Submitted by Dr.Kattlove’s Cancer Blog

The other day in my class with second year medical students, one of them asked me how I handled the stress of oncology practice – namely caring for so many patients who would eventually die of their disease. He was planning to specialize in pediatric neurology, a specialty with a dismal success rate. At least we oncologists have a fair number of cures. Not so with brain damaged children.

I often wondered myself why I didn’t get overly depressed by my practice. Sure, there were certain times that were quite sad, particularly with certain patients who did not survive. But, generally life went on for me.

This question has actually been the subject of many articles in the oncology journals. Dealing with dying patients is a major stressor and many ways to deal with this have been proposed. They range from more vacation to talking to others. All probably effective, but the one I’ve seen most often is apathy. That is, instead of talking to patients about their issues and about dying, many oncologists just give more chemotherapy or whatever drug hasn’t yet been used for the particular patient.

It is much easier to prescribe than talk. That is why we have such an excess use of antibiotics in this country. It is simpler and quicker to prescribe an antibiotic than discuss why a viral illness such as a cold won’t get better faster with antibiotics. The same is true of many oncologists. Giving more chemotherapy is easier than discussing a patients’ symptoms and their likely outcome.

How can oncologists be so unfeeling in the face of gravely ill patients? Recent studies in how people react to pain may explain this. Scientists have learned how to measure the brain’s reaction to pain by a certain imaging procedure called functional MRI. When people feel pain, the fMRI lights up certain parts of the brain that have now become more active with the pain. Also, when people see others experiencing pain, some of the same areas of the brain also “light up” – appear more active. A measure of empathy.

But what if someone sees lots of people who experience pain – even mild pain? Recently researchers performed fMRI studies on acupuncturists – consistent pain producers. When the acupuncturists saw people getting needles stuck in them, their brains didn’t “light up”. The fMRI showed no pain response, no empathy.

Why no empathy? Maybe acupuncturists have trained themselves out of empathy. Perhaps this is a defensive measure that allows them to work without the stress and agony of seeing others experience pain. It makes sense.

So I ask, is this what happens in oncologist’s brains when they see people with terminal illness? Are their empathy receivers turned off? Perhaps that is true for those that respond to patients’ distress with more chemotherapy. Did I also turn off my empathy receiver? Although I wasn’t a chemotherapy giver (in fact patients would sometimes leave me because I recommended against more chemotherapy), I did have to get through the day, the week, the year. I don’t know. Perhaps we all learn to “turn off” in certain situations – starvation in Darfur, floods in Bangladesh, you name it. Bad things happen and if we feel them too deeply, we would suffer too much.

I guess that is true of oncologists also. It would be intolerable for them if they suffered along with their patients.

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