Although the ever-expanding list of targeted drugs, the complexity of molecular pathways and genetic composition of cancer, and the seemingly relentless stack of evidence-based trials are daunting, the toughest yet most important lesson to me so far is to realize when doing everything is not warranted, necessary, desired, or feasible. It is important to understand when the odds have won, to know when to stop fighting the cancer, to know when to shift hope toward something different. This realization can liberate you, the practitioner, but much more importantly, can be liberating to your patient and their family as well.
I carry around the quote “We cannot do everything, and there is a sense of liberation in realizing that,” by Archbishop Oscar Romero, in my bag, and resort to these words when I feel like I have to do more for the patient but can’t. These words carry much meaning in the life of an oncology fellow.
The diagnosis of cancer rocks a person’s livelihood. The independence, control, and balance one may have had in life before a cancer diagnosis quickly gets maligned. Giving control back to a patient is sometimes the most necessary and most beautiful thing you can do for someone. By advising a patient not to come in for lab testing, a transfusion, a doctor’s visit, or chemotherapy, you are freeing them both physically and mentally. Now don’t get me wrong here. If cure is truly an option, the patient just has to bear down and deal with it for a while. But in other situations, when the cancer has spread out of control, oftentimes that mimics the patient’s life too. Consumed by healthcare-related appointments, there is no time for fun, relaxation, travel, or family.
I learned this important lesson while caring for one of my young female metastatic sarcoma patients. To reduce the tumor burden in her lungs, I was going to treat her with intense inpatient chemotherapy. Physically, this would take my patient away from her 4 children for a longer period of time, and would exhaust her. I was going to make her pain free with ever-increasing doses of opioids, but mentally, this was too sedating and did not make sense. Instead, I realized that helping her maintain balance in her life was by far the most important thing I could do to help her. This was achieved only when I was able to realize that less was more, and think of my patient as a loving mother, caring wife, and wonderful friend, rather than as a patient with cancer.
This patient has been able to spend true quality time with her friends and family. She is liberated by doing less, and in the meantime, she has liberated my thought process as well.
The relationships formed in an oncology clinic are unlike anything. It is the best of times and the worst of times. There are hugs of joy and hugs of sorrow, tears of happiness and tears of utter disappointment. Because these bonds form quickly, the desire to do everything for a patient is strong. Over time, as you understand more about your patient, you realize what is truly important for that person, and it often doesn’t necessarily mean ridding him or her of the cancer. We cannot do everything, and that can be a blessing for all parties. It just takes a while to understand that.