August 9, 2023
As I sit at a coffee shop trying to study for an upcoming in-service examination, my phone rings. I see that the caller ID is from the hospital, and I know what is coming. I take a deep breath and answer, only to hear the standard greeting for delivering bad news.
“Hello, Anthony, is this an okay time to talk?”
My heart sinks, and I wonder if there will ever be a good time to hear bad news. I respond affirmatively, and my primary care provider delivers the news I had been dreading: the radiologist is very concerned that you have cancer.
A few days earlier, I had noticed a painless testicular mass and immediately scheduled an appointment with my primary care provider. The subsequent ultrasound, which included a trainee performing the exam under the supervision of a trainer, went smoothly.
The trainer repeated the ultrasound after the trainee was complete. She then met with the radiologist to see if additional images were needed before I left. I knew this was not the standard routine. As I left the hospital, I had a sinking feeling that things were not normal, and that the results would not be benign.
The next few days were a blur. I oscillated between feeling nothing then having a rush of thoughts flood in. I reflected on the patients to whom I’ve delivered bad news during my short career so far, and I thought about the countless hours I had spent studying, researching, and working. At the time, I was training as a third-year general surgery resident at the University of North Dakota in Fargo.
I thought about the personal sacrifices I had made, including missing out on time with friends and family. Missing weddings, births, and moving across the country away from everyone I knew—all for the sake of becoming a physician who can make a difference in patients’ lives.
I had postponed so many things, telling myself that I would have time down the road. But now, I wondered if all those sacrifices were for nothing. Was my goal of making an impact in patients’ lives now unattainable?
Even though I had suspected this outcome from the beginning, tears still welled up in my eyes. My primary care provider assured me that this type of cancer is curable in 94% of cases and outlined the next steps, including further testing and referrals to specialists. Of course, I only heard that 6% are not cured. She then suggested a consultation with reproductive medicine to discuss fertility considerations. I got off the phone, slowly packed up my stuff, and headed home.
The next day, I reached out to the leadership of my program at the University of North Dakota to inform them of this news. At this point, I was trying to figure out how to work as much as possible through the surgery I would need and the subsequent chemotherapy.
During the conversation, I found them remarkably receptive and kind. They told me to take off as much time as I needed and not worry about patients or the service I was on. This was the polar opposite of what I expected from a surgical residency leadership.
As I returned home, I started to reflect on many things, but predominantly on the concept of wellness that recently has become a focus of so many physician talks and articles.
During my time in medical school and residency, I attended many lectures and workshops on wellness and self-care, but I had never taken the time to apply any of the recommendations or strategies to myself.
I realized that much of what I had learned during my training, and what I often tell patients to practice, I was not applying to myself. This was a wake-up call.
While my diagnosis was not terminal, I appreciate that it could have been, and I have seen many people my same age who have had their lives cut too short.
While we all strive to be the best physicians in order to take care of people, it is truly important that we also take care of ourselves. Evident by my experience with surgical residency leadership, the surgical culture clearly is shifting from the classic mindset of residency takes precedence over all else. It is important that, with these changes, we fully instill this perspective within ourselves and take the time not only for self-care, but also to fully enjoy our families and friends.
The thoughts and opinions expressed in this viewpoint article are solely those of Dr. Duncan and do not necessarily reflect those of the ACS.
Dr. Anthony Duncan is a general surgery resident at the University of North Dakota with plans to specialize in burn surgery and critical care. He also has a passion for medical education research and quality improvement.