I have a patient in his 60s who is riddled with metastatic lung cancer. He isn’t on hospice (oncology refuses to let him out of their clutches just yet; actually, the problem is that around here Hospice won’t accept patients still on palliative chemo or radiation) but is aware of what they have to offer. He and his wife have assured me that they will let me know when they feel they need their help.
In the meantime, he comes to me for a visit because he is worried about his blood pressure.
Up until his cancer spread, I had been treating him (successfully) for high blood pressure. Pretty routine; good control; no big deal. The problem of course is that now he is extremely unlikely to live long enough to have a heart attack or stroke. I have already told him to stop his BP meds, and he has. At this point, his blood pressure isn’t even all that bad, but he occasionally gets readings at home in the 150s over 90s. This has him concerned.
My gut reaction was a combination of, “Why?” and “It doesn’t matter.”
Although I have explained this to him and his wife several times before, either the chemo-brain or the whole brain radiation for metastatic disease has left him a little foggy. I need to find another way to explain this without coming right out and saying, “You’re going to die of cancer before your blood pressure has any chance of hurting you.”
So I said this instead:
Imagine there’s a house with a leaky faucet. You know that it’s important to fix leaky faucets, because they can cause big problems with the plumbing down the road.
He nodded his understanding.
Now imagine that the house is scheduled to be demolished next month.
“Ah,” he said, smiling with comprehension. “It doesn’t matter.”
Exactly so.
One of the greatest pleasures I have in my job is watching things click. That “Got it!” moment when a vaguely abstract concept is presented in terms just different enough to trigger comprehension instead of confusion is exhilarating for both of us. Nothing beats the effectiveness of a great analogy.
Lucy Hornstein is a family physician who blogs at Musings of a Dinosaur, and is the author of Declarations of a Dinosaur: 10 Laws I’ve Learned as a Family Doctor.
