When surgeon Bhuvanesh Singh sees his patient back in the hospital months after what he thought was a successful surgery, he grapples with feelings of failure.
Bhuvanesh is an Attending Surgeon at Memorial Sloan-Kettering Cancer Center. He has cared for over 5000 patients with cancer in his over 20-year career at the center. He is recognized as a leader in his field, having delivered over 500 lectures worldwide. He has helped to refine surgical techniques, contributed to the improvements in cancer staging, and has been involved in research that has dramatically changed the management of cancers of the head and neck region and lung. Not satisfied with available treatment options, Dr. Singh completed a PhD in Medical Molecular Biology to pursue laboratory research. His laboratory work has led to the development of novel anticancer compounds that are currently being optimized for use in the treatment of many different types of cancers. The story Dr. Singh is shared today occurred almost 20 years ago and was a defining moment in his career and life.
This story originally aired on August 23, 2019 in an episode titled “Surgery.”
Story Transcript
I’m going to first thank both Maryam and Erin for all the advice they gave. They said don’t have more than one drink. No comment. They said don’t grab the microphone or pull it around. No comment. They said don’t use props. Ed, can I have my first set of slides, please? I’m going to have to use props. I’m sorry.
‘You have to cut to cure.’ That was the mantra. That was the central focus of all of my surgical training. That’s what I was being taught.
When I first met Alice, I had finished four years of medical school, I had finished six years of residency training, and I was deep into a two-and-a-half year fellowship at Memorial Sloan Kettering. So the way that I thought about my role as a surgeon was pretty well established. I knew my job. My job was, of course, to cut to cure. That’s what I was meant to do.
Now, Alice had cancer of the tongue and she was very atypical. First off, she was very young. She was only 36. Most people who have tongue cancer are older and they tend to be smokers and drinkers. Alice, clearly, was not, so it made her different.
There was actually one other thing that had made her different. Alice was pregnant.
It’s going to be tough. I’m sorry.
So as I walked into her room, she was talking to her husband. She was going over the details of everything that he needed to do while she was in the hospital. As I watched her, she was confident. She was focused. She was completely in control of everything that was going on in the room.
So I did what I had done so many times before. I started to take her history. I started to fill out the paperwork that was required to get her ready for surgery. As a fellow, that was my job and that’s what I needed to do.
Of course, as I did this, I kept my interaction professional, surgical, efficient. Let me get this done so we can move on to the really important stuff, which is the actual operation.
Alice, though, she wasn’t having any of that. She wanted much more than this fact-filled surgical interaction. You see, Alice was a real force and I quickly realized I had no choice but to sit and talk with her. There was no other opportunity for me.
So we ended up talking for a while. When we first started talking, all I can think was, “Man, this is so inefficient. I have so much other work to do.”
But as we talked, her guards came down and, as I think back, so did mine.
She told me about her two-year-old son. She told me about her pregnancy and I told her about my family. You see, I was about the same age. I also had a two-year-old son and my wife and I were expecting our second child. So the similarities were obvious and, for those reasons and for many, many more, we were obviously completely connected.
So we kept talking until her husband finally left the room. And when he did, her voice cracked. I looked at her and there was sheer terror in her eyes. She fought back her tears. She said to me that she had to live. She had to live because she had to take care of her son and she had to take care of her unborn child.
This situation was clearly not familiar to her. She was used to being in control. She was trying to hold on. She was trying to stay strong. She was trying not to show her fear so that her husband wouldn’t worry.
That interaction really affected me and, at first, I really didn’t understand why. The one thing I knew at the end of that, though, is that I had to make sure that Alice was going to be okay. At that point, what that meant to me was that I had to make sure that her surgery went perfectly.
The next day, Alice came into the operating room and everyone was drawn to her. Her personality and her situation really broke through. Even the hardest in the room couldn’t help but be drawn in and completely connected to her.
At some point, the room completely became silent. Everybody knew what was at stake. Everybody was doing their part to make sure that Alice was going to be okay and that she did well.
The normal banter in the room wasn’t there. The room felt completely silent. You could hear a pin drop in there.
I was hiding in a corner. I was going over the steps of the operation in my head and Alice saw me. She called out and she asked me to come over. As I did, I desperately tried not to make eye contact with her. Maybe I didn’t want her to see the concern that was in my eyes. Or maybe I didn’t want to see the fear that was in her eyes.
But Alice was a force. I had no choice. I walked over to the table and I held her hand. As I did, from behind my mask, I said, “Alice, don’t worry. Everything is going to be okay. Everything will be okay.”
Those words completely reassured her and I felt her relax. As she went off to sleep, she thanked everyone. We were ready.
Alice needed a complicated five-hour operation. This involved taking out part of her tongue. It involved taking out the lymph nodes in her neck. And as a fellow, my responsibility was to help the attending surgeon and learn about the procedure and the process.
But on that day, instead of assisting, I slowly took over. Nobody stopped me. You see, this was Alice and it was my job to make her better. There wasn’t anyone in the world that was going to do better than me that day.
The surgery that day, it flowed like artwork. The room was absorbed. Everybody was watching the brushstrokes as the instruments were moving across the field. Every structure, even those that we normally don’t even think about, were carefully identified and preserved.
At the end, the cancer was completely removed. All the margins were clear. The surgical field was flawless. And even my typically very harsh and very judgmental attending had to stop and take notice. On that day, I was perfect.
So of course we celebrated the surgical success with Alice and her family. We all felt that a weight had been lifted and a sense of order was somehow restored.
