Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The cancer journey well-traveled

Kenneth D. Bishop, MD, PhD
Physician
May 11, 2014
Share
Tweet
Share

Last summer I met with a patient in my clinic who had come to the hospital with leg weakness and his CT scans showed widespread cancer. His type of cancer is rare and treatable with a pill, which he had been taking for about a month. He was tolerating it without too much trouble.

During our first visit, he was insightful but overwhelmed. “I know how sick I am — just get me to December, that’s all I need,” he said. He had a family milestone coming and told me he would be happy if he made it just one day beyond. Toward the end of the appointment, we reviewed everything and for the first time his emotions came through.

“I don’t know what I did to deserve all this,” he said, meaning the weakness, and the pain, and the cancer in general. It wasn’t self-pity; it was honest confusion.

He made it to December. We celebrated with him and I started to look forward to his appointments as a highlight of my week. He told (purposefully) bad jokes and needled me every visit about not bringing him a danish and coffee. At the end of each half-hour he would say thank you and meant it.

A few months ago, we ordered a CT scan to check on how all of his different sites of cancer were responding, and one area was much worse so we switched to a newer pill that hadn’t been available when we started his treatment. None of his symptoms had become significantly worse. A few weeks later I ordered another scan to see if the new pill was working and that same spot had grown much more. Not working. His lab work was starting to reflect it as well, so decisions about the next step in his treatment would need to be timely.

The next step was chemotherapy. Here’s the conflict with chemotherapy in patients with stage 4 cancer: Most of the time, stage 4 cancer is incurable. Just thinking and writing that sentence feels like I’m squashing hope for a thousand patients to come, whom I have yet to even meet. Maybe soon a treatment will be approved that will cure metastatic cancer, but today this happens almost never. So we give chemotherapy to prolong someone’s life as much as we can, but the trade off is choosing among inevitable side effects. It can’t be a decision made without careful consideration.

I’ve already had more than one patient’s family member ask me if it’s ever worth going through chemotherapy for metastatic cancer after their family member had passed away. Sometimes yes, sometimes no, is the best answer I’ve been able to come up with so far.

We talked about it and my patient wanted to go ahead and try it. We scheduled it for the next week but for a few different reasons we postponed for another week when he came back in. Over the weekend he got much sicker and died the following week, never having had the treatment.

He will always represent for me the cancer journey well-traveled. It’s never a good road to walk, but he started off toward his self-ordained promised land and he was fortunate to have made it. When his disease progressed, he wasn’t bitter and he didn’t rage against the injustice of it. He got to where he wanted to go.

During our last visit, he said another thing. He had clearly been reflecting and had been thinking back to his months overseas in the service when he was young, on all the friends who weren’t fortunate enough to join him on the trip home, and he told me he felt like everything he had after that was a gift. His family, his job, his life.

Almost like he was saying that he didn’t know what he had done to deserve all this.

He died and I’ll miss him even though I never knew him in any capacity other than as my patient. I looked forward to seeing him because I knew I’d laugh at some point when I did, and because he didn’t fall into the trap of focusing on the injustice and inequity that advanced cancer sets for us.

He walked his road, and he made it to the end of it, and then he proudly and gratefully stopped walking.

ADVERTISEMENT

Kenneth D. Bishop is a hematology-oncology fellow who blogs at Out Living.

Prev

Medical school drug testing is a moral and scientific failure

May 11, 2014 Kevin 6
…
Next

The success stories of medicine deserve more attention

May 12, 2014 Kevin 9
…

Tagged as: Oncology/Hematology

Post navigation

< Previous Post
Medical school drug testing is a moral and scientific failure
Next Post >
The success stories of medicine deserve more attention

ADVERTISEMENT

More by Kenneth D. Bishop, MD, PhD

  • a desk with keyboard and ipad with the kevinmd logo

    A hematologic emergency in the ER

    Kenneth D. Bishop, MD, PhD
  • The people who will cure cancer are the patients

    Kenneth D. Bishop, MD, PhD
  • Medicine cannot be reduced to just a job. Here’s why.

    Kenneth D. Bishop, MD, PhD

More in Physician

  • When cancer costs too much: Why financial toxicity deserves a place in clinical conversations

    Yousuf Zafar, MD
  • The hidden rewards of a primary care career

    Jerina Gani, MD, MPH
  • Why doctors regret specialty choices in their 30s

    Jeremiah J. Whittington, MD
  • 10 hard truths about practicing medicine they don’t teach in school

    Steven Goldsmith, MD
  • How I learned to love my unique name as a doctor

    Zoran Naumovski, MD
  • What Beauty and the Beast taught me about risk

    Jayson Greenberg, MD
  • Most Popular

  • Past Week

    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • Why I left the clinic to lead health care from the inside

      Vandana Maurya, MHA | Conditions
    • How doctors can think like CEOs [PODCAST]

      The Podcast by KevinMD | Podcast
    • A surgeon’s testimony, probation, and resignation from a professional society

      Stephen M. Cohen, MD, MBA | Physician
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • What street medicine taught me about healing

      Alina Kang | Education
  • Recent Posts

    • Affordable postpartum hemorrhage solutions every OB/GYN can use worldwide [PODCAST]

      The Podcast by KevinMD | Podcast
    • When cancer costs too much: Why financial toxicity deserves a place in clinical conversations

      Yousuf Zafar, MD | Physician
    • Psychiatrist tests ketogenic diet for mental health benefits

      Zane Kaleem, MD | Conditions
    • The hidden rewards of a primary care career

      Jerina Gani, MD, MPH | Physician
    • Why physicians should not be their own financial planner

      Michelle Neiswender, CFP | Finance
    • Why doctors regret specialty choices in their 30s

      Jeremiah J. Whittington, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 3 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • Why I left the clinic to lead health care from the inside

      Vandana Maurya, MHA | Conditions
    • How doctors can think like CEOs [PODCAST]

      The Podcast by KevinMD | Podcast
    • A surgeon’s testimony, probation, and resignation from a professional society

      Stephen M. Cohen, MD, MBA | Physician
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • What street medicine taught me about healing

      Alina Kang | Education
  • Recent Posts

    • Affordable postpartum hemorrhage solutions every OB/GYN can use worldwide [PODCAST]

      The Podcast by KevinMD | Podcast
    • When cancer costs too much: Why financial toxicity deserves a place in clinical conversations

      Yousuf Zafar, MD | Physician
    • Psychiatrist tests ketogenic diet for mental health benefits

      Zane Kaleem, MD | Conditions
    • The hidden rewards of a primary care career

      Jerina Gani, MD, MPH | Physician
    • Why physicians should not be their own financial planner

      Michelle Neiswender, CFP | Finance
    • Why doctors regret specialty choices in their 30s

      Jeremiah J. Whittington, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The cancer journey well-traveled
3 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...