give hope, but prepare for death.
i've been holding back tears in clinic lately.
maybe it's because i'm tired, or maybe it's because these people are dying in front of me and there is little i can do.
to set the scene: my weekly clinic is at the veteran's hospital associated with Famous Cancer Center (henceforth referred to as FCC), where i am for most of my oncology training. this is a common setup at training programs. it goes without saying that all my clinic patients are vets.
i have been seeing CW for about two months now--this seems like an eternity in cancer time. CW has renal cancer, a fairly aggressive and difficult to treat disease. he has been to other cancer centers but is now seeing me for what he believes to be the best care available. his cancer has spread to his lungs and his brain. two weeks ago he had the tumor in his brain surgically removed. now he's in my clinic asking for more treatment, but i'm in the difficult position of telling him that the best care is really at FCC where all the clinical trials are based. i call one of my attendings who treats renal cancer at FCC. he is more than happy to accept the patient, but the VA hospital will not pay for the study at FCC.
"we have $800 in the bank," says his wife as her eyes tear up. "we are $25,00o in debt from his medical bills, already." CW tells me that they are going to cut down the trees on their property to sell for timber. they have nothing left. and CW is dying in front of me.
thus far, so early in my oncology training, my most difficult interactions have been with patients who are at the end of the line. i struggle with how to tell them they are dying while providing them hope at the same time. isn't this somewhat contradictory?
give hope, but prepare for death.
posted by oncologist @ 9:47 PM
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My Mom's a retired RN who spent most of her career in oncology, often only able to make a patient relatively comfortable with Marinol to fight the nausea of the chemo and opiates for the rest.
And she's pushing seventy and still hasn't quit smoking, to speak of contradictions. The only contradiction I know to rival it is a friend who went to med school and is in clinical research, but who thinks the world is overpopulated. Seems to me, he missed is calling: a natural for abortionist or euthanasia activist.
But keep up the good fight. The biggest problem with medicine these days is that doctors have to go through so much sleep deprivation and slave labor that any 'bedside manner' they might have had is eaten up by misanthropy before they ever hang a shingle. Kind of like air traffic controllers, it takes a special personality in addition to brains and a substantial investment in education to be any good at it.
I hope you have that personality. I'm a cardiac arrest survivor who would love to get cancer in his eighties or nineties (because that would gurantee a few more decades of pre-cancer life. I also have a neighbor who's daughter is going through an alternative trial regimine after her Burkitt's Lymphoma didn't fully comply with the only 'approved' treatment.
For all I know, her folks may go bankrupt trying to save her life. I've been in Chapter Seven for medical expenses that weren't even life threatening, they were just contractually excluded from my insurance. Tell CW that at least one person out there thinks he should borrow the money from a loan shark if that's what it takes to have a shot at more life. He'll get his shot at the alternative to life eventually, and at that point, money is not a problem as far as I know.
And if FCC can avoid having his expenses written off by a bankruptcy judge by hooking CW up with a foundation that has grants available to help this along, maybe there's a way CW can remain whole in more ways than one. But in a 'your money or your life' situation, only Jack Benny could pretend to debate the issue.
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