Don S. Dizon, MD, FACP, FASCO

Mar 22, 2012
Earlier this week I passed my friend and colleague, Dr. Ekaterini Tsiapali, in the stairwell. We rarely get to catch up these days, so it was really quite a nice surprise to see her.

"What did you do this weekend?" I asked.

"I watched Wit, you know, the movie where Emma Thompson plays Dr. Vivian Bearing, a 50-year-old woman with terminal ovarian cancer? She's such a great actress." Kat said.

"Yes—I saw it a while ago," I responded, with a slight scowl. It led to a discussion of the "Hollywood treatment" of adult oncologists. I had seen Wit, and recently, also saw 50/50. Neither of them portray medical oncologists in a great light. I read that Margaret Edson, the playwright of Wit, was inspired by her year as a clerk on an oncology/AIDS ward, but I often wondered whether a specific event lies at the heart of Wit. After all, how could she have such a poor view of oncologists? What did we do to her?

I like to believe those of us who choose medical oncology do so because in the end, we want two things: 1) to cure cancer and 2) to alleviate suffering. In Hollywood, this is too often treated as an "either/or" proposition, rather than a vision that can be pursued in tandem.

On a personal note, I like to believe that I am not that type of doctor and that my patients do not perceive me as a cold and unfeeling scientist. I'd like to believe that they see empathy in my interactions and sense that I do care about them—clinical trial or not. However, I was reminded of one event that made it apparent to me that the way our patients see us may indeed be contrary to how we believe we should be perceived.

Recently, I had a patient with a very aggressive uterine cancer. She had surgery followed by chemotherapy (on a trial), which she just could not tolerate. Ultimately, we decided to forgo the final treatment, and she began post-treatment surveillance. Unfortunately, a short time later, she wound up hospitalized again and continued to progress despite treatment.

In her first outpatient visit after her hospital discharge, I recall discussing her situation, that she had progressed despite our best efforts, and that further standard treatment carried far greater risks than any potential benefit. I recommended against further treatment and asked her to consider how she wanted to live out the rest of her time, for I believe she had reached that "terminal" phase. They were saddened and stunned, and we sat for a while as the news sank in. She cried, he cried, and I sat silently. I answered their questions and at the end of the visit, our social worker came in and offered support as I quietly stepped out. But before I did, I made a plan to see her again, to make sure she was okay, and before I left, I told her again how sorry I was.

Three weeks later she was back in the hospital—a repeat bowel obstruction—one she would not recover from. I remember going in to see her with the intention of offering my support. However, she was neither sad nor happy to see me; she was angry. I recall being taken aback by how angry she was, recalled how her husband would not look me in the eyes. 

"What you did was the cruelest thing anyone has ever done," she said. "How could you tell me I was dying like that? You call that compassion?" I listened to her as she wept and screamed at me. In the end, all I could do was say the first thing that came to my head—"I'm so sorry."

I guess in the end, we are all human. I realized that my patient was angry not only at me; she was angry at cancer, at treatment that didn't work, and at her body for "giving up." I also realized that the best way to handle the situation was not to "defend" myself, but to let her say what she had to say.

Ultimately it made me realize that movies like Wit and 50/50 may reflect someone's experience with cancer, and that we cannot dictate how someone reacts to cancer and their journey through it any more than we can dictate their response to a prescribed course of chemotherapy. At the end of the day, I know we cannot change how we are perceived, but I know we must always act with compassion and empathy, and in so doing, we can never stop trying.


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