Dear Mrs. Nyman,
Thank you for allowing me the privilege to share some thoughts for your blog. Your posted messages are intensely personal, very conversational, and spiritually grounded. I will try to follow your lead, as best I can.
Some introduction:
Over my 37 years as a physician, I have mostly done academic clinical oncology. Sometimes this was medical oncology and hematology, either clinical, clinically focused lab based research, or a combination of both. Later, this was radiation oncology and clinical research related to my patient care and that of my colleagues. The decision to specialize in oncology was driven by observing my mentors when I was a medical student and early resident, by the challenges and opportunities posed by trying to help manage patients with malignant disease, by the excitement of new advances as I was finishing medical school and beginning training, by my mother undergoing surgery for breast cancer and receiving chemotherapy in an early trial of adjuvant chemotherapy shortly after I graduated from medical school, and by the training opportunities available.
However, at the core of all of this, what consistently kept me centered was the human connection. My internal definition of “being a doctor” required being regularly involved in caring for other human beings. When I didn’t have this, there were times when it was “ok.” Particularly in the beginning, when I was immersed intensely in my lab work – trying to get started, develop techniques, prove myself, and get results. However, over time, it became clear that being exclusively in the lab was not my calling. Later, I felt I had to choose between one or the other, as doing both at the level of excellence I expected was, for me, too demanding. I chose patient care and left the lab behind.
In the early 1990’s, my clinical practice became focused on the nonsurgical care of pancreatic cancer. This assignment found me – almost accidentally, from my perspective. It was a function of the institution where I worked, programmatic needs, and no one else to do the task. This was a hard assignment for lots of reasons, and I had to grow into it. I would say it took me about five or six years before I began to feel truly comfortable in this new role.
When I met you, your husband, and other members of your family at the end of September 2009, it quickly became clear that none of you, as of yet, quite understood what was likely happening. There was a huge disconnect between how “bad” Mr. Nyman’s images appeared and how well Mr. Nyman was feeling and looked that day. As a physician I never presume that I really know what will happen to any of my patients. However, I do know what is likely. That doesn’t mean it will necessarily happen, but it does mean that, to the extent possible, I try to avoid letting my patients and their families be “blind sided” by what I think might be coming, especially if it looks like it might be very bad and distressing. Since I don’t really know what will happen, I can’t and don’t say too much, but I try to provide sufficient “just in case” interventions to be prudent and helpful. My fear was that your husband, and therefore all of you to some extent, were about to fall off the edge of a clinical cliff called “dying from metastatic, pancreatic cancer.” I couldn’t stop the fall, although I wished that the means to do that was available, but I could do some things to try to cushion the fall a little, just in case. So, I did. Unfortunately, it was only a few days later when my fears for your husband and family began to be confirmed all too clearly.
Your husband’s brief period of radiotherapy was a time of medically necessary intervention and also provided “safe haven” during which you and he could learn what was happening, process this most unwelcome reality, and decide how to proceed. These are among the most challenging of times for any person and family. For some patients and families these challenges lead to a place of coming together, intensified love, and spiritual enrichment, in addition to severe emotional pain and wrenching loss.
From talking with you since your husband’s death, it seems this growth has happened in your family. You and they came to this unwelcome time and task with intellectual strength, love for each other, psychological determination, and spiritual preparation. It wasn’t easy; it’s still not easy. But, you all gained and grew. As much as you lost? Who am I to say? I think that’s the wrong question, really. You lost husband and father; companion, teacher, and guide. How does one even measure that loss, much less replace it? I think the concept is that even given what you lost and lost so irreplaceably, the experience was not exclusively about loss and pain. In fact, I think this is the underlying message of what you write and post. Life can go on: painfully, differently, and with adjustment; but, also with increased spiritual connection, strengthened family love, and a desire to both grow one’s humanity and share the power of that growth. This is a powerful message for all of us. It’s a message we want and need. It’s not guaranteed, only possible.
My thanks to you, your family, and your departed husband for providing, and modeling, this important message and lesson.
Ross A.
Dear Dr. Abrams,
Thank you for giving voice and face to the innumerable oncologists out there who treat and sometimes truly care for our loved ones. My mom died of metastatic breast cancer 8/17/09, and I sometimes wonder if my mom made a difference in the life of her oncologist.
Your side of the equation is one that I have occasionally considered, but sometimes in the midst of ongoing or acute loss, it is easier to blame “you” for not having the answers, for not being able to make it better, for not having some kind of miraculous, even if risky treatment to bring our loved ones back from the brink of death by cancer.
It is a thief, but as you and Margaret point out, it is also a philanthropist of sorts, when allowed to be that.
Thank you for your compassion and expertise you lend to this family, and to your patients.
