"The farther backward you can look, the farther forward you are likely to see." -Winston Churchill
Other than those esoteric gentlemen (or is it gentlepersons?) whose job it is to dispatch robust but morally askew, to say the least, prisoners to the shores of the river Styx (by way of the needle and the damage done, if you know what I mean), is there any other career more displeasing than that of the medical oncologist?
Not that we don't get a frisson of delight whenever the towering monstrosity named Cancer keels over after a relentless chemotherapy attack and crashes to Earth, never to terrorize the huddled populace again. It's just that I personally get discouraged from time to time when I see the effect that my treatments have on folks who look just like me, smile just like me and walk around the yard just like me pulling little weeds out of flower beds (okay so I'm a little behind in my gardening).
Some chemotherapy treatments are gentle on the soul, but every now and then a tumor must be attacked with a regimen guaranteed to capsize even the sturdiest vessel sailing across the sea of life. The goal is almost always cure with these difficult combinations, which seems to be a worthy trade-off. It just makes for a rough passage.
I found myself counselling a patient last week who had completed the first cycle of one of these hideous regimens. We spent the first half of the visit documenting the various miseries he had experienced after his first treatment. The atmosphere within the room stifled with despondency, as if a championship had just been lost in the last few seconds of the game, when I realized that we both were making a crucial mistake in our analysis. I caught his eye and said the following:
"It's important to look back upon all of the side effects you've had in the past two weeks. But now I want you to turn and face the other direction. Look to the future - to a day when you are no longer on chemotherapy and you no longer have cancer. Every step you take toward that goal is a step further away from the suffering you are experiencing now. My job is to stand on the sidelines and pass water bottles and encouragement to you as you trod on toward the end of this marathon. Don't worry - we'll all wait up as long as it takes until you cross the finish line."
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That was a great analogy, I find it difficult myself to be the positive support that is needed in just day to day life, I admire you for the way you think and how you seem to overcome these rather unpleasant moments and make them positive. After all, its all in the frame of mind isn't it? I say it all the time. But setting that frame of mind into motion for someone else is a whole different ball game. Great post.
Your attitude is commendable. As a family doc I rarely had the wisdom to treat a cancer patient (well, there were exceptions when I felt confident enough to beat a dermatologist to a removal of an early basal cell cancer). But we can still have satisfaction from curing some infections, some trauma and other disorders. When the patient complains about current ails, we need, as you suggest, stress the positive prognosis whenever we can in addition to the required potential side effects or nature's adverse powers.
I've stated forever that oncology would be the toughest field of specialization. Most of the oncologists that I've recruited over the last decade or so have been very sensitive, caring people which I was initially surprised by considering the nature of the specialty.
This is a good story and your conveyance of the message is what I'd be looking for in the same situation. Thanks.
spending a day seeing patients can sometimes feel like a giant metaphor festival as the oncologist and i both try to phrase and re-phrase things in patient-friendly, positive, hopefully understandable terms. i really like this one...and may steal it. thanks.
oncRN
I am a faithful reader and am trying to get my friends on board. Can you get your friends to lose the obnoxious flash ads on the side bar?
"Don't worry - we'll all wait up as long as it takes until you cross the finish line."
That's my favorite part.
(Stage IV breast cancer for five years and counting.)
That is absolutly the best attitude to have.. I will say again your patients are lucky to have you.
Great post.
And these "hideous regimens" to which you "cheerfully" convince people to submit - do they have a 100% success rate? Or are you condemning some number of people to "hideous" suffering when they ought to be out getting what enjoyment they can out of whatever life they have left to them?
And when these "hideous" treatments do work - what percentage of the time is that again? - on that wonderous day when the patient no longer has cancer, what sort of body and mind have you left him with? Is it a life worth living or any kind of life at any kind of cost? Maybe has this patient traded cancer for crushing depression, a ruined heart, severe cognitive impairment, and a host of other "minor" problems. But, by golly, we sure whupped that cancer good, didn't we?
I once had an oncologist tell me, in all seriousness, that the operative philosophy in this field is "cure 'em or kill'em". His exact words. I really don't understand how you can cause such great pain for such limited return. I really don't.
I copied your post off for my wife and then started reading the comments. I agreed with them right up untill I got to n mac's. N Mac doesn't seem to grasp that all human health events are exercises in probability. Today, some small percentage of people who acquired a common cold will die....the recovery rate is not 100% regardless of the ailment or treatment.
After my wife was diagnosed with breast cancer, we consulted different oncologists who had been recommended to us. All gave us the probabilities of various treatments (the "hideous regimens") working. After choosing the oncologist we felt most comfortable with (due to her appreciation of managing a couple of underlying conditions while treating cancer), we made an informed decision on the regimen. My wife has a PhD in Immunology and I'm a Chemical Engineer, so grasping the implications of the probabilities was perhaps not as difficult as for those with no math background.
We worked from the following probabilities (all in a 10 year window)....Surgery alone provided a 49% probability that the cancer would not recur. Surgery plus radiation plus tamoxifan boosted the probability to 65% with few side effects. Adding the highest probability chemo regimen to the preceeding boosts the probability of no recurrence to 80%....but when speaking of survival, you have to knock off 2%-4% for potential heart and liver toxicity. So we were left deciding if an 11% to 13% improvement in odds was worth the "hideous regimens". After days of discussion, my wife ultimately decided (it was a joint decision but its her body so she has the final say) they were, though both of us wish we had more certainty.
If the 20% chance of recurrence comes to pass, will I feel terrible that I didn't try to talk her out of chemo? Of course, but it was an informed decision and the odds were not only better than the lottery, they're better than the office football pool.
All those decisions mentioned in the 2nd paragraph of n mac's post are the province of the patient, not the Oncologist. In the US, no one can force cancer treatment on you. My wife's Oncologist says she has the full range of patients...those for which anything less than 100% success is not worth it to those who want to try anything for a 1% chance. Both extremes and everything in between are valid choices as long as the patient is informed.