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.
That’s precisely why I was drawn to the name of your blog…The Cheerful Oncologist sounds almost oxymoronic. As you are indeed a ray of light to your patients, I bow to you
Comment by Potato — August 8, 2005 @ 6:47 am
I read this blog this morning, after learning of the death of Peter Jennings from lung cancer. That’s what I have. (always must note, I have been a life-long non-smoker) I am just approaching my one-year diagnosis anniversary, and am doing very well, having had an excellent response to Tarceva. I can’t help but wonder, however, when it will be my turn. As each day, each week, each month, each season passes, I am counting down my time on earth. I know it. Others don’t want to admit it. I try to enjoy each day, and sing in gratitude for the days I have, and for my fortunate response to one of those “try this” drugs. As far as treatment, there are few side-effects (for me). There are annoying skin eruptions, strange cracks appear on my feet and fingers, hang-nails turn into raw, throbbing, nerve-filled bits of flesh….. but it is a miracle to me. My tumors at last scan were 50% smaller, and I am largely asymptomatic. I have some shortness of breath with stairs, or fast walking, and my stamina is lower. But I wonder when it will get worse. When will I be truly ill? Who will take care of me? Who will adopt my pets? How long will it take? Will I suffer? Will I be gracious, or angry? Will I lash out? Will I have good pain relief? Will I see age 55? (I’ll soon by 54, so I’ll see that one, I’m pretty sure) Will I see Christmas? Will I see my last child’s wedding in November? Will I see a grandchild?
All humans face mortality, but none so blatently as the cancer patient. Particularly the cancer patient whose misfortunate has been to present with one of the difficult cancers. With the news focused this morning on Peter, and lung cancer, I have hope that this newly shed light will help to bring attention to the needed research funding to discover better more effective treatments, so lung cancer will no longer be the greatest cancer killer in the US.
Comment by Feisty — August 8, 2005 @ 2:16 pm
Amen to that, Feisty - and keep fighting!
Comment by The Cheerful Oncologist — August 8, 2005 @ 6:58 pm
Indeed for those of use who have lived through a “we’re talking quaility of life here” diagnosis, it can be disheartening to see how far medicine has come over the past 50 years and still see such terrible cracks. Strangely, though, I remain confident that with the work of doctors, researchers, and brave trial-by-fire patients, we can get to the point where we remember cancer, not live with it.
This is my solem hope at any rate.
Comment by Chris — August 8, 2005 @ 8:01 pm
I’d be happy with a chronic, manageable disease at this point.
(ps thanks Dr. C for cheering me on!)
Comment by Feisty — August 8, 2005 @ 8:43 pm
As your patient, I’d just want you to tell it to me straight. These are the things we can do, these are the odds it will help you — or won’t help you — and what you will endure for the possible results. Then, I’ll make my decision as to what I’d like to do
That’s the best you can do…
Comment by Eyes for Lies — August 9, 2005 @ 3:46 pm
Yesterday was the 5th anniversary of my cancer surgery. Time to write another thank-you to Katie Couric who turned her husband’s tragic death into a crusade to defeat one form of cancer. Notes to my surgeon and my oncologist are in order as well. Perhaps they could use a reminder of the battles they’ve won.
Every patient who comes through your office teaches you something which you take to the next one. Some forms of cancer are increasingly becoming chronic, rather than terminal, illnesses. New medications, new treatments, new surgeries - new hope.
Comment by Judy — August 9, 2005 @ 5:19 pm
This depressed me. I lost my mother to gallbladder cancer four years ago…a rare and weird cancer that mimics pancreatic cancer but without the treatment knowledge to treat it.
It was unbearable to watch. She had chemo and radiation and I begged her oncologist to consider the whipple procedure, I had my oldest son (a physician himself) search high and low for clinical trials but to no avail. I now look back and wish we had done nothing, her quality of life would have been better…but on the other hand at least the treatments gave her hope.
It’s foolish to say this and I know it’s been said many times before but why is it we can put a man on the moon and yet there is no cure for cancer….I really hate it.
Comment by Saint M — August 10, 2005 @ 4:05 am
Saint M - the only way I can fathom our lack of progress in treating such diseases as gallbladder cancer is to think of a community of prehistoric hominids gazing over a vast field of prairie during the warm months and asking “Why can’t we grow things that will sustain us all year long, rather than hunt for nuts during the period of snow and darkness?”
We did conquer our need for food, and we will defeat cancer - all in good time. The problem is you and I are miserable during the eternal wait…
Comment by The Cheerful Oncologist — August 10, 2005 @ 4:48 am
Doc, I am enjoying your comments to our comments.
Comment by Feisty — August 10, 2005 @ 5:28 pm
The best and most economically sensible approach to cancer is prevention and early diagnosis.
Sadly, treatment of advanced disease offers limited benefit, and high costs–both in side effects and cost. In one recent trial for breast cancer that improved survival by a few months– the drug costs exceeded $100,000.
We may defeat cancer some day but will we be able to afford the treatment?
Comment by Pagoff — August 11, 2005 @ 5:14 pm
As I go through nursing school, and work in a hospital every day, I am amazed by the difference in some patient’s outlooks. I cannot fathom being an oncologist having to look someone in the eye and say, I’m sorry, but there is nothing else we can do, except keep you pain free…
I wish more would say it, however… having watched my mother lose a valiantly fought, but rapid battle to lung cancer 10 years ago (She was also a life long non-smoker) I watched her last few months a living hell with different treatments that offered little hope other than to be “not giving up”; I hate seeing patients in my unit who have a primary cancer, with mets to various organs, enduring another surgery or another treatment because, “this one will work”. I realize attitude is a primary weapon against cancer, but there has to be a balance with quality of life…
Comment by DisappearingJohn — August 11, 2005 @ 8:43 pm
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Don’t you think forty years of the so called “War on Cancer” is enough? Don’t you think maybe a completely different paradigm is now called for–that is, to treat the CAUSE–not the SYMPTOMS–of cancer? I simply do not understand how Cancer, Inc. can possibly believe that infusing warm sentient beings with known toxins could be remotely helpful, particularly for late stage cancers. Had someone not had the bright idea that mustard gas was a good thing to put into human beings, I wonder where cancer would be today. Cured, I imagine. Poisoning people to cure them. Makes no sense.
Comment by Catherine — September 19, 2005 @ 10:51 am
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Comment by testanchor787 — October 16, 2005 @ 1:41 am