Within These Hands
The following dialogue occured in my office. The dramatis personae: myself and a patient just diagnosed with adenocarcinoma of the lung.
“I became short of breath this summer and went to my doctor. He kept telling me ‘There’s nothing wrong with you!’, but I still was short of breath. Then I had a CAT scan and they found fluid in my right lung.”
“Did you have a chest x-ray before the scan?”
“Yes, about two months before, and supposedly it was normal. He kept saying, ‘There’s nothing wrong.’”
“What happened after your CAT scan?”
“I was in bad shape. I couldn’t breathe, and they put me in a room in the office. He came in and said I had a lot of fluid on my right lung.”
“What did he recommend to be done?”
“He didn’t recommend anything! He said ‘It’s out of my hands!’
“He said, ‘It’s out of my hands?”
“Out of my hands!”
Later that afternoon, after finishing my dictation, just at that moment when the glaze of sunlight melting through the window blinds begins to murmur “sleep…sleep” into the ear of the weary worker, I recalled this conversation and suddenly jerked to life like a cat hearing an electric can opener. What was the message being sent to my patient by the doctor whose leadership in this crisis consisted of waving a white flag?
“It’s out of my hands!”
I said it to myself a couple of times and felt an uneasy sense of relief come over me, as if I had just climbed into the last lifeboat on the Titanic and was watching the crowd on the deck grow smaller as we rowed into the darkness. Just think of how easy our jobs would be if we were allowed to play the ‘out of my hands’ card whenever the going got tough. It would certainly bring a sigh of relief to us, but what about the person who is still trapped on the sinking ship? For a physician to admit defeat just when a patient is diagnosed with cancer would imply, in my opinion, three things:
1. Ignorance - “I don’t know what to do!”
2. Irresponsibility - “It’s not my problem!”
3. Irreversibility - “You’re a goner!”
Certainly there are patients who are too debilitated or too ill to have any meaningful chance of recovering from their newly diagnosed malignancy. We oncologists not only recognize this fact, we strive to identify such individuals so that they do not receive futile treatment as a substitute for gentle, if discouraging words of support. The problem is that my patient with the large malignant pleural effusion was not on his last legs. He would benefit greatly from a multidisciplinary approach to his problem, including such things as closed chest thoracostomy with pleurodesis, not to mention chemotherapy and targeted therapy. For this to happen though, someone has to stand up and make the following statement:
“I am here to serve you. The only justification I have for my paycheck is to help people living with cancer. When you come to me for that help, you are putting your life into my hands. Let me tell you what is contained within them.
“Within my hands are responsibility - to ensure that you receive only thoughtful treatments proven to have a chance to relieve your suffering or prolong your life. Within my hands are diligence - to ensure that your care is given correctly and quickly so as to not waste time. I also hold empathy, optimism and good cheer, and will shower you and your family with them whenever the skies turn bleak with despair.
“No mortal being can guarantee a perfect outcome for the patient with cancer. But I can guarantee that until the final chapter of your life is written, whether it be years from now when our time together is but a faded memory, or just a few weeks from now when your last breath is but moments away, I will never let you slip out of these hands. They were designed to grasp, and lift, and pull, and touch. Doctors who use their hands until the day they wear out will only please their designer, who sees how splendid they were and how satisyfing was the work that they completed.”
That was beautiful.
Comment by Ali — October 1, 2005 @ 5:42 pm
Love it, Doc.
Comment by Feisty — October 3, 2005 @ 3:50 am
What a crock. Cancer, Inc. doesn’t have a clue how to treat cancer.
Comment by Catherine — October 3, 2005 @ 5:57 am
Within These Hands - from The Cheerful Onclologist
The Cheerful Oncologist relates a conversation he had with a newly diagnosed cancer patient. The patient’s primary physician had offered no treatment options, simply stated it’s out of my hands. Fortunately for the patient, and for those of us who
Trackback by MSSPNexus Blog — October 3, 2005 @ 12:56 pm
“Cancer, Inc” may not have all the answers, but thank goodness somebody is at least looking and trying. Doc, I applaud you- as someone on the other side of the table, it is great to know you have an expert (as much as one can be in such a deadly game) in you corner.
Comment by Chris — October 3, 2005 @ 5:06 pm
Chris believes: “Cancer, Inc” may not have all the answers, but thank goodness somebody is at least looking and trying.
For forty-plus years now, they’ve been “trying.” The treatment of cancer is so grotesquely profitable now, don’t expect a “cure” anytime soon.
Comment by Catherine — October 3, 2005 @ 5:14 pm
Obviously, Catherine, you are angry that we have not found “the cure” for cancer - which is not just one disease. The fact that we have been trying is not a submission of defeat, but acknowledgement of the ongoing struggle to survive and understand the problem. One could have admitted that we could not prevent infections, the leading cause of death 100 years ago, but doctors did not give up hope. We are curing many patients with cancer, and thank goodness there are doctors and nurses willing to persue that goal. For others, we do what we can to ease their suffering - some will live longer, and some will see the sun setting sooner on their lives. The war on cancer is a long and winding road.
Comment by Scott — October 3, 2005 @ 7:12 pm
Hey, don’t kid yourself. If they ever find a “cure” for cancer it will be sold in every corner of the world - after all, everyone likes to buy a high-quality product, not to mention one that saves your life.
Comment by Dr. Craig Hildreth — October 3, 2005 @ 7:17 pm
This may be your best post yet and you have had some great ones before.Thanks for sharing your thoughts.
Comment by James Gaulte — October 3, 2005 @ 8:02 pm
i appreciate the asthetic quality of the touching part of your view on it. someday i would like to be a midwife. (non-medical model). a big part of that is the spirituality and touch. the midwives call it “catching babies”. your words and your thoughts on not letting your patients slip out of your hands reminded me of this is a very sentimental way. thank you……….
