Archives of The Cheerful Oncologist, Volume 2

You left me standing here
A long, long time ago,
Don’t leave me waiting here,
Lead me to your door.

-Lennon/McCartney, 1970

The old woman lay propped up on two rather stiff pillows which were tucked under her at what seemed to be uncomfortable angles. Her voice trickled out with the hesitant phrases of the seriously ill as she cautiously shifted her body in the bed. Above her a spiderweb of tubing hung from several poles, and outside in the hallway a vacuum cleaner roared back and forth slowly across our ears. I got up and closed the door.

The old woman was my patient, now entering her eighth (or ninth, perhaps) day in the hospital after developing pneumonia and severe esophagitis from simultaneous chemotherapy and radiation therapy. The first 48 hours had been terrible for her, and I began to grieve when I thought that she was going to die, another victim of the good intentions of a team of doctors.

The old woman was tougher than we thought. She was blessed with a beautiful combination of both undauntedness and good luck and survived the initial storm - the fevers and hypoxemia that lash cancer patients who show any signs of weakness. Now she was beginning to recover. According to my schedule she had two more cycles of chemoradiotherapy left before completing the full course. She had just asked me how long she would be off of treatment.

“I don’t believe it is safe to continue on with any further therapy,” I said. She stared straight ahead as I spoke, and I turned to the window and continued my argument, swinging my head back and forth between her and the far side of the room, for sitting over there on the sill were her husband, son and daughter-in-law.

I presented my case to them, explaining that because of this setback any further complications could prove fatal. In my opinion this patient was now officially off of all treatment. From now on, the journey ahead would be toward recovery and hopefully a return to the normal home life we all tend to take for granted in times of good health.

“Because Mom hasn’t finished all of her chemotherapy and radiation therapy won’t that hurt her chances for remission?” asked her son.

Good question, I thought, but putting everything into perspective I felt that she had received enough treatment to deal a serious blow to her tumor - perhaps enough to induce a long remission, perhaps not. It was irrelevant at this point, but I wanted to convey that information to the family in a way that they would understand, without resorting to quoting impersonal statistical data (also known as medical lingo). I paused for a second and then came up with this explanation, which I shared with them:

“Think of two cancer patients beginning treatment as two cars who need to cross a dangerous mountain in order to reach home on the other side. The first car drives over the mountain without any difficulty and eventually pulls into the village safe and sound. The second car takes a bad turn and careens off a cliff, crashing into the rocks far below, killing the passengers. The first car represents those who sail through their treatment without difficulty and obviously the second car represents those patients who die from the toxic side effects of treatment before they have a chance to see if they have defeated their cancer.”

“Excuse me, Doctor, but it seems that Mom isn’t in either one of those groups, is she?”

I turned toward my patient and addressed her directly. “That’s right - you weren’t in either one of those cars. You are in a third car that made it all the way to the summit, then broke down. You are still alive, but in order to stay alive you’re going to have to walk down that mountain. It will be a long journey, but with help from all of us, you just might make it all the way home.”