Breaths Of Life In The Midst Of Change: Lessons Learnt From The Paediatric Oncology Ward – Dr Yvonne Lai

9 MINUTE READ

from Luke’s Journal CMDFA 2020 Vol 25 No 2

I have come to realise, over the years, that many doctors and dentists have certain idiosyncrasies. For many, these may include the incessant attention to detail, obsession with perfection and a self-critical nature.

For dentists, one of the outward, tangible measures of success is the quality, retention or longevity of our dental work in the respective patient’s mouth. For those in specialist training, the importance of this criterion may be magnified on a higher level, when the measure of our competence in final specialist qualifying exams is in the quality of our work after a minimum twelve month follow up period, including patients with multiple co-morbidities or who require interdisciplinary management.

Accordingly, despite being Christian health professionals, when we are under pressure it can be easy to be focussed on the end goal, and to subconsciously use this as proxy for our self-worth, instead of remembering that our intrinsic identity lies solely in our status as heirs to the throne of Christ, as his sons and daughters. Additionally, many of us excel in our areas of expertise, and if we are not careful, it is easy to think as practitioners that we have “everything else” under control, and that our professional selfworth is intricately tied to our clinical success with our patients and positive outcomes.

I have not been immune to this. I will share my reflections on lessons learnt working with terminally ill patients in private and public sectors in my work both as a general dentist and during my previous specialty training which challenged my subconscious desire to have and be “in control” of things which were clearly in God’s hands.

The first event occurred seven years ago. I was the sole dentist present in a country town and preparing to see an elderly man for some routine dental work. Mr B. was in his seventies, diagnosed with multiple myeloma, and already receiving chemotherapy. After interdisciplinary consultation, it was agreed that the dental treatment be performed before treatment for bisphosphonates resumed as soon as possible, to ameliorate the chances of existing dental infection compromising the remaining medical treatment.

“It is easy to think as practitioners that … our professional self-worth is intricately tied to our clinical success with our patients and positive outcomes.”

Mr B. was in the waiting room sitting in the chair. As I was finishing my notes for the previous patient, the receptionist entered the room. I was informed that the patient “did not feel too well” and had shortness of breath. I walked out to the waiting room where Mr B was seated and asked him how he felt. Mr B looked at me but did not respond. We sent a nurse to seek help from the medical surgery across the road. I squeezed Mr B’s shoulder and asked him “Can you hear me? Squeeze my hand if you can hear me”.

Barely a minute passed. The doctor from the surgery across the road arrived just as Mr B’s eyes glazed over and his head slumped forward in his chair and he was placed into the recovery position.

A second doctor was sent for from the surgery and the ambulance called as we attempted resuscitation, defibrillation and use of the appropriate medications.

Mr B. was pronounced dead in the ambulance on the way to hospital.

I cancelled my patient list for the day and held a debriefing session with my dental team, who were visibly upset. Our dental team visited the hospital in the country town to offer our condolences to the family and visited the medical clinic across the road to thank our medical colleagues for their help.

Given that we were in a private dental clinic, this incident was unexpected for all of us. While I felt like I had handled the situation with composure and taken control as the sole attending dentist, I drove home feeling guilty over the ordeal. In the days that followed, I admitted to myself that I felt this way because I was used to having complete control, that I wanted control, but in retrospect, could not have further influenced this patient’s outcome. This scenario would be encountered rarely in a dental private practice setting. Nevertheless, the appropriate procedures were followed to seek and administer emergency first aid, and we called for help as soon as we could. Despite our best efforts, the patient died. It was all very sudden and unexpected: this was a private dental surgery, not a hospital, and Mr B. was merely waiting for dental treatment and had been given a one to five-year prognosis for his medical condition.

I found it helpful to debrief with a fellow colleague not involved with the incident. I realised God was ultimately in control of the situation and called the patient home that day. I needed to relinquish my feeling of wanting to have control over my patient outcomes when some of these were clearly outside of my control. I also needed to remember that I was merely God’s servant, stewarding my time, talents and skills in service of others. God was still God – and I was still me. God still reminds me of this lesson today.