Comment by Aimee — October 4, 2005 @ 5:00 am
Craig said: If they ever find a “cure” for cancer it will be sold in every corner of the world - after all, everyone likes to buy a high-quality product, not to mention one that saves your life.
You don’t actually believe this, do you? What do you think would happen to the multi-multi-billion dollar industry of cancer treatment if a cure were found similar to, say, the discovery that Helicobacter pylori cures peptic ulcers, for which two Australian researchers–who, by the way, spent DECADES trying to convince Official medicine of its truth–won the Nobel Prize? If–and it’s a big if–a cure is found, Cancer, Inc. will take many more decades to dismantle.
Here’s the way the researchers described it:
The [Nobel] prize has come after years of ridicule by the MEDICAL FRATERNITY which refused to accept their revolutionary theory.
“I’m amazed and a bit shocked to tell you the truth [to have won the prize] after all these years,” Professor Warren, emeritus professor at Royal Perth Hospital, said.
“It was really annoying that I couldn’t convince people that these bacteria were growing and they were important as well.”
Scott, just because I don’t believe the B.S. put out by Cancer, Inc. doesn’t mean I’m “angry.” I just simply understand the economics of “treatment” vs. “cure.” Ka-ching!
Wake up, people. Sheesh.
Comment by Catherine — October 4, 2005 @ 5:34 am
Good post . . .
Comment by DP — October 4, 2005 @ 3:15 pm
Catherine, what exactly do an ulcer study and cancer research have to do with each other, besides being of a medical and scientific nature? What shady cabal runs “Official medicine?” Who are these “Medical Fraternity” illuminati? I think it’s time to switch meds. The ones you’re on have obviously induced paranoia. Or maybe Big Pharma wants you to be paranoid… Yes, it’s all part of their master plan. :eyeroll:
Comment by Ali — October 5, 2005 @ 7:52 am
Whoa. Wow. How impressive. If I need a doctor, will you be mine???? Please?
What a wonderful, wonderful post!!!
Comment by Eyes for Lies — October 5, 2005 @ 4:52 pm
This is “lump-in-my-throat” material. Thank you so much for sharing this with us.
(And I know an awful lot of people who are no longer living with their cancer, be it through surgery, chemo or both, years after their diagnosis. If that isn’t a cure, what is a cure?)
I’d love to post this in our ER….
Comment by Kim — October 6, 2005 @ 6:13 am
Kim said: And I know an awful lot of people who are no longer living with their cancer, be it through surgery, chemo or both, years after their diagnosis. If that isn’t a cure, what is a cure?
And I know an awful lot of people who were KILLED by chemo and radiation, so if that’s a cure, keep it the hell away from me.
Comment by Catherine — October 6, 2005 @ 6:38 am
Well put. Docs that may have a thought let alone a lifestyle that supports that view are few and far between. I had a few fab docs when I had cancer; sadly my Mother didn’t. So of us win, some don’t. But nobody gets out alive anyway. Nice to have a ‘nice’ touch no matter the road.
Comment by Kim — October 9, 2005 @ 12:36 am
Ali asked: what exactly do an ulcer study and cancer research have to do with each other, besides being of a medical and scientific nature?
Well, how many OTHER cures–including cancer cures–do you think have been passed by because of inside-the-box thinking as demonstrated by how long it took the two Australians to get their voices heard?
By the way, good ol’ Craig will probably censor this post, too. Anyone who doesn’t cheer him and his POV won’t see their comments here, eh, Craig?
Comment by Catherine — October 9, 2005 @ 5:52 am
As someone with a large tumour who was told to come back in 6 weeks as ‘it doesn’t feel like cancer’, I just wanted to thank you for your assumption of responsibility. I am now in the hands of a doctor who spends time with me on the phone and in the waiting room pre chemo despite the fact that he is one of the leading oncologists in London. He doesn’t forget his oath, and I so thank him for it…
Minerva
Comment by Minerva — October 9, 2005 @ 11:30 pm
I’m right behind you, doctor. Quite eloquent and very inspirational. Like you, I’m willing to make oncology my career and I wouldn’t be able to that if I bought into the concept of fear and hopelessness.
Comment by ThirdDegreeNurse — October 11, 2005 @ 4:10 am
You chose to answer a question with a question. I’m glad science and medicine are more evidence-based than your claims. Craig hasn’t censored your comments, so I’m not sure exactly why you think he will.
Comment by Ali — October 11, 2005 @ 5:56 am
DR. C,
Outstanding/very inspiring ! Similar to you, my wife+I pursued medicine to
“touch” people. Not to be governed by, Insurance cos. to “herd” people through our office as quickly as possible!
Thanks for the renewed challenge.
Our hands were definately created to be used for His greater purposes!!
Blessings! ; )
Comment by RJB (Iowa M.D.) — October 11, 2005 @ 4:25 pm
I am a Registered Nurse who has been on the journey of fighting cancer.I am the windsheid, not the bug. I work on a daily basis with my hands. I give with them, I take with them , I use them for all prposes of providing comfort to anyone looking to touch them. Life is not measured by the breaths we take but by the moments that take our breath away!!!!! My hand to your hand, my heart to your heart and the two shall unite as friends.
Joyce Arciuolo R.N.
Comment by Joyce Arciuolo R.N. — March 3, 2007 @ 2:52 am
While I continue to fight the battle of my ‘Inbox’, please know over the years that this one article is THE one which I have kept and continue to circulate for the benefit of many. I am very happy that this article is still accessible, with thanks.
Comment by Sandi Pniauskas — November 25, 2007 @ 9:09 pm