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

Missed opportunities give leverage to cancer

Kenneth D. Bishop, MD, PhD
Conditions
August 21, 2014
Share
Tweet
Share

Last week a patient said to me, “You live your whole life thinking you’re going to have time to enjoy life later on, and then this happens.” Then he started to cry because we had just reviewed his recent CT scans and some of his lab results and he had a new diagnosis of a type and stage of cancer that meant he likely had about eight months to live. Treatment might give him another three.

Two weeks and one day before this, he had no symptoms.  The next day he left a social event early because he had indigestion.  Then his skin started to turn yellow.  Then he got yellower and his eyes also turned yellow so he made an appointment with his primary care doctor which led to labs and CT scans and a biopsy and here we were.

You live your whole life thinking you’re going to have time to enjoy your life later on. Off the top of my head I can think of three patients who voiced this same lamentation at some point since I started fellowship. This man wasn’t giving me advice; he wasn’t warning me of anything.  He was wiping his eyes and speaking into nowhere at nobody.

I felt like it might not be the best time to ask him what he’d have done differently but, man, did I want to.

In general, I object to carpe diem sentimentality because its evocation mostly just makes me feel guilty when I’m not out having transcendent life experiences. Since Dead Poet’s Society hit theaters, I’ve heard it frequently enough by this point that it almost seems dismissive of people’s suffering now.

I sat with the man a little while and we came up with a plan (we had other things to fix before we could even think about chemotherapy).  Then I left the hospital and drove around for a while.

One thing that’s really wonderful about being an oncologist is the relationships with patients tend to be very genuine, and patients often take the opportunity to have a meaningful conversation. I’ve had many talks over the years about really profound stuff, and more than a few of them were about what makes life meaningful. The prospect of imminent death tends to clarify this for people.

Once, I met a champion free diver with leukemia whose only regret was that he didn’t take better care of his teeth (could I possibly have made that up?). I was an intern on overnights when his blood pressure dropped because he finally developed an infection his failing immune system couldn’t handle.  I went to his room to talk to him about how aggressively he wanted us to treat the infection this time, and through clenched teeth but smiling lips he calmly asked me not to transfer him to the ICU and by morning he was gone.

Some patients aren’t quite as unburdened:  The misery of advanced cancer compounded by the emotional anguish of regret, or words unsaid, or missed opportunity is a very hard thing to witness, and gives the disease leverage it shouldn’t be afforded.

I’ve consolidated what I’ve gleaned to these:

1. Pay attention. Sometimes “you live your whole life thinking you’re going to have time to enjoy your life later on” means “you were so focused on what might be better someday that you missed what was actually happening.” Forgive me for stealing a line from somewhere, but you can’t buy happiness with unhappiness.  I don’t remember where I heard it.  Some hardships we endure because they’re worth it (ask anyone who has been woken up every 45 minutes by a newborn baby), but I wonder if we subject ourselves to some hardships because we’re convinced that we’re buying an equal measure of goodness in the future? I know I could be much better at indulging in some simple joy right now, because the thing about the future: we never actually get there.

2.  Move. It’s possible this is my own bias, but my impression is that patients who navigate advanced cancer more comfortably are folks who were more physically fit before they got sick.  It may be circular logic, but I also think these were people who got out and did stuff.  I don’t think free diving is mandatory, but moving around a little is better than not moving around a little, if you’re able.

3. Sit still. Some of the best conversations I’ve had with end-stage patients were with people who intentionally took time to reflect on their lives. I suspect they were also reflective people before they got sick.  Some folks wrote things down (I’ve known a few patients with their own blogs), some found gratification in corresponding with family and friends, and for some it was enough to sit in a chair and look out a sunny window. The contemplative process took some of the victimization of cancer away, and gave the patients some power back.

ADVERTISEMENT

4. Forgive something. A women I was seeing regularly in a clinic I visited this year has stage four cancer and is constantly in some degree of pain.  When we’d get past the medical part of the visit and into the chatting part, she would bring up how angry she was with one of her family members because of years of unresolved conflict.  When this came up, it was obvious that worse physical pain would wash over her and it was hard to watch.  Resentment is a burden we carry that hurts us, and usually doesn’t affect whatever or whomever we resent. Sometimes we resent ourselves for things we did, choices we made or didn’t make.  The cost is more than emotional: It manifests in our bodies, and it costs too much.

