly.
“Ah, great,” I remarked. “I’ve been struggling to wrap my head around how the blockchain works. Do you have a minute to explain it to me?”
Like Mr X, Mr Y was surprised at first. A health care person was asking him for help instead of the other way around? In an instant, his personality returned. “Why, sure,” he said, smiling. “No one else I’ve seen here has ever asked me for help with anything.”
He spent the next half hour teaching me how blockchains function and how he thought they’d be used in the future. One moment of vulnerability and humility, and our relationship was completely different and better for both of us. Non sine periculo, says the Latin: nothing without danger.
These are my stories. Now what can you do to help build more of your own moments of humanity with patients? The best answer I can give is the adage of being yourself. Pursue your own ideals. Pick up a hobby, something you’re interested in but haven’t tried yet. Go to a concert for an artist you like. Walk in the woods and simply soak it all in. What these ideas have in common is the pursuit of something outside health care, the pursuit of something for its own sake. These interests and hobbies (ie, pieces of the mosaic that make up who you are as a person) form the basis for connection with others—patients, colleagues, and friends.
By way of illustration, consider Ms Z, an older patient with metastatic breast cancer. She came to our appointment along with her grandson, who was in his early 20s and wearing a black T-shirt for the hardcore metal band Kublai Khan TX. Throughout the visit, Ms Z’s grandson was antagonistic, expressing skepticism about chemotherapy and treatment options; I interpreted his actions as distrust of the medical establishment. However, a different person emerged when I asked him whether he’d been at the Kublai Khan TX concert a few days prior at a delightfully seedy local venue.
Looking at me in disbelief, he blurted out, “You? You were at the Khan show? I thought all you medical people were stooges.” With a few minutes of bonding over the catharsis of the mosh pit and downtuned guitars, an entire new level of trust was formed. The moral of this story is that by being your most authentic self with patients, you can truly connect with them during what may be a dark hour of their lives and help them in a way that no one else could—because no one else is you.
