Treating cancer sometimes involves walking a fine line between helping and hurting patients. We oncologists find ourselves moderating internal debates between the little angel on our right shoulder and the little devil on our left as whether to expose someone to the toxicity of chemotherapy in an attempt to blast the invader slithering through lymph nodes, or the liver, or some other helpless part of the body.
Experience alone cannot give physicians good judgment, although it is essential in their maturation. There is another gift, the sine qua non of the pinnacle of medicine, that gives doctors perfect insight into the dilemma of treat versus do not treat, of when to say to the family "It is time to shift the emphasis of our care on comfort measures."
Whatever this skill is, I am incapable of putting it into words. It is a sixth sense, an ability to predict the future and put it into words that will provide answers, if not solace, to a grieving family. No doctor alive or dead (myself included among the living ones) has ever been able to perfect this special power. This means that sometimes the wrong decision is made, and a patient who could have been helped is left to wither from their tumor, whereas another suffers needlessly from the effects of treatment, only to die anyway.
Doctors practice each day with the angel of unnecessary caution sweetly whispering to them "Don't do it - your patient will die," while the devil of greed, of recklessness scolds them with oleaginous taunts - "You're a doctor and you're not going to help this person? You loser!"
May all who practice the art of medicine find the courage to perform their duties with compassion, even if it means letting go just when their grip seems to be the tightest.
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Sometimes the best help of all is having the courage to know when, to say when. I am a cancer survivor for now, but I can tell you from my heart, I want a Dr. who can face with me, when it's time to let go. I want to know he, or she can step up to the plate. Keep me comfortable, but not feel it's a failure of any kind if it came back, or treatment was not all we'd hoped for. Only so much is in any physicians hands..the rest isn't up to you.
Letting go is so very hard...
and to top it off with cancer...
comfort....
and
prayers
Thank you for sharing your perspective on this agonizing choice.
My sister and I survived both cancer and the difficult rounds of chemo that were required to fend off the disease. We also lost both of our parents to cancer.
In a weird replay of events, our dad died of cancer in 1994 just months before my diagnosis. He chose not to have chemo and I chose (with my familiy's support) to undergo treatment. Eight years later my mother died of cancer just six months before my sister's diagnosis. Same story: At 81 Mom chose no chemo,yet my sister at 48 chose treatment.
In all four cases we had wonderful doctors who helped us navigate those choices. Blessings to you for walking this path with your patients.