OCT. 19, 2009

Lasting impressions: Wren on becoming close to patients

BY DIANE ROGERS

Raised in the Midwest, “where we don’t talk about emotional stuff like that,” surgeon Sherry Wren, MD, didn’t know how to respond when patients told her they loved her.

On a recent morning, Wren was toying with a wire sculpture she’d picked up from among the dozens of thank-you’s that clutter her desk. Her hands danced across a Wonder Woman action figure and a hand-carved eagle before settling on the flexible contraption. She constantly worked it into different shapes as she talked about the other, intangible gifts her patients have bestowed, including the ability to talk about feelings and fears.

“When I first started my practice years ago, I met this wonderful woman,” Wren began. This 57-year-old patient had an unresectable liver cancer. But because she worked only part-time for a school district, as a teacher’s aide, she had no health insurance—and no access to private hospital care.

For the next few months, Wren wrote multiple letters in an ultimately unsuccessful attempt to find coverage for a liver transplant for her patient. So over the next two-and-a-half years Wren cared for the woman. While her cancer spread, Wren learned of her childhood in Germany just after the war, when she would find food for her mother and siblings by begging from the American GIs. She later moved to California, married and raised a family.

When the woman had reached her final days, Wren admitted her to the hospital. “In the end, I took care of her pain,” Wren said. “She had a very comfortable and dignified death.”

Since then, Wren has become more familiar with the wide gamut of feelings that cancer patients experience. Today, when she meets a patient in her clinic for the first time, she asks them to tell her why they have come. “Usually people are scared to say they have cancer, and they won’t use the word ‘cancer.’ They’ll say, ‘I’m here because I have a mass’ or, ‘The doctor said something looked suspicious.”’

Wren likes the challenge of performing very high-risk surgery—removing 25-pound liver tumors or complicated abdominal tumors. And she’s willing to take on the so-called “peek and shriek” cases: “Another surgeon will open up a patient and say, ‘Ohmigod, it’s too this or too that,’ and close him back up.”

Still, Wren has learned that treating cancer is about more than performing surgery. She wants her patients to know about their disease, and its implications for their lives and their families. When the surgery is extremely high risk, she even asks patients if they have completed their wills. “It communicates that there are very high-risk issues at stake. I have to understand in my heart that a patient grasps what the risks are.”

For many of her patients, Wren said that she gains satisfaction from extending their lives. Take the patient whose pancreatic cancer required a 12-hour operation: He has called Wren every Thanksgiving for the last 15 years, to thank her. Then there’s the patient she operated on nine years ago to remove a metastatic gastrinoma tumor that other surgeons told him was inoperable: He’s become a nature photographer and surprised her this year with a framed close-up of a hummingbird.

Wren is grateful for the relationships that she has formed with these patients, but acknowledged that it did not come naturally. “Every surgeon has to sort out in her own mind how close she wants to be,” Wren said.

For Wren, the defining moment may have come when she was launching her practice and cared for the woman with liver cancer who had no insurance. “Over the years I got to know her and her family incredibly well,” she said. When it was time for the funeral, the patient’s son insisted that Wren sit in the front row of the church with him and the other family members. In his eulogy, he talked at length about the relationship his mother and Wren had developed.

“By then I was crying,” Wren said. “His remarks made me realize that as a surgeon you can touch people in ways that you cannot comprehend. That’s when I realized that it was okay when patients said they loved you.”

Stanford University Medical Center integrates research, medical education and patient care at its three institutions - Stanford University School of Medicine, Stanford Hospital & Clinics and Lucile Packard Children's Hospital. For more information, please visit the Office of Communication & Public Affairs site at http://mednews.stanford.edu/.