there’s this thing i do whenever i’m nervous. the corner of my mouth trembles and i pick the skin on my fingers until they’re raw and bleeding. the stinging pain of compression as i halt the gentle haemorrhage soothes my nerves a little. my manicurist gives me hell about it.

i saw someone else do the same yesterday. he is a young patient of mine, who’s been diagnosed with cancer. i stood by as the surgeon explained his treatment options – different forms of surgery depending on intraoperative findings, possible outcomes and complications, what to expect once the operation ends. diagrams were drawn, figures were thrown at him. he learned that he could have up to 5 scars on his neck, chest and abdomen as well as a tube going into his lungs when he wakes up from surgery. he was also told there was a chance the tumour may be unresectable.

it wasn’t anything new to me. i’ve assisted one of those surgeries and seen quite a number of patients go home without a stomach or part of their oesophagus and small bowel. i’ve watched the lung collapse on command during the operation and touched a still-beating heart. i’ve smiled at the end of the surgery when the collapsed lung expanded, its pink sponginess returning to its former glory.

i watched my patient lock and unlock his fingers, picking at his nails until they bled. he took in the jargon – anastomosis, stapler, thoracoscopy – without much question. he only interrupted the surgeon to ask if there were any restrictions to what he could eat.

in the routine of explaining complex procedures to our patients, it is usually the ill man himself that reminds us of what matters most: quality of life. he wasn’t interested in the surgery itself or the effort we are making in preparation for the operation. i’m sure he only understood 60% (at most) of what we told him about his condition and the options of treatment.

he just wanted to know if he’d ever taste his mother’s meals again.

i thought of the stressors that have compelled me to abuse my fingernails involuntarily. all of them raised my cortisol levels enough for me to lose sleep, look to the skies, head over to my favourite pub and avoid human contact. they were nowhere near the stress of receiving a diagnosis of cancer, yet those mechanisms of coping are a luxury for my patient, a young man who has less than a week to mull over the choices presented to him in that short 20-minute family conference.

if i ever had the illusion that this job will get easier with time, i definitely do not have it anymore.


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