Dr. Abrams,
Thank you for sharing your thoughts with us. I hope that you continue to read Margaret’s Blog, the readers’ comments, and also continue to participate with your comments. We all benefit, from these posts. Thank you for caring and sharing ~~~
Dr. Abrams,
Thank you for taking the time to write this blog. Also, thank you for being a Dr. who spends the time to explain things to his patients and their families. It gives a feeling of stability in a tumultuous sea of change and chaos. Thank you.
Dear Dr. Abrams,
I am one of the Nyman children. When my mom and dad first told me about the cancer, they also talked about you and the quality of care they knew my dad would get at Rush. Since then my mom has mentioned you often and I know the compassion you showed her and my dad over these months has meant so much to her. I’m grateful my dad didn’t just have a doctor who looked at his physical body, but one who thought about his heart and mind, his spiritual life, his wife and family. I have tears in my eyes after reading what you wrote because I know you genuinely cared about my dad and what happened to him. Thank you for everything you’ve done for my family. You are a blessing to us.
Dr. Abrams,
I am a childhood friend of Margaret’s. I have been most touched and impressed by their story right from the start. I am even more impressed and touched by your articulate, sensitive, loving care of Nate and all your patients now that I ‘ve heard you speak.
I’m Linni’s husband’s grandmother on his mom’s side – in Fla. and I wish to commend you for the person you are and the doctor of medicine, to this family who is so very precious to the hearts of all of us. We need more physicians like you who genuinely care for the families of the patients they serve, in areas most would never consider – the spirit heart.
Thank you for sharing your compassion, and may God continue to bless you in all you do. Mere words can never express the gratitude of a loving heart.
Dr Abrams, I am a childhood friend of Margaret. My brother is a neurologist who also allows himself to care about his patients…and experience the pain that brings. I thank God for Drs like you and my brother. It is a lot easier to stay disconnected and avoid sharing in the pain. So thank you again
In the novel, To Kill A Mockingbird, the attorney, Atticus Finch, defends a black man unjustly accused of raping a white woman. It leads to trouble for his family and he loses the case. Crestfallen, his son, Jem, has an exchange with a neighbor, Miss Maudie, and she says this: “I don’t know if it will help saying this to you… some men in this world are born to do our unpleasant jobs for us… your father is one of them.”
Dr. Abrams, you are one of those men as well. Of all the options open to you in medicine, you chose one that more often than not has unpleasant treatment and even more unpleasant outcomes. Not every doctor is skilled in matters of the heart and spirit, but you are, and perfectly suited to do medicine’s unpleasant job.
My daughter wants to pursue a medical career, and your example for motivation to do so is sterling.
“The LORD bless you and keep you; the LORD make His face shine upon you and be gracious to you;the LORD turn His face toward you and give you peace. Amen”
God bless you, Dr. Abrams
Terry Davis
Dear Dr. Abrams: May God continue to give you the compassion and the wisdom needed daily to cushion the fall of so many people and families. Thank you for not assuming to know the outcomes but instead giving your patients the “just in case” interventions to be prudent and helpful. Your honesty and gentle manor are a blessing.
I add my thanks to you for not only caring for Nate, your patient, but also my sister, Margaret and their family. May God bless you as you continue touching the lives of others as they journey through the difficult days of terminal cancer. You are a blessing!
I am just a reader of the blog. I have watched this blog family care for each other in a way that can only be defined by their common love for God. I, through this blog have become a believer in God. God brought you into this family. You were given the precious job of caring for Nate’s family’s heart at a difficult time. You tenderly answered their questions. God put the Nyman’s in your life and all of us in this blog family are very grateful. May your example as a caring, loving and gentle doctor shine like a beacon for others in your profession.
I thank you so very much, Dr. Abrams, for your skill and your love as you helped my friends, the Nymans, and all others under your care.
All I can add Dr. Abrams is God Bless You. What a treasure to Nate and his family.
Dr. Abrams, Thank you for your willingness to get involved in your patience lives. I know it’s been a huge blessing to the Nyman family and I’m sure to many others. Also, thank you for the blog post. It’s not often you get to hear from a doctor what their heart is and what lead them into a specific field of medicine.
Thank you for your excellent care of the Nymans and for your wise words. It is interesting that your own mother battled cancer. We are called to use our suffering and the comfort we received to comfort others. You are clearly doing that.
Your words also remind me that I should not run from pain but move toward it. It can be used for good in my life, and in the life of others if I let it. Not everyone suffers as the Nymans have, but we all have pain and loss of some kind and it is wise insight that a loss does not have to be, and indeed may not be able to be, replaced. We can grow through our loss and share the power of that growth. I will remember that.
Thank you, Dr. Abrams, and may God bless you and continue to give you wisdom and strength as you serve others in your very challenging and demanding job.
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