5. Let go of fear. The patients I’ve watched live well with end-stage cancer have somehow conquered their fear. It’s not that they were unafraid, but they managed to assimilate dealing with symptoms, and disease progression, and eventual death into the process of living their remaining days. Fear doesn’t achieve anything, but it’s well capable of physically draining us and yanking us out of the present into a possibly fictitious future.  It’s another facet of the same mistake made by my newly-diagnosed patient.

Like I said, I didn’t have the chance to explore any of this with the man. The fact that this was one of the first sentences he spoke after learning life altering news makes me suspect that his personally held values came into a new clarification for him. It must be terrible to find a mismatch between the life you lived, and the life you wished you had lived.

Frankl has a suggestion for us, which I like:  “Live as if you were living already for the second time and as if you had acted the first time as wrongly as you are about to act now!”

Not everyone gets the opportunity.

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

Prev

How to move the needle on wellness

August 21, 2014 Kevin 1
…
Next

Why do doctors ignore their own self-care needs?

August 21, 2014 Kevin 7
…

Tagged as: Oncology/Hematology

Post navigation

< Previous Post
How to move the needle on wellness
Next Post >
Why do doctors ignore their own self-care needs?

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 Conditions

  • Private practice employment agreements: What happens if private equity swoops in?

    Dennis Hursh, Esq
  • Inside the final hours of a failed lung transplant

    Jonathan Friedman, RN
  • Why South Asians in the U.S. face a silent heart disease crisis

    Monzur Morshed, MD and Kaysan Morshed
  • Why chronic pain patients and doctors are both under attack

    Richard A. Lawhern, PhD
  • The quiet work of dying: a hospice nurse’s reflection

    Christopher M. Smith, RN
  • Medicaid lags behind on Alzheimer’s blood test coverage

    Amanda Matter
  • Most Popular

  • Past Week

    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • What street medicine taught me about healing

      Alina Kang | Education
    • Are we repeating the statin playbook with lipoprotein(a)?

      Larry Kaskel, MD | Conditions
    • The silent cost of choosing personalization over privacy in health care

      Dr. Giriraj Tosh Purohit | Tech
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Past 6 Months

    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
  • Recent Posts

    • Private practice employment agreements: What happens if private equity swoops in?

      Dennis Hursh, Esq | Conditions
    • Inside the final hours of a failed lung transplant

      Jonathan Friedman, RN | Conditions
    • Why South Asians in the U.S. face a silent heart disease crisis

      Monzur Morshed, MD and Kaysan Morshed | Conditions
    • Why chronic pain patients and doctors are both under attack

      Richard A. Lawhern, PhD | Conditions
    • The overlooked power of billing in primary care

      Jerina Gani, MD, MPH | Physician
    • The quiet work of dying: a hospice nurse’s reflection

      Christopher M. Smith, RN | Conditions

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

Leave a Comment

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

    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • What street medicine taught me about healing

      Alina Kang | Education
    • Are we repeating the statin playbook with lipoprotein(a)?

      Larry Kaskel, MD | Conditions
    • The silent cost of choosing personalization over privacy in health care

      Dr. Giriraj Tosh Purohit | Tech
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Past 6 Months

    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Confessions of a lipidologist in recovery: the infection we’ve ignored for 40 years

      Larry Kaskel, MD | Conditions
    • A physician employment agreement term that often tricks physicians

      Dennis Hursh, Esq | Finance
    • Why taxing remittances harms families and global health care

      Dalia Saha, MD | Finance
  • Recent Posts

    • Private practice employment agreements: What happens if private equity swoops in?

      Dennis Hursh, Esq | Conditions
    • Inside the final hours of a failed lung transplant

      Jonathan Friedman, RN | Conditions
    • Why South Asians in the U.S. face a silent heart disease crisis

      Monzur Morshed, MD and Kaysan Morshed | Conditions
    • Why chronic pain patients and doctors are both under attack

      Richard A. Lawhern, PhD | Conditions
    • The overlooked power of billing in primary care

      Jerina Gani, MD, MPH | Physician
    • The quiet work of dying: a hospice nurse’s reflection

      Christopher M. Smith, RN | Conditions

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

Leave a Comment

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

Loading Comments...