Letter to Mummy

Blog 042518

I was inspired to write letters to myself by a letter I wrote to my mother when I turned 65 and retired from forty years of medical practice. Dorothy and I had already written quite a bit about art-based approaches to palliative care, and we learned it was common practice for ancient Egyptians to write to their beloved dead. Presumably their way of grieving loss, surely rooted in spiritual beliefs. So Dorothy wrote to Patrick, her husband who had died a year before she and I met, and I wrote to my mum, who died when I was twelve. So here’s the first half of my rather long letter—I’ll include the second half in another blog.

Dear Mummy,

High time I wrote you! The last letter I actually posted would have been from boarding school—more than fifty years ago. Yesterday, I was thinking about you and having a good cry—I guess grief lasts a lifetime. Maybe there haven’t been many people I’ve really trusted since.

But—65 years young and happier than ever! You’d be proud, and sure let me know it—like when I won that prize for Latin or that little silver cup at the school sports. Well, I just retired after forty years of doctoring, and about twenty years ago I finally figured out my course was subconsciously set the moment I first heard you’d died. Uncle Ken always tried to talk me out of being a doctor, and I could never come up with why I was so set on it. After all, I hated science in school! But I know now it was no accident I chose first oncology, then pediatrics. Your death made me declare a twelve-year-old’s war on cancer. And after my miserable adolescence I lost my heart to the first sick child I saw—though it was scary as hell at first.

It still astounds me no one told me you were dead until three days afterwards. Looking back, I’m sure that lack of candor left an enduring mark on my whole career, and we’re still avoiding the truth when we talk to our patients. So I want to tell you a bit of what I’ve learned about telling patients and families the truth, because I’ve been dwelling on this ever since they finally got around to letting me know what happened to you. The last four years, I’ve been a children’s hospice doctor. People often ask me why—and lately I’ve been figuring that one out, too. I came back to Barts ten years after graduating as Britain’s first fulltime pediatric oncologist. Amazing to think the first chemo ever given for cancer was given to a little boy in Boston less than thirty years before—that child would be the same age as me if he’d lived.

It was the universally held view, in 1960’s British medical circles at least, that telling the patient outright what was wrong with them—putting a name to their illness—would throw them into such a crisis it would quickly kill them. So silence was maintained by all. My very first week, this radiation oncologist asked me to see a patient I’ll call Brian, whom he’d been treating for a widespread bone cancer. Did my new chemotherapy treatments have anything to offer, he wondered?

One look at Brian’s X-rays told me his time was terribly short, and that any drugs I might offer would buy him a couple of months tops. When I went into his room, he was stretched out on a gurney in obvious pain, his parents on either side. It wasn’t till I came closer, and our eyes met, that I realized abruptly that this whole scenario was an uncharted sea for me. I’d never had to tell a patient I had little beyond a little comfort to offer, let alone utter that spectral “D” word. I’m sure no one way back in the 1950’s spoke directly of death with you; and it flashed on me that in all the conversations I’d witnessed between senior doctors and patients I had never seen real candor shown. None had even talked to us privately about how such dialogues should go; it just wasn’t in the teaching curriculum.

Enough for today… to be continued. Oh, and I included this letter in my memoir, “Journeys with 1000 Heroes; A Child Oncologist’s Story”, due out this July (d.v.)….