Originally published on Cancer Doc in Evolution; reprinted with permission.
The Patient’s Story
The pulsating rhythm of my cell phone awakens me from my afternoon respite. It takes me a few seconds to get my bearings so I can focus on the call that I had been anticipating all day. I answer the phone with trepidation for the news to come, knowing in my heart it will not be good. My PCP tells me, “The blood work shows that your PSA is elevated and the scans we did show some spots in the bones that concern me. I spoke to an oncologist who is going to work you in tomorrow. We are going to get you better.”
My PSA is elevated? There are spots in the bone? My PCP want me to see an oncologist? What does this all mean? Sure, I knew my wife was right that my constant need to find a bathroom at work and at night was not normal; yet, I clung to the hope that it was just part of the process of getting older. When the back pain started I was a little more concerned; yet again, I am in my 50s, and am allowed some aches and pains.
After hopping on the web and searching PSA and oncologist, my deepest fear just came true. An oncologist is a doctor who treats cancer. Do I have cancer? Why didn’t my doctor tell me? Other than seeing the doctor yearly for my cholesterol, I like to think of myself as a normal 52 year old. No one in my family has cancer. I try to eat right and exercise and now I may have cancer! The fear of the unknown paralyzes my thoughts and I walk outside to get some air.
Before I know it, minutes become hours and I am sitting on the dinner table with my wife and daughter. As my wife passes the salad bowl, I cling to her hand and she asks, “Honey, is everything ok?” I don’t answer her, just nod yes. I really don’t know the answer to that question. We had so many things planned for our lives, and now the future is not as clear as I hoped. I stare in her eyes, cherishing and reminiscing on all the memories we have created, hopeful that there will be more.
I’m concerned about money, too. Will I be able to provide for our family and continue to work? How much does cancer care cost? I have been a good employee for 15 years with my company, yet how will they treat someone with advanced cancer?
Our daughter breaks the awkward silence with her laughter. She is entering her senior year of high school. All of a sudden her future flashes in front of my eyes. Will I be there to see her walk across the stage for graduation, celebrate her first job, walk her down the aisle, or hold my future grandchild? She can sense something is wrong, yet I deflect and change the subject. Why worry them now, before I even know what is happening? It is better I go to the visit tomorrow by myself and then try to find the courage to share with them my new future.
The sound of the alarm pierces the room as the restless night turns into morning. I can’t stare at the ceiling anymore, and decide to go for a run to help clear my mind. The crisp fall air and beauty of the fall leaves remind me that change is inevitable; when it comes to my health, stability would be nicer. I blare the music through my headphones, trying to fight my fear and forget, for a few minutes, the visit that is to come. As I come back home, I decided to cook breakfast for my ladies. I embrace them an extra second longer before they leave for school and work. They still sense that something is not right, yet I reassure them, with the hope they buy my act. I get ready, head out the door, and arrive at the doctor’s office, ready to find out my fate.
The nurse greets me with a smile, and then it’s strictly business as she starts reviewing my insurance cards. Next she records my weight and blood pressure. She gives me multiple forms that I need to fill out. She then leaves with me information about cancer and who to call with questions, and says the oncologist will be in next. The door closes and I am left alone, surrounded by walls and emotions of angst and dread all closing upon me without a clear escape. I close my eyes, take a deep breath, and disappear into my thoughts before a knock brings me back to reality.
The Oncologist’s Story
What a day this has turned out to be! Three new consults already seen in the hospital and two more awaiting me after clinic. Running behind in clinic and have to make it to my daughter’s college information night at school. From diapers to a senior in high school, where did the time go? My stomach growls, did I eat lunch today? As I try to remember, my nurse hands me the next chart. I read quickly: 52 yo with elevated PSA and bone pain referred by his PCP. I close my eyes, take a quick breath, and knock on the door to meet my new patient.
The Moral of the Story
When you tell a patient, “You need to see an oncologist,” their world is changed forever. The fear of the unknown and the emotional connotations that come with the word cancer can never be underestimated. As an oncologist, it is key to recognize and address your patient’s anxieties from the start of the visit. Always think of what emotions are waiting for you behind that door.
When I see my own patients, I don’t always know the best way to find some common ground. All I recommend is that you take the time to walk in their shoes, and use empathy and kindness. Never forget that the journey your patient takes only works if you can walk together.