In looking back, the same lesson I learnt seven years ago disguised itself in many other ways in the course of my subsequent specialist training in Paediatric Dentistry. During my time as a Paediatric dental registrar, I developed an interest in and had a burden for patients with special needs and particularly those in the Paediatric Oncology unit. A void had been left with the departure of a consultant some years earlier and so I became involved with resurrecting regular inpatient dental ward rounds for the Oncology unit, and in strengthening stronger ties with the Oncology team to further optimal patient care.

I had a passion for helping these children, but also learnt the importance of balancing this passion with resilience as a registrar in the hospital in order to deliver the best patient care. While some of these patients did recover after intense medical treatment, occasionally some did not. Three of the long-term patients I was involved with in interdisciplinary team management, passed away within a ninemonth period. The first patient was an eight-year-old girl with no limbs who was on the waitlist for a combined procedure for bone marrow aspirate and dental treatment. The second was the four-yearold son of a family friend who died from a rare form of leukaemia after two failed haemopoietic stem cell transplants. The third had leukaemia and died shortly after a relapse. I was involved in a very small part of a larger journey for all these patients. Nevertheless, the mourning of the loss of young lives is always very difficult for everyone involved, especially for the families of the deceased, and I did find this confronting. In these moments, God continued to show me that, once again, my role as his steward is to help these children to have the best quality of life that they can for the time they have, and that God is sovereign and that we do not have control all the time. My role in His greater plan was to be the best Paediatric dental registrar that I could be, not necessarily openly evangelising in the wards, but sharing His compassion with others through doing the best dental management I can and in caring for my patients.

“I am to offer myself as a living sacrifice to [God], which drives me to strive to give the best possible care to my patients.”

In my journey back then as a paediatric dental registrar, I came to realise on a more practical level, that clinical work, study and life, has, will, and shall continue to serve up the odd, or even constant, surprise. Whilst I have long-known many of God’s promises on a cerebral level, I have been challenged to own these promises on a heart-level, regardless of life circumstance. For me, the antidote to the urge to control things, especially outcomes I clearly do not have control over, has been to remember and acknowledge that God loves me (John 3:16, Lamentations 3:23) and that God is Love (1 John 4:8), that I have been bought with a price (John 3:16), that I belong to him and that I am a co-heir with Christ (Ephesians 2). Accordingly, my response to God is that I will serve Him because I love Him, regardless of the life circumstance, because he first loved me (1 John 4:8). These promises and reminders have been a breath of life to me when I am stuck, under pressure at work, or when I am feeling vulnerable to the societal messages or the lies that I might be tempted to believe: that I am only as good as the last patient that I treated; especially when my perceived failures seem to add to the expectations to perform or to please other people; or when I am tempted to value tangible results in patients over other intangible outcomes which are equally as important.

It is a relief to be reminded that our time, talents, money, and resources (Matthew 25:14-30) are all gifts from a good God. As such, I will serve Him with my heart, acknowledging that my life is not my own but a gift from God. Therefore, I am to offer myself as a living sacrifice to Him (Romans 12:1), which drives me to strive to give the best possible care to my patients – realising my role is to give the patients the best possible quality of life, regardless of how long they may live, and that the rest shall be in God’s hands.

When I am under pressure, it is a relief to remember that my identity lies in the fact that I am first a most beloved daughter of God, and being a dentist is secondary to this, as God has given me the skills in these areas to serve others to glorify Him.

“For I am convinced that neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers, neither height nor depth, nor anything else in all creation, will be able to separate us from the love of God that is in Christ Jesus our Lord.” (Romans 8:38-39)

Dr Yvonne Lai is a specialist paediatric dentist. She has been involved in clinical supervision of undergraduate students in Western Australia, New Zealand, and currently performs this role in paediatric dentistry clinics in the University of Adelaide and is actively involved in research.

Back to issue: Breath of Life

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