To no one’s surprise, Alice’s recovery went way ahead of schedule. She was eating and speaking normally in two days, she was out of the hospital in four days, and a week later, she flew home with her family and went back to her normal life.
Later, as I thought about what had just happened, I felt completely satisfied. I felt like I had done my job. I had no doubt in my mind that Alice and her family would now be okay. I had cut. And of course now that meant that Alice would be cured. That’s what I expected. In fact, that’s what everyone expected.
A few months pass. I was still a fellow. I was actively involved in my training. Under the heavy workload of the day and the countless surgeries that I was performing, Alice slowly became a distant memory. My experience with her, though, left me with a strong sense that surgery was indeed my primary purpose. I remained focused towards perfecting the precision and the efficiency of using cold steel, the best care for the patients that I was treating.
One day, after a long case in the operating room, I was making rounds on the hospital floor and an older woman came running across the floor. As I watched her, I saw she was hiding something under her coat. When I looked closer, she was hiding a baby under her coat.
Now, the hospital can be a very dangerous place for babies so I ran after her with a sense of urgency. And as I got to the room where she was going in, I had a whole lecture ready for her to say why she was doing this and how dangerous she was. But when I walked in, my eyes were drawn to this gaunt and frail woman sitting in the hospital bed.
She was in obvious pain. She was having trouble breathing. She was gasping for air. Her hair was frazzled and her eyes were barely open, but when she saw me, she perked up and she smiled.
At first, I didn’t recognize her. But when I looked in her eyes, I realized who she was.
I felt my knees buckle. The room started spinning and I had to steady myself. There in the bed was Alice. She was barely recognizable.
The woman that had been running across the floor was her mother and the baby was her six-week-old son that her mother was bringing to be with her.
Alice’s cancer had unfortunately progressed. I'd seen this look before. I knew exactly what it meant. In I saw in Alice’s eyes she also realized what was going on. Alice was dying.
I was in complete shock. I was completely overwhelmed. I remember running out of the room and somehow find my way to a bathroom and I lock the door then I completely broke down. I cried for what felt like hours.
At that moment, I began to replay every step in Alice’s care, every step of her operation. I did everything right. In fact, I did everything perfectly. Why was she here?
When I finally gathered myself, I washed away any evidence I was crying. I put on a brave face. When I got to her room, I took a deep breath and I went in.
Alice was really happy to see me. I just couldn’t figure out why. I was so disappointed in myself so I hid my shame as we talked and she filled me in on what had happened.
She had flown home. Unfortunately, the pathology from the surgery had shown that the cancer had spread to the lymph nodes. Because of this, she had to endure seven weeks of very damaging and debilitating radiation therapy. But despite this aggressive treatment, the cancer had spread to her lungs. At this point I knew that there was absolutely no hope for curing her.
As I sat in her room, I really struggled to control my emotions. Alice, on the other hand, she was as strong as ever. She was completely focused. She told me she had one goal. And she wanted my help to stay alive long enough to reach that goal. She wanted to write letters and make videos so that her sons could read those letters and watch the videos for each of their birthdays until they turned eighteen years old.
What she wanted to do was make sure that her sons knew their mother. She wanted them to appreciate how much she loved them. And even though she wasn’t going to be there, she wanted to make sure that they were somehow taken care of.
Over the next few days, I checked on Alice regularly, every free minute I had. I did everything I could to help her stay alive. She was so, so strong. The levels of her pain were unimaginable but she refused to take any pain medications because she wanted to stay focused and alert enough so that she could write letters and make the videos for her sons.
I often watched her from outside her room. I saw her smiling and joking into the camera. She was putting on a brave face so her sons would see her in a good way. As she shared her feelings and her advice, she looked into the camera as if though she was looking at her boys. I really prayed that her boys would see her eyes that were so full of hope and her smile that was so infectious and not the obvious pain and sorrow that she was desperately, desperately trying to hide.
That time for me with Alice was incredibly challenging. I really began to think I had made a mistake. I felt I had failed and that was difficult for me to overcome. You see, Alice, she somehow knew exactly what I was thinking. And late one night when we were talking, she paused.
She looked up at me. She took a hold of my hand and she told me, “It’s okay. It’s okay.”
She told me how much she appreciated everything I had done for her and especially the time that I had spent with her and how much she valued the care that I had given to her. Almost as if so she could read my mind, she reassured me and she asked me to take care of others like I had taken care of her.
Her words were powerful. They were healing much more so than any scalpel or medicine that I had, that I could give her. At that moment, instead of me taking care of her, she was actually taking care of me. Even at the end, she felt better by making sure that those around her were taken care of, including me.
So through sheer will over the next three days, Alice made all of her videos and completed all of her letters. I don't think you'll ever appreciate how difficult this was for her to do. And when she finished, she was elated, and we all celebrated.
A few hours later, she died. I cried with her family and I cried so many times after that I just lost count.
It’s hard to believe but that was over twenty years ago. It really feels like yesterday. This is actually the first time I've been able to share Alice’s story in public, and I really felt the need to share her story because, you see, Alice helped me appreciate the most important thing about being a doctor. She made me realize that it’s not about precision and cold steel but rather about easing fears. It isn’t about cutting the cure but about caring and using hugs and laughter to heal.
I feel so privileged to do what I do now but, today, I see my role as a surgeon very differently. It’s my job to help people during their most difficult time. It’s my job to try and help them heal. I guess it’s my job to try and do exactly what Alice did for me.