The Navigator
“Act with kindness, but do not expect gratitude.”
-Confucious, 551-479 B.C.
Please read the following problem, then select the one best answer to the question that follows:
A 52 year-old post-menopausal woman is diagnosed with infiltrating ductal carcinoma of the breast. Her tumor size is 3.5 cm and angiolymphatic invasion is present. She undergoes a lumpectomy and sentinel lymph node biospy, and two out of five nodes contain metastatic carcinoma. No further disease is found on routine imaging studies which include fusion PET/CT imaging. Her tumor is estrogen-receptor positive, progesterone-receptor negative, and HER-2 is overexpressed by fluorescent-in-situ-hybridization (FISH).
She is treated with adjuvant dose-dense chemotherapy using sequential doxorubicin, paclitaxel and cyclophosphamide, followed by radiation therapy and a 52-week course of trastuzumab monoclonal antibody therapy. A five-year course of the oral aromatase inhibitor letrozole begins upon the completion of radiation therapy.
The patient develops the following side-effects during her treatment: severe alopecia, nausea, anemia, one episode of fever associated with neutropenia, fatigue, numbness of the toes and feet, diffuse myalgias from pegylated filgrastim injections requiring the use of oral narcotics, erythema and dry desquamation of the skin over the breast.
One year later, her oncologist states that she can now have her portacath removed and won’t have to return to the office for three months. He offers congratulations to her on successfully completing all of her intravenous therapy and says, “Hooray - you made it through!” The patients replies, “Thanks to you, Doctor. You and your staff worked so hard - you are all the greatest.”
The correct response to this compliment is:
A. “Thank you. It’s very kind of you to say that.”
B. “Hey - that’s what we’re here for.”
C. “I know - I’m lucky to have such wonderful nurses.”
D. “It was a long haul, wasn’t it? Did you ever think it would end?”
E. “Well, I couldn’t let you down now, could I? I don’t want to ruin my reputation!”
The proctor will now collect the answer sheets. No peeking at your neighbor’s paper, now. Are all the sheets in? Good. Now, the correct answer was:
F. NONE OF THE ABOVE.
Did we fool you? Perhaps you’re wondering why The Cheerful Oncologist rejected all of the above replies to his grateful patient and came up with a different answer. Pehaps you are also wondering why you didn’t pick the winning numbers in last month’s 360 million-dollar lottery, as our narrator is. Never mind that - here is what I said to my patient:
“You did all the work, not me. Think of what you went through last year as a crucial airplane trip out of a dangerous country to the land of good health. You owned the airplane and you were the pilot. The fact that you made it safely home is due to your efforts, not mine. I was just ground control, sending up directions and messages of encouragement to you. You made all the sacrifices and now, with a little more help, you’ll get to enjoy the rewards of this investment in your future.”
