Frances Milat
Melbourne, Australia
“Tell me about despair, yours, and I will tell you mine.” —Mary Oliver
Early in 2020, as my family flew home to Australia from a medical sabbatical in the United States, we started to hear reports of serious illness and death among our colleagues. Soon, the medical institutions and communities that had welcomed us with open arms became viral battlefields, and makeshift hospitals erupted in city parks where our children once played.
Back home, over the months that ensued, daily routines I cherished as a physician were disbanded. Patients with chronic diseases were encouraged to stay away from our hospitals, and face-to-face consultation became a distant memory for all but the acutely unwell. Global shortages of personal protective equipment, ventilators, oxygen, and medications dominated our lives. Media feeds lit up with images of exhausted medical staff caring for the sick. Often, we were also the sick. Healthcare workers were counted in the columns of the critically unwell and dying, distorting our sense of self and blurring the line separating the well and the unwell. Everyone was vulnerable.
My home city of Melbourne became a ghost town: empty streets echoed in their loneliness and our schools closed their doors to the passages of childhood. My own children moved from bed to desk to greet school friends online, and with each passing week, symptoms like upset stomach, headaches, and fatigue visited my family in place of laughter and ease. Melbourne endured the longest lockdown of any major city worldwide, and we felt every one of those 246 days.
The comradery and warmth of medical ward-rounds at my teaching hospital shifted. Donned in masks, face shields, scrubs, and aprons, patients could barely hear us over the noise of monitors and thick, immutable fear. We called families over video chat and contemplated things that mattered. At the end of each day, I sat alone in the hospital chapel, transfixed by the beauty of the stained-glass windows and the yellow light that flooded the small, sacred space. Outside our hospital walls, there was a glimmer of hope. Scientific discovery was fast-paced, and vaccine rollout was imminent.
I was one of the first of my team to receive the vaccine. My father had been recently diagnosed with metastatic prostate cancer and I needed to protect my family. Within days of receiving my vaccination, my local lymph nodes swelled, and I laughed at their severity. A concerned colleague suggested that I should have some imaging. When the shadow of breast cancer appeared on the ultrasound screen, I was not surprised. Why not me? My own mother was diagnosed with cancer at a similar age. I had seen so much illness and suffering and knew that no one was immune. I called my mentor from medical school, a wonderful breast surgeon, and asked for help. Words still fail me when I think of her kind, supportive voice and rapid review.
In the lead-up to surgery, I was living several lives simultaneously. I accompanied my father to medical appointments, did my best to support the homeschooling of our children, and attended multiple appointments of my own. My medical expertise was in cancer-related endocrine and bone disease, and now I was the patient. I gave a virtual conference presentation on the management of ER+ breast cancer and aromatase-inhibitor induced osteoporosis as I prepared to face my own treatment. While waiting for my pathology results, I worried what I would tell my children.
The months that followed were overshadowed by surgical, oncology, and radiation oncology appointments. To remain functional, I compartmentalized parts of myself. At home, I was absorbed in family life, and at times, could almost imagine that the treatments were happening to someone else. At the hospital, there was no escape. I was on the other side of the consulting desk. I was the specimen being examined. In rare moments of reflection, I was not sure who I was.
My radiotherapy occurred in the gloom of yet another Melbourne lockdown. My husband gifted me Julia Baird’s book Phosphorescence, which explores awe, wonder, and things that sustain us when the world darkens. It traces Julia’s own cancer journey and recovery. How fitting. This book became my lighthouse: I underlined passages and carried Julia’s words in my arms to each appointment. Some sentences remain etched in my consciousness: “you may be surrounded by…family and friends, and by the shiniest love, but you walk alone through these medical valleys of darkness.” I thought about those valleys, how deep I was in their shadows. Although I diligently followed medical orders and had completed my treatments, parts of me were left in specimen jars. I was not whole. My medical training had equipped me with tenacity, grit, and scientific reasoning—useful qualities when facing treatments. However, I knew that I needed different tools to address the fragmentation I felt. In addition to completing my cancer treatments, I also needed to heal.
