Treating Cancer Patients ‘Like Cattle About to Be Slaughtered’

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This story is from the Anamnesis episode called Empathy and starts at 42:33 on the podcast. It’s from Vadim Gushchin, MD, a surgical oncologist at the Institute for Cancer Care at Mercy Medical Center in Baltimore.

Following is a transcript of his remarks:

Several years ago, I got an email about a 10-year-old boy in Moscow, Russia, with a rare blue round cell tumor, whose parents were looking for an opportunity to have cytoreductive surgery.

I’m a surgical oncologist who focuses on treating peritoneal surface malignancies, and I am often called to review complex cases of peritoneal carcinomatosis in patients from other countries. When I got the email about the boy in Moscow, I happened to be on the way to visit my mom, who lives in Russia.

Reminders of Soviet-Style Healthcare

I eagerly agreed to stop by a major children’s hospital just a few bus stops from my mom’s apartment to review the boy’s case and discuss it with his parents and oncologists.

When I walked into the children’s hospital, it looked and felt nothing like the Soviet-style hospital from my own childhood, which had bare yellowish walls and cracked, worn-down floor tiles. This hospital looked like a construction made of brightly colored blocks from a boutique kid’s store designed by a gifted toddler with a dream of living in a place filled with all the toys imaginable.

The hospital exterior matched the spacious hall, corridors, and the informal uniforms of friendly personnel. Even the infectious control restrictions on the way to the chemotherapy unit did not remind me of the Soviet-style medicine that I knew.

When I entered the boy’s room, I saw the top-notch hospital equipment, and the brand of his chemotherapy port was precisely the one I put into my patients back in the U.S.

I examined the boy and reviewed all of his films and lab data. After the exam, I met with the treatment team in the physician’s office. There were a group of about four or five resident physicians here, who were sitting down and intently listening to me — the surgeon from the United States — as we dealt with this complex tumor.

He Hissed at the Parents?!

I was conferring with the treatment team when I heard something that caught my attention. The parent of one of the patients on the floor knocked and timidly asked to speak to his child’s physician. Immediately, the young residents who were listening to me hissed at the man and rudely demanded that he close the door from the other side.

I could tell that this reaction was such a natural thing to them, as it was to the parent — he immediately closed the door, recognizing that he was at fault for interrupting the doctors. But for me, this behavior was strikingly unprofessional. I felt a wave of rage consume me as I imagined myself in the parent’s shoes, worrying about my sick child and being told to get lost.

As I sat in the physician’s office, I found myself in a strange position, being a foreigner among my Russian colleagues, who had a different professional training and ethics code. When I witnessed how the residents treated the father of the young patient, I thought about speaking up, but I knew I could not react immediately in the moment.

I was a guest, a consultant, and had a mission to facilitate my sick patient’s treatment plan. An outburst would compromise his care, as nobody would listen to my advice and I would not be able to help the parent and the patients I was here for. So I kept quiet.

But on the other hand, I could not live with this. In the country that I grew up in, and where I still have connections and family, they were continuing to treat oncology patients like “cattle that were about to be slaughtered,” in the words of some of my patients.

I had previously seen this at adult oncology hospitals. But the situation with children magnified the problem, and brought it right in front of me. A patient was not a patient, but a nuisance. And doctors were above them.

Seeing physicians as above their patients was something that I noticed before consulting on this case all those years ago. I remembered seeing family members waiting in the parking lot for doctors to come out to their cars so they could ask a question about their relatives, like people waiting for actors and actresses coming from a Broadway show.

In an effort to continue caring for my sick patient, I did not speak up that day. But the image of the parent begging to speak to a doctor and being turned away has stuck with me.

The truth is, it is typical for a Russian oncologist to avoid talking to the patient, to stay above it, not to address the questions important to the patient. It happens not because the doctors are bad people, but because of the way they are trained. I remembered it from my own medical training.

‘Heartless’ Oncology

I recalled my time as a medical student back in Russia. I read introductions in Russian textbooks that doctors are responsible for their patients’ health. However, reality taught young physicians that surgeons cared about well-performed operations, and cardiologists were concerned about plaque-free coronaries and good blood pressure numbers.

In that worldview, patients were supposed to follow the doctor’s recommendations with obedience and admiration. There was no room for a patient’s personality or basic needs in this paternalistic world, beyond their becoming healthy. Therefore, for medical students there was no need to be taught how to communicate with patients, how to practice patient-first medicine.

For a medical student, it was easy to follow this paternalistic doctrine, and only American professional education had radically changed my attitude towards patients.

I was challenged on my first day of residency training in the United States. The attendings made it clear that our patients were people, whatever their social or life situation was.

After practicing in the United States for many years and intermittently working on cases in Russia, I wanted to bring a patient-first perspective to resident physicians in my home country.

Shortly after the incident with the parent and residents, I tried to partner with any leading Russian oncology institutions to start a course in patient communication and evidence-based medicine for oncologists.

Once, I chaired a session on postgraduate education in oncology at one of the main national meetings in St. Petersburg, Russia. After the session, an oncologist who lost his mother to breast cancer came up to me. He was still raw from going through the heartless system of oncology care in Russia and was determined to change the system.

This conversation ultimately led to the concept of a remote training program in oncology for young physicians. The ultimate goal was to bring a concept of residency training to Russia with a patient-first approach as the core tenet.

The Higher School of Oncology has trained about 50 young physicians in 6 years since I started weekly online seminars. We detailed our experience in a paper published in the Journal of Global Oncology this year. Patient communication has become a major focus of attention in Russian medical training now, so even the minister of health promotes it in medical schools and postgraduate training.

I still remember the episode in the physician lounge in the children’s hospital with sadness. My reaction made me recall my training, and the importance of teaching “patient first.”

At first it seemed to be insincere and even corny to pledge every step that you are suggesting the course of action in the “best interest of the patient.” Gradually, doing uncomfortable things for yourself to benefit patients became my second nature.

Now, pulling myself together after my sleep was interrupted countless times and going to see the patient in the emergency room instead of relying on the report of a resident; letting the family be present at the bedside of their dying relative and talking them through it, or being on the phone with my colleagues from other institutions to find an appropriate clinical trial for the patient who I cannot help, it doesn’t seem special at all.

That is what doctors do. I was trained this way.

One needs to be idealistic to see that values matter. I feel that teaching these values is as important as teaching medicine itself. That alone may change the system.

Other stories from the Empathy episode include “‘Can You Explain Why You’re Sending Me to the ICU?'” and “It Isn’t the Dead Child Who Haunts Me”

Want to share your story? Read the Anamnesis Storyteller Tip Sheet and when you’re ready, apply here!

Last Updated July 09, 2021