Perspective
Remembering Bob
A patient helps a medical student and cancer survivor find the confidence she needs.
By Yaolin Zhou
When I first met him, he was a thin, energetic 59-year-old wearing a bright yellow polo shirt that seemed to match his personality. I was a first-year medical student who felt intimidated. I also had recently been diagnosed with a brain tumor myself. Bob had traveled far to undergo radiation therapy and chemotherapy for a recurrent oral pharyngeal cancer. I was far from home, too, having transplanted myself more than 1,000 miles to start medical school—no less than four months after my craniotomy. Bob didn’t know about that, though. He only knew I was a doctor-in-training. Eager to have me participate in his examination, he threw off his shirt and jumped on the exam table. I was shadowing his radiation oncologist, the same kind man who had helped coordinate my initial neuro-oncology follow-up care at Mayo Clinic.
Because I was still recovering physically from my craniotomy, trying to develop study skills after having received no guidance about potential cognitive changes, my first year of medical school had been lonely and terribly exhausting. My fellow classmates, who were as supportive as they knew how to be, did not make me feel better by telling me We’re all in the same shoes, and This is hard for everybody. My parents continually told me it was OK if I wanted to quit and come home. They were just relieved I was alive. I didn’t want to quit; yet, every day I felt inferior to my peers.
By spring, wanting to use my own cancer experience and growing medical knowledge to benefit others, I began volunteering as a patient advocate at the local Hope Lodge, a house where cancer patients and their families can stay while getting treatment. I also asked if I could work on a research project with Bob’s radiation oncologist. Bob’s physician and I started an intensive retrospective chart review of patients with recurrent head and neck cancer. Admittedly, I knew nothing about the topic, and after several frustrating days in the basement of the radiation oncology building, I asked if I could shadow him in the clinic as well. I thought seeing real patients would help motivate me to do the project, which meant poring over patient charts—anonymous descriptions of lives I knew were much richer than the dry medical histories suggested. Bob had come to Mayo for a series of therapies that would last for months.
Concerned about his expenditures on temporary housing, I suggested to my mentor that he be referred to Hope Lodge. A few weeks later, while volunteering, I saw a man hurrying around the large open kitchen helping with cooking, cleaning, offering food, and talking to everyone. It was Bob. Once he noticed me, he ran over to embrace me and subsequently called out to all in his raspy voice, “This is my doctor!”
We visited every week that spring, deepening our friendship. Because he had such difficulty with his voice after the surgeries and radiation, I did most of the talking. Even though I was very frank about feeling incompetent, he ignored me, telling me I was going to be his doctor.
Bob believed in me.
During our visits, Bob would present plates of pie, cake, and ice cream before me, despite my protests. He, on the other hand, struggled to take even minimal amounts of food, coughing and choking while trying to eat.
Bob finished his therapies, and I finished my first year of medical school the same week. I had promised him that I would stop in to say good-bye before he left for home. As many of my classmates headed out of town, I rushed to Hope Lodge to see Bob.
When I arrived, Bob and several other cancer patients and their caregivers were sitting around a dining table conversing. Not wanting to interrupt, I whispered to him that I had passed my exams. He nodded in understanding and then began banging the table to get the group’s attention. In his loudest voice, he announced that I had passed my final exams. Only mildly impressed, the others continued talking; but Bob winked and smiled at me. After all, I was going to be his doctor.
That evening, Bob and I ran around Hope Lodge and its gardens taking snapshots and giving hugs to each other and to other guests. The next morning, I received a phone call. Bob had been found slumped over on the floor of his bathroom. He had been rushed to the emergency room and subsequently sent to surgery with a perforated bowel.
I spent the afternoon in the surgical intensive care unit holding his hand. I needed to be brave because I was going to be his doctor. Within 24 hours, he underwent a stroke, renal failure, and cardiac arrest. But I hadn’t studied neurology, nephrology, or cardiology. With little understanding of his medical situation, I only knew it was grave. Bob was in a medically induced coma: eyes taped shut, on full ventilator support, and with tubes exiting every crevice of his body. This was not the Bob I knew.
Naïve about the pathophysiology of septic shock, I simply held his edematous hands and offered prayer as nurses and surgical teams came and went. “Take good care of him,” I silently pleaded. Wanting to be reminded of my friend when he was healthier, I brought out the photographs of Bob taken the night before his collapse, hoping members of the medical team would notice them.
Other Hope Lodge patients and their spouses came to see Bob, too; but they soon left. I decided to stay. My four-week summer break had just begun, and I would be spending most of it with Bob, though he was never aware of my presence.
No one knew how long Bob would live. His survival chances were zero. I knew that, but Bob’s family didn’t. His wife and his son flew into town and told me that Bob was a fighter. Yes, I thought, but cancer does not care who you are.
Within a few days, Bob’s body was so swollen I could hardly look at him. No longer allowed to touch him with my bare hands because of his infections, I put on gloves. Bob was no longer Bob.
Three weeks after Bob finished irradiation and chemotherapy for his recurrent cancer, his family made the decision to withdraw life support. It had been difficult. Even though Bob had said he wanted everything possible done, they finally acknowledged that didn’t include living indefinitely with ventilator support.
I was privileged to be able to share Bob’s life and death. During that first very difficult year of medical school, he believed in me and thought I could be his doctor. I needed somebody to believe in me. Bob recognized and cherished my compassion. He trusted I would gain the expertise necessary to become a great doctor because he knew that foundational to the practice of medicine is a heart that cares about the needs of the patient. Even though I will never be Bob’s doctor, there will be other patients like him—brave and generously dispensing hope and love.
The memory of Bob and his remarkable joy continued to buoy me through my medical training. It gave me personal strength when I faced a recurrence of my brain tumor a year later. It gave me the courage to return to medical school after taking a leave of absence to receive radiation and rehabilitation. And every day, it furthers my drive to become the kind of doctor Bob believed I could be. MM
Yaolin Zhou is a fourth-year student at Mayo Medical School.