Cancer Doesn’t Have to Win, Even When Your Patient Dies

Cancer Doesn’t Have to Win, Even When Your Patient Dies

Adetokunbo Oluwasanjo, MD

Jul 10, 2017

My father was diagnosed with metastatic prostate cancer on the night of my very first call as an intern.

Over the next 2 years, I came to understand the quote from Harper Lee’s book To Kill A Mockingbird: “You never really understand a person until you consider things from his point of view… until you climb into his skin and walk around in it.”

See, my father was an obstetrician and gynecologist and my mother was a pediatrician, and although we were intimately associated with the medical world by the nature of our careers, it was not until my father received his diagnosis that my parents and I truly understood what it was like to navigate those same hallways we had known and walked through, this time as patients, not physicians.

It is a very humbling road, when we ourselves travel through the same fragmented systems as our patients. We see with new eyes, we listen differently.

We had been blessed, but I hadn’t appreciated it. Up until my father’s diagnosis, illness was something my parents went to work to fix, and something I spent long, harrowing years studying, not something that lived amongst us.

Well, that changed quickly.

So, it’s my very first call as an intern. I get a call from my mum, who would never call me if she knew I was at work.

“It’s cancer. It’s a Gleason 9, and it’s spread to his bones.”

My first question was, “What’s a Gleason 9?” Talk about being blindsided.

There was an eerie silence.

“Mum…?”

My dad had developed a little bit of a teenage swag. You know, the walk that makes you look cool when you’re a teenager and not so much when you’re in your late 50s. He’d chalked it up to arthritis. I don’t know how long he’d had urinary symptoms—that would have been TMI on my family communication scale—but at some point, he mentioned it to my mum and she got on his case.

So, I’m on the other end of the phone, absorbing the information that his full biopsy results were to be read sitting down.

I still struggle with whether being a doctor when you or someone you love is diagnosed with cancer is a blessing or not. We often felt we were told only parts of what we needed to hear, because almost every other sentence from the doctors, once they knew he was a physician too, was punctuated with, “…but you know that already.”

And quite a few times, we didn’t.

We had this awkward dance of not wanting to be that patient… you know, the one who has all these technical questions and goes on and on… but, we still needed answers.

Lots of answers.

My dad had gone right back to work. It was his sanctuary, his place of refuge, until a metastatic lesion in his spine made it difficult to walk. Before then, I might have seen my mum shed a tear or two, but in that season, I knew the color of her tears.

The last few weeks before he passed away were the longest.

We were back in Nigeria, where we are from and lived at the time, with no palliative care and only sketchy pain management recommendations, so we were left to figure out how to make him comfortable on our own. We dosed his morphine ourselves, made him as comfortable as we could. I remember finally getting over the fact that he was not going to be with us much longer, but I never got over the gnawing heartache that he was not always comfortable.

In that season, as cancer tried to look its ugliest, something else won.

The kindness of people.

The worst of times was also the most beautiful.

As a family, we grew closer together. If we complained about things we did to each other before, they became insignificant.

Our faith was made stronger.

I grew up. I had to make several clinical decisions and my parents would turn to me helplessly as their “new” doctor.

Cancer can do that. Make you forget who you are.

I’d go “Dad, you’re a physician, what would you tell your patient?”

And he’d sigh and go, “I know.”

The staff moved my mum’s schedule around so she could make it to his appointments. Her colleagues rallied round without complaining.

As oncologists, we get to cure cancer, but we also see a lot of death and suffering, which means we get the chance and choice to celebrate the things that outlive them. The things death can’t steal. The power of the human spirit and the power of the human bond. We get the opportunity and privilege to make cancer a win-win.

After my dad passed away came the painful task of putting his stuff away.

Like away… away… for good.

My dad was very organized, particularly with his paperwork, and I found stories I had written to him when he was a resident in the UK and my mum, brother, and I had moved back to Nigeria. Stories I wrote when I was about 6 or 7 that he had kept.

Stories titled “The Butterfly and the Princess” and “How the Cat and the Mouse Became Best Friends”… and I, of course, bawled my eyes out. I never knew he kept those stories. I didn’t even remember those silly stories! Now, they seemed priceless.

And in his passing, he reminded me I could write. I started to write again.

As oncologists, we sometimes feel helpless when our patients are no longer curable, and when they die, it stings. Almost like a part of us died too.

We should remember that to many families, it’s the presence we bring to the suffering that counts.

It’s just as important as a cure—making that final passing dignifying and honorable. Giving them space to grieve but being close enough to hear their needs. Sometimes it’s sitting in the room with them in the silence interrupted only by bleeping monitors. Sometimes it’s the tear you try to hide that reminds those families that you’re human too and that this absolutely sucks.

It’s taking the time to hone those skills in breaking bad news softly, and discussing the need for palliative care and hospice—knowing they may not like it now, but will be so glad later. It’s taking the time to pause and listen as your anxious patient tells a joke before they leave, knowing it might be the last one you share with them. It’s taking the time to ask the caregiver in the room how they are holding up—sometimes that’s what the patient is really worried about that day.

It’s taking the time to be human and present.

So even when we think there’s not more we can do, there always is. Even in dying, you can make a difference. A big difference.

You know, my dad told me after we left one of his appointments, close to the end…

“You know, Toki?”—as he fondly called me—“I’d pick you as my doctor! You did a really good job in there summarizing that doctor’s recommendations and I really understand what we are going to do from here.”

That’s beaten any other professional feedback or compliment I’ve gotten. Hands down.

Truth is… I hadn’t summarized much of anything. There wasn't a whole lot left to be done. From this point, it looked we were just going to be “hanging out.” We were just waiting for the inevitable. But we were going to do it together.

In that period of dying, between all we can do and nothing we can do, is a sacred space. A space you can be part of.

No, death is not final, even when we lose our patients. In many ways, it’s a beginning. Through your empathy, your presence, your kindness, your humanity, you can bring healing better than you know. No death from cancer is ever painless, but you can make it beautiful.

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