Our train starts to move slowly down well-traveled tracks. Sunny out,
clouds in the distance. We pick up speed.
We offer obligatory greetings,
courtesy How you feelings?
We both know why she’s here
we defer that talk
as if deferring for a few minutes will make it easier.
The trackside turns to trash, human detritus, rusting hulks without utility.
I edge closer, negotiating perfunctory reviews–
her history, her physical, her labs, her imaging–
she owns them, they’re hers alone.
Then it’s time to enter the forbidden room of abnormals:
machine-made “shadows,” the blood’s “too highs.”
Her cloak of woven fear lies quietly on her shoulders.
It stays immobile when I say the halfway word “tumor.”
It doesn’t wrinkle or slip upon finally hearing
that we have arrived at our destination,
the train stop with the “Cancer” sign swinging,
greeting us as we brake to disembark.
We enter the cavernous shell of an ancient building, pigeons circling great
columns as if this was normal. At the center of the main floor the newly electronic train
schedule flashes its options. It suggests we are free to choose whatever
route we wish.
I recite the complexity of the science of it all.
She is dismayed by the excessive information I offer,
couched in pretentious “We can do this… or this…”
She thinks, but politely defers saying
“We aren’t going to do anything. I will be doing it. Alone.”
When I eventually crawl out
from behind the evidence-based wall
I’ve taken for shelter, she says
“What should I do?”
I say something about shared decision-making.
She says “Fine, but I’m asking you
‘What would you do?’ “
I review again the pros and cons of option A
and the cons and pros of option B.
I mention the experts don’t agree,
the consensus statements have no permanence.
The latest study contradicted the previous one.
We sit on a long, well-lacquered bench, facing the ever-changing
train schedule, squirming on the hard wood and the too many
choices. Her fear moves over a bit to give confusion more room
to rest and then quickly fester.
A mild anger starts to swell, impregnated
by the word “cancer,” nourished by indecision.
The turmoil is discussed obliquely, hesitantly,
as a fully informed decision-making process.
She looks at me with the courage
of those facing this choice:
“I’m asking you again because I trust you–
what would you do?”
I realize my good intentions have been frail
and, so far, failing.
We get up to leave, confusion and fear walking close behind.
The train is waiting, refueled. We step on, sit down.
The train lurches, then slowly leaves the station, gaining deliberate
speed, heading out in a new direction.
“What I would do, if it was me, is….”
About the poet:
“As a family physician, listening to my patients in New Hampshire and Maine over the last forty-two years has taught me so much more than books and courses–most importantly, perhaps, that I should listen better. Writing about my patients’ stories both serves to honor them and, hopefully, encourages me to listen a little better to each and every one of them.”
About the poem:
“This story is about two facets of the patient-physician dynamic that, unfortunately, seem to be fading: relating as two people who care about each other; and, derived from that, the trust that may be even more critical to the patient’s outcome than all the evidence-based protocols we have available to us.”
Johanna Shapiro and Judy Schaefer
12 thoughts on “Riding the Rails”
Bill, you’ve always been as much poet as physician. This cuts to the core of the patient empowerment vs. tell me what to do issue. Most of us want a trusted physician to give us info, but also a recommendation.
Thanks so much for this. I particular like the fact that our long-time patients are empowered to confront their doctors, to make us uncomfortable, to hold us accountable. I come away from your poem with that wonderful upset feeling in my stomach that tells me I have truly connected.
Thanks for your kind words. Hope all is well with you and yours.
Very thought provoking, and well spoken, demonstrates a bond and trust that a patient has with their doctor that is slowly being lost in this fast paced world.
thank you so much for this complex, yet profound poem.
it really reflects so much of the experience, when people are at the beginning of their cancer diagnosis.
I wish there was more recognition & respect given to the more humanistic, non- medical events shared between health professionals & patients/ clients of a health service.
This poem is a keeper. Utterly beautiful in rendition and progress. I hope I can share it when I speak with a cancer group in Norfolk England next month.
Trust – means so much more (I think) than knowledge and information. Maybe I shouldn’t say or believe that, but I do.
When my/our time comes I hope we are in the care. and maybe even the company of, a doctor with whom it is ‘safe’ to die. For we do this alone. Thank you.
If you were asking for permission to share this piece with your group in Norfolk, lease accept my humble appreciation for you wishing to do so. Please share with them and ask them to always ask their physicians what they would do personally if faced with a clinical issue.. It may not always be applicable but it takes the discussion to a different level.
The issue of trust is a critical one,especially as team-based care is taking us away from face-to-face time with our patients. It is time both in a given visit and over a given lifetime that lows us to build theta necessary trust. We need so much more of that…time.
Thank you for your kind comments.
Thank you so much for this powerful story. The train metaphor is very effective!
thank you for sharing your story. We forget to listen to the question and fail to understand what the patient wants to know. It is such a delicate balance sometimes.
This really hit home for me , a cancer survivor (so far).
Very nicely done!
Beautiful expression of the complex interaction that is so much part of the physician’s role. The skill lies in sharing the art of compassionate healing and the science of medical evidence with you patient. They have entrusted you with their care.
Very nice story.
Train metaphor compatible with the rural practice.
Too many young physicians now are trained to give “options” and are reluctant to make recommendations.I have seen this problem myself as a patient, and it represents a lack of good training. Giving recommendations IS the job of the physician.