The Gall of Failure
Have you ever found yourself in a situation where you, having been charged with the responsibility of delivering a precise yet lively, complex yet inherently logical sales pitch, pause for a moment during all the blabber and think to yourself:
“How can I keep talking this up when I know it’s a pile of crap?”
If the answer to the above is in the affirmative, then welcome to the frustrating world of the medical oncologist. We sit down every day with patients afflicted with a seemingly endless variety of tumors and promote treatments that can make cancer disappear, shrink cancer, stop cancer from growing, slow down the progression of cancer, improve the quality of life of cancer patients, but in many cases cannot accomplish the main and only objective that counts - curing cancer. This limitation of modern treatments is perfectly understandable - after all, it is not year 3005, when The History Channel offers such evening programs as: “Before the Cure: When Cancer Ruled the Earth.” Don’t get me wrong - I have nothing but gratitude for chemotherapy regimens and biologicals that do eliminate a legion of malignancies right here today. It’s the rest of the horde - the adenocarcinomas, the metastatic melanomas, the refractory lymphomas, to name a few - that discourage oncologists as greatly as a captain who watches his lifeless schooner drift in the pale calm under a fierce Pacific sun. We oncologists demand perfection from our treatments and do not receive it. We therefore feel foolish sometimes when we counsel patients about taking a chemotherapy regimen that doesn’t have a whole lot to offer.
Nevertheless, as the wise old sage once proclaimed, “Oncologists are hewed from resolute timber, even if they bellyache like a kid who just missed the height cut-off for some emetogenic amusement park ride.”
We keepers of the flame of hope for those living with cancer will not falter even as we rail against state-of-the-art treatments that produce only modest results. In our view, anything that can improve the lives of our patients must be considered. But forgive us if we sometimes daydream about what it would be like for surgeons to have to deal with similar limitations in their art.
Try this example: a patient with painful cholelithiasis visits a surgeon, who says that the best treatment available for the problem is to open up the belly and trap the gallbladder between two metal plates so that the stone is crushed.
“What if it fails?” says our patient.
“Well, then we’ll try the next best option,” sayeth the sawbones. “I’ll inject a solution of arsenic directly into the gallbladder, which may wither it along with the stone.”
“Yea, but what do we do if that fails?”
“The last resort would be to open you up again and tie off the cystic artery, which will kill the gallbladder but put you at risk for death from blood poisoning.”
“Gadzooks, Doc! Why can’t you just cut the gallbladder out?”
“No one has ever found a way to do this procedure, I’m afraid,” he replied. “We can only hope that as research continues, someday we’ll find a cure for cholelithiasis that will be safe and effective.”
And with that, the patient left the doctor’s surgery and drove his team down the narrow cobblestone streets back home to his village.
That is how I feel when I look into the faces of my patients who have just been diagnosed with a recurrence of cancer that will snuff out their unique lives long before the flame runs out of wick. Until the day comes when the final secrets of the malignant cell are uncovered we oncologists will continue to stumble on with our potions, hoping that some distant dawn will contain within its glorious pink clouds a miracle for those who suffer.
