I created a rule for myself when I started this blog: no writing about work. I don’t want to make anyone, least of all my patients, feel uncomfortable if they come across this. But what are rules, if not for breaking? Here we go:
My attitudes towards medical treatment is changing. Being a card-carrying member of the nuts-and-berries club, I have historically been into holistic health, interventions that seemed “natural” (whatever that means), topped off with anti-establishment sentiments. As a young woman, I was not a compliant patient for the relatively minor health problems I struggled with at the time. Admittedly, there is lots wrong with medicine as its practiced in the US, and I still have my critiques and enjoy alternative therapeutics today, while working as an advanced practice nurse in a highly specialized, often medically-agressive practice. The more I know about cancer, the more I respect that patients may very well need that chemo or radiation bomb. Its toxic, but it works. Cancer is not a beast you want to do battle with without access to all the ammo you can get your hands on.
I had a recent patient encounter which made the new me crazy. She is a high risk patient– in remission but relapse remains very possible, and without proper treatment a near-certainty. By following through with the standard of care, her chances actually become pretty decent at remaining disease free– she is curable. She has received a sliver of what would be recommended in her situation, as far as cancer treatment goes. She wants to stop everything, citing side effects that most patients would find acceptable, and furthermore, she isn’t interested in trying the other phase of recommended treatments, which are far less likely to cause her pain or suffering. Moreover, our whole discussion was peppered with her smirks and a bizarre affect, which seemed to suggest she found the whole thing one big joke.
I promise you, dear patient, this is no joke. You are gambling with your life, and for what? To die in your fifties? There are lots of ways to go out in this world- dying of metastatic cancer isn’t one of the best ones, trust me. I can understand stopping treatment if side effects are severe, or when the risk-benefit ratio is unfavorable. But not to walk away from something due to a strange, misinformed naivety mixed with fatalism, instead of making a balanced, informed decision. I think there was a time where I would have respected her individualism, the fact that she listens to her body and takes the reins to steer her care in the direction she believes is right. Today, I think she is foolish.
She got to me more than she should have. She’s around my mom’s age. My mom has been pounded with chemo for the last year. She’s still not in a remission. Statistics are a tricky animal, but my mom would trade her odds for this individual’s situation in a heartbeat. I don’t want to get too dramatic– this wayward patient could well relapse and die even if she did anything and everything her oncologist asked. Others in her situation have. But respect cancer, and respect yourself, enough to try for that cure. So many have suffered and struggled– the patients that came before, who fought to their end, the doctors, the chemists and biologists and geneticists who did the painstaking, at times heartbreaking reasearch to bring us to this moment in time, where we have more to offer cancer patients beyond “go home and enjoy your last days.”
We have tools– imperfect, sometimes inadequate. But we have them, so give them a try! They might save your life.