A month before his 49th birthday, Geoffrey Fleming, MD, had a biopsy of his liver to diagnose an unidentified metastatic disease that he already knew was “something bad.”
The next day, he jetted off to Scotland for a family golf trip, deferring the results of his procedure until his return.
On Aug. 26, 2019, he got the news: he had a liver and bile duct tumor known as metastatic cholangiocarcinoma, a cancer that, when treated, offers an average lifespan of 12-18 months.
As an Intensive Care Unit (ICU) provider at Monroe Carell Jr. Children’s Hospital at Vanderbilt, the concept of terminal illness isn’t new to Fleming, who has spent most of his career leading families through end-of-life conversations. While the news was disheartening, he found himself at peace knowing his life so far has been full of love and purpose.
“I know there are things worse than death — I’ve seen them in the ICU,” said Fleming. “I am fortunate to have stood at the bed of many children who died, and they have taught me how to be brave. They taught me how to live well — how to find the joy in a bowl of ice cream — and how to die with dignity and acceptance.”
Although he can no longer safely work in the ICU due to his immunosuppression, being on the other side of the hospital bed has taught Fleming a lot about what it means to show up for patients.
For starters, he believes the role of a physician has changed from being the sole owner of information to being a knowledgeable guide who can help put information into the context of a patient’s care. He likes the term “health care docent” but realizes some might not agree with the analogy.
“All the time, our patients bring us ideas about their care, whether it’s information they’ve found on Google or that somebody has given them. I used to live by this motto that said, ‘My MD is better than your Google search.’ But, in doing so, I missed an opportunity to partner with my patients,” said Fleming.
While such dubious web-touted “treatments” as ionized water and keto diets may not cure cancer, Fleming now realizes how terrifying it can be as a patient to feel like one may be missing something that could potentially benefit their health.
“My plea to my colleagues would be to do what my doctors did, which was sit with me while I asked these questions and walk me through what was plausible, what was not plausible, what could potentially help and what could potentially hurt,” said Fleming.
Another view Fleming has gained from being on the patient side of care is the importance of establishing a connection with each patient, no matter the severity of their illness or how busy the provider’s day may be. As an ICU physician, Fleming admits he often struggled with spending enough time connecting with patients who were less sick than others, forgetting that this may be the sickest that family has ever seen their child.
As a patient, Fleming spends most of his time in waiting rooms, anxiously looking forward to the moments he’ll have with his care teams. When those moments finally come, he wants to know he’s being seen.
“When I say ‘seen,’ I don’t want them to see a 49-year-old ‘cholangio’ in room three. I want them to see Geoffrey, who is a father, a husband, an ICU physician, a golfer, someone who loves to play bluegrass bass and who is a bit of a prankster. I want to be seen as me,” said Fleming.
“As a provider, I have so often been afraid of becoming too emotionally connected to my patients or their families, because patients die. But I’ve realized my care team is very good at making a connection with me that doesn’t require them to open the Pandora’s box of their heart. They just remember that I’m a golfer or ask me about my daughters, and it is so meaningful to me.”
Along with establishing a personal connection, Fleming has realized the power physicians have in providing patients with opportunities that make them happy, even if they may not seem like a great idea initially. He now calls this ‘bravery’ as a provider.
In the ICU, Fleming once treated a dying boy who was a fan of the “Iron Man” movies. When a new “Iron Man” movie came out, Fleming and his nurses arranged for the child to see the movie in a theater accompanied by his care team.
“He died two days later having seen Iron Man, and he loved it,” said Fleming.
“Sometimes as providers, all we have to do is be brave and ask ourselves, ‘What could go wrong? Is this about me, or is this about the patient?’”
Fleming’s oncologist, Jill Gilbert, MD, professor of Medicine at Vanderbilt-Ingram Cancer Center, showed bravery in allowing him to fly to Scotland the day after a liver biopsy, a trip that provided cherished time with family and a chance to fulfill a golfer’s dream.
While being on the other side of the hospital bed has allowed these lessons to crystalize, Fleming says the most important lessons he’s received have come through witnessing the dedication of his colleagues and through the privilege of treating dying children.
Since his diagnosis, Fleming, his wife, Amy, also a pediatrician and dean of Student Affairs at Vanderbilt University School of Medicine, and their three daughters have been living as normally as possible, finding joy in the little moments such as sharing dinner, playing games and taking walks with their dogs. He feels their family has always excelled at taking life one day at a time, a habit fueled by occupations that have constantly reminded them life is fragile.
“I have done as much with my 49 years as I could ever have wanted to do. I have no regrets. Even my mistakes are so interwoven into the fabric of who I am that I wouldn’t try to alter them. I’d hate to see what bits of me I would lose because of it,” said Fleming.
“My mantra through this has been, ‘Love deeply, live passionately and demand meaning and purpose in your life.’ That for me is the shorthand answer to ‘How do you get to a place where you’re 49 facing your mortality and are at peace with it?’
“I want to be a grandfather, I want to see my children grow up, I want to see many years of life with my wife,” said Fleming. “I’m sad about the idea of dying, but I certainly do not have any fear and anxiety.”