I began treating a patient (mid-50s white male no prior medical history) at bedside in our Neuro-ICU approximately one year ago. He had just been admitted for his second seizure from a brain tumor which was discovered the week prior. Shortly after meeting for the first time, he and his wife were informed of the tumor pathology – a glioblastoma multiforme (GBM) – which is a well-known, poorly prognosed brain cancer. The statistics for this illness are not at all encouraging to patients, with an incidence rate of 3.19 per 100,000 (median age of 64), a higher incidence rate in Caucasian males than other demographics, and a survival rate less than 3 months untreated, 5% total for those living longer than 5 years.¹ GBM is a devastating illness and the ripples of influence stretch wide.

I was only a few months into fellowship when I began treating this patient in the Neuro-ICU. He was my first patient with GBM, and I was consulted to help support him and his wife during this intense time of suffering. I remember feeling so much anguish as I sat bedside. I found myself monitoring my own countertransference for a man who was about my father’s age who was grappling with the devastation of this diagnosis. His tears filled my own eyes, and I knew despite all of his hope and vitality, that he was feeling the powerful dialectic of hopeful and hopeless all the same. I continued to see him for several weeks after his discharge from our hospital for virtual video sessions. He was especially permeable to notions that life was too complex to only feel one way about this experience. I chose to implement a fusion of Dialectical Behavior Therapy (DBT) and Acceptance and Commitment Therapy (ACT) approaches to help highlight present moment awareness, self-as-context, distress tolerance, and valued living in the face of illness. We laughed, we cried, and we shared much together. When treatment ended, he expressed having more of a handle on this experience than the day we met in the hospital. His tears did not overwhelm him as much, and his grief and despair were seen as only part of his experience versus the entirety of it all. This is what I could hope for, and I was grateful that I had the privilege of being there with him.

Very little writing exists which captures the nature of remembering/recalling patients after the completion of therapeutic work. Gratefully, Irvin Yalom’s The Gift of Therapy, a common language that all practicing clinicians know quite well, describes three tenets which echo for me within this patient encounter and hold real weight for my remembering experience. They are the concepts of Therapist and Patient as “Fellow Travelers”, Let the Patient Matter to You, and Cherish the Occupational Privilege. From Yalom’s most essential words of wisdom, “We are all in this together and there is no therapist and no person immune to the inherent tragedies of existence “[Fellow Travelers]”, “…often patients do not vanish from my mind for the week, and if I’ve had thoughts since the last session… I make sure to share them [Let the Patient Matter to You]”, and “Life as a therapist is a life of service in which we daily transcend our personal wishes and turn our gaze toward the needs and growth of the other… There is extraordinary privilege here. And extraordinary satisfaction, too [Cherish the Occupational Privilege].”² These guiding principles give more meaning to my remembering, and I hope they can guide you as well.

I Still Think of You is a short exploration of what it means to be a fellow traveler at critical junctures in our patients lives, and how these moments leave everlasting impressions on the work we do and the people we become. It is equally a way of processing my own experience of that first snapshot in time we had together – specifically, how little I knew that the image of him sitting in his hospital bed would persist in my mind the way it has. I hope this poem can provide some community around the impact our patients have on us and how we all have a common curiosity and longing after our time ends. I Still Think of You is a tender exploration into these sentiments. The literal shape of the poem is metaphoric for the course of this patient’s illness, and the phrasing is meant to give intentional pause and process during the reading (“|”). To my patient – no matter where you are, it was a privilege to be there with you. Thank you.

I Still Think of You

We met beneath the blinking LED lights and beeping monitors.

You had on a dark blue gown | wig-of-wires all combed out.

I was received by fretted creases upon your forehead.

I confirmed DOB & MRN | you gifted me your name.

We spoke of the seizures which brought you here.

You said you were so scared | my heart ached

because you were living your gorgeous life –

planning for the yearly winter ski trips

with your wife | 17-year marriage.

And how to tell your little girl

that you | were dying.

The glioblastoma.

G|B|M

|

|

|

I

still think

of you.

References

• Tamimi AF, Juweid M. Epidemiology and outcome of glioblastoma. In: S. De Vleeschouwer (Ed.), Glioblastoma. Brisbane, AU: Codon Publications; 2017. http://www.ncbi.nlm.nih.gov/books/NBK470003/ [Crossref], [Google Scholar]
• Yalom ID. The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients. New York, NY: HarperCollins Publishers; 2002. [Google Scholar]