Under Pressure and Coping

Thanks to the vision of one man, health-care workers now have an emotional outlet to help them deal with the stress and loss that they face on a daily basis. . illustration by Alex Nabaum.


Krishna Komanduri, MD, first met the young man about a decade ago while completing his cancer training in San Francisco. The man was in his early 30s, about the same age as Dr. Komanduri, and had been healthy - a runner, in fact - before developing a type of cancer called Hodgkin's disease.

"He's really one of those patients who has stayed with me the longest," says Dr. Komanduri, a stem-cell transplant physician now working at the University of Texas M.D. Anderson Cancer Center in Houston. Sitting in an auditorium among other M.D. Anderson clinicians, Dr. Komanduri describes how he had recommended a typical regimen of chemotherapy, to be followed by a series of radiation treatments.

The young man did start the chemotherapy. But from the beginning, he resisted the idea of radiation, worried about the potential for long-term damage, including to his heart. Dr. Komanduri tried to dissuade him - repeatedly. Without the radiation, the risk of recurrence was significantly greater, he told the patient. But he couldn't make any headway. "I went as far as I could," he says to his M.D. Anderson colleagues, "without alienating him or pushing him away."

Finally, he says, he had to learn to live with - both professionally and personally - the consequences of the patient's decision.

Dr. Komanduri's story unfolds during a powerful hour in which doctors, nurses, and other M.D. Anderson staffers break from their usual focus on blood-cell counts and chemotherapy side effects to discuss the emotional underpinning of decisions they make every day. The sessions, called Schwartz Center Rounds, are held on a regular basis at hospitals around the country - the result of a vision of Boston health-care attorney Kenneth Schwartz.