I typed “healing” into the PubMed search engine, hoping for some answers. Instead, I scrolled through the scientific and technical aspects of wound healing. I learned that modern medicine itself offers no consistent definition for healing. In contrast, when entering “cure” into the search, the screen enthusiastically lists once unimaginable publications of novel therapies made possible through scientific discovery. These scientific advances have changed the course of once untreatable conditions, including breast cancer. It is because of these advances that I am here, writing this today. However, the path to healing extends beyond the completion of cancer therapies, and also requires our attention.
The word healing is defined as “to make sound or whole,” stemming from the root haelan, the state of being hal, whole. This definition made sense to me and resonated with my own sense of incompleteness. I needed a strategy to become whole again. I turned to books written by doctors about their own cancer journeys and read the late Dr. Paul Kalanithi’s exquisite When Breath Becomes Air. He wrote about the strengths of science “to organize empirical, reproducible data” but recognized scientific shortcoming and its “inability to grasp the most central aspects of human life: hope, fear, love.” Kalanithi understood what it meant to make people whole, and the answer was connection: “I will share your joy and sorrow / Till we’ve seen this journey through.”
On completion of my radiotherapy, I felt disconnected from my body and surrounds. I instinctively returned to the early loves of my childhood—the ocean and literature—for guidance and connection. I took long walks along the shore, and when I was medically able, I immersed myself in the sea. I swam through the changing seasons, savoring the instant relief my body felt every time I stepped into the water.
Between swims, I found myself in bookshops and libraries, poring over volumes of literature in search of shared experience and understanding. I discovered poetry and passages so beautiful that they seemed to soak through my skin and become my lifeblood. I came across words that spoke of suffering, grief, hope, and love in ways that medical literature could not. I started to think about why I became a doctor. The answer was simple. I loved stories—other people’s stories, and, more recently, understanding my own.
Until this point, my life had taken a relatively linear path, where caring for others was my defining quality. To heal, I needed to understand my own story. In childhood and early adulthood, I carried a notebook and a novel in my bag, to both document the world around me and to escape from it whenever I needed. I wrote for the same reason a scientist might use a microscope—to examine words and thoughts more closely and in doing so, to find clarity and meaning. I stopped writing when my mother died almost twenty years ago. It was too painful. Instead, clinical research became my solace, and I wrote for scientific understanding. I knew that research had the power to change the trajectory of illness and ameliorate suffering. In the face of loss, this gave me purpose.
Since my cancer diagnosis, I have come to understand that any story is incomplete without the inclusion and integration of its many parts. Storytelling is an ancient form of connection that joins our past, present, and future. My cancer journey has allowed me to understand and reconnect these disparate parts, and I think we can help our patients do the same. For what is medical consultation but a sacred form of connection, of data gathering and interpretation, of storytelling? We just need to ensure we are asking the right questions of ourselves and our patients. Our questions need to delve deeper than medical facts and reflect on reasons for living.
Last year, two years following my initial diagnosis, my daughters wrote thoughtful messages in my 50th birthday card. They wished me many ocean swims and hoped I would find more time to write. They know me well. I started writing again, documenting my own story to gain clarity. I hoped that my words would one day make their reader feel less alone. I took longer swims in our local bay, through kelp forests and seagrass meadows, finding wonder and awe between every breath. That stretch of ocean close to my home continues to heal. My right arm, once tight from treatments, now delights in long strokes through cool waters, always hungry for more. I leave my worries on the sand, with my towel and sunscreen.
At work, I continue to review, examine, diagnose, and treat. The patient stream seems endless. I have honed my clinical acumen, my capacity to interpret data, and ability to manage acute and chronic illness. But to heal? This journey has been far more complex—for my patients and for myself—and I am still learning. What I do know is that becoming whole is about connection with ourselves, our stories, and with those we love, but also with the frameworks of society that give our lives meaning. If we ask our patients about healing, they have more answers to this question than I could find in medical literature. For many, it is about finding joy, even under the weight of chronic illness. For others, it is about purpose, service, kindness, connecting with nature, friends, family, food, dance, literature, music, and movement. For many, it is about having their voices heard. Though I cannot offer a new definition of healing, I know what it means to become whole, and I think our patients do, too. We start where we always start, with their stories, and we let them guide us. Perhaps this way we will find our way back to healing.
FRANCES MILAT is a clinician-researcher and writer who lives in Melbourne, Australia. She is dedicated to holistic patient care and is interested in the role of story in healing. She is an avid ocean swimmer and enjoys taking photographs of the underwater world close to home.
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