The Other "C" Word in the Oncologist’s Office

The Other "C" Word in the Oncologist’s Office

Prateek Mendiratta, MD

@cancerdocinevo
Jan 10, 2017

The movie Cinderella Man by Ron Howard tells the unbelievable story of the boxer James Braddock. The movie traces the journey of a family man who faced enormous odds, tackled them with grace and dignity, and became a world heavyweight champion.

Mr. Braddock embodied another trait that I am fortuitous enough to witness every day in my office—a trait that my patients harness to battle the disease they are faced with. This trait allows my patients to take blow after blow like a boxer and find the strength to persevere and continue the battle.

The trait that my patients and Mr. Braddock share is courage, and it continues to humble and motivate me each day.

One patient I met embodied this trait and taught me to never underestimate the will of patients with cancer and their families. I had met this patient while holding the consult pager during my weekend call. Whenever I carry the consult pager, I always have a sense of fear and anticipation of what will come. Every new consult carries a new diagnosis and a new person whose life I will touch in some way. This person and I will share a bond and the patient will place their trust in me in the hope of getting better. It is these experiences that shape us as oncologists and why we decided to pursue medicine in the first place.

My new consult had presented to the intensive care unit with a month-long history of rapid weight loss, shortness of breath, rectal bleeding, and pain. Scans had revealed a tumor in her colon with concern for dissemination within her lungs and liver. A pulmonary embolism had invaded her pulmonary veins, limiting her ability to breathe. I entered the room and it was filled with a potpourri of sirens and alarms beeping, multiple tubes and lines around her emaciated body. She had pursed-lip breathing to enable the air to flow through her lungs. With all this chaos, she greeted me with a smile and took my hand as we spoke. I knew right then and there that this patient had the will to fight.

We spoke and I heard her story. She was estranged from her family, unemployed, divorced, and working in a gas station. She had no permanent home and would find a place to lay her head at night with whichever friend of hers had an empty room. Her only family connection was a son in Canada. She was a veteran and had served our country proudly. She was also very proud of her Irish background and told me her one true passion was dancing the Irish jig. She performed weekly with a church group that traveled around the city competing. I pled my ignorance and explained that was something I was never aware of and she started teaching me about this historical dance form. She also made it clear to me that she would continue to dance regardless of what I, “the cancer doctor,” was about to tell her. I started talking about her diagnosis and concern about a potential terminal cancer when she stopped, and said, “Doctor, we are going to beat this and you are going to see your first Irish jig.”

The first step before a boxer enters the ring—or a dancer takes the stage—is to have a plan of attack. We laid out our plan of attack for her cancer. We got her out of the ICU and started chemotherapy to hopefully destroy her cancer cells. Eventually, we got her discharged and leaned into her support system of friends. Every 2 weeks she would sit in her chair in the infusion suite with her headphones on, listening to her beloved Irish music. She would always be tapping her feet to the rhythm of the music. She started gaining weight, getting stronger, and her breathing was improving. Like every beginner learning to dance, we had our falls and stumbles, yet she got back up and fought on. She used her courage and battled with a smile and a dance in her step. As she battled, we are started noticing that all the hard work paid off. The scans started to show the tumor was actually responding. Days became weeks which became months, and after 6 months of tolerating treatment and continued response on CT scans she was able to take baby steps on the dance floor.

Months went by and she continued to endure the chemotherapy without major side effects and even the cancer remained at bay. Every 2 weeks she would show me pictures of her dance group. She would remind me how I was way overdue to witness my first Irish jig. She also would mention to me that she had every intention to watch me dance also. I wasn’t sure what to tell her each time. The lines can get blurred between patient and doctor interactions outside of the office. We are trained to become detached and try to not overstep the bounds of what is acceptable to do with our patients. After months of her and the nurses teasing me, I eventually folded and gave in. How bad could it be, an Indian oncologist performing his first Irish jig?

The big day came for me to dance with my patient. I wasn’t going to suffer alone and brought my wife and daughter. She knew they were coming and as we entered the church, she had a gift for my daughter. She introduced me to her friends and they all knew my name and shook my hand and thanked me for helping their friend. I was not prepared for this and was humbled again by this wonderful field of medicine in which I practice. Not everyone gets to experience this feeling for doing their job.

The music played and we started to dance. This time she was ordering me around and I had to be the one who listened. I tripped and stepped on toes more than once; yet I also laughed and I felt tremendous joy. My wife and my 2-year-old had a blast, and this night all happened because a beep from a consult pager introduced me to a person with more courage than I could ever imagine.

Two years after becoming a world champion, James Braddock defended his title against Joe Louis. He battled yet eventually lost in the eighth round. Joe Louis became one of the most revered boxers of all time. At the end of the movie, Joe Louis acknowledged that Mr. Braddock was the “most courageous man he ever fought.” Not every patient I meet wins their battle with cancer. After some time, my patient eventually succumbed to her disease and died at peace, with her son and friends by her side.

Everyone fears the word cancer, however, every patient reacts differently to the word. I have seen shock, anger, fear, and tears. I have also seen compassion, love, devotion, courage, and determination to fight no matter what is placed ahead of them. For my patient, dancing the Irish jig with her oncologist was her metaphorical championship title, and for being part of that I will forever be grateful.

Originally published on Cancer Doc in Evolution; reprinted with permission.

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