I recently read a post by oncologist Dr. Stephanie Graff on the experience of blame, from self and others, that people with cancer are subjected to:

The talk about risk factors and early detection makes us think we can achieve perfection, and that cancer is somehow a personal fault … let us stop making accusations and blaming persons diagnosed with cancer. They are blameless.

Her post, “The only perfect cancer statistic is an imperfect one,” is a great resource for any of our patients who have experienced or are struggling with this.

Another type of blame we can see in oncology practice is when our patients’ families worry that they somehow did not do enough to save their loved one.  They blame themselves for not going to more or different doctors or a different hospital or cancer center.  They second-guess a decision to accept hospice care.

With the inundation of media advertisements and news stories on new cancer treatments, there is a misconception that there is a treatment success for every cancer and situation.  I hope one day that is the reality, but it is not yet.

Some time ago I wrote a metaphorical letter about cancer and hospice to someone, in the hope to find a way to reassure him that he, his family, and his loved one’s doctors, had truly done everything possible.  He told me it was helpful to him and so I thought I would use it as part of this post, in case it can be also helpful to others.  Here it is below (slightly altered from the original letter to protect privacy):

***

Dear friend,

Once upon a time a wise and experienced colleague of mine shared with me that he often viewed the task of a medical oncologist as akin to a knight fighting a dragon.

We raise our swords and drive the dragon back for as long as we can, but too often, even from the onset of the battle, we know we will not win, and ultimately it is the dragon which will be victorious.

Most of the time, we do not know when or why the dragon attacks, or how it chooses its victim.  We have limited weapons to battle the dragon.  Sometimes, our weapons succeed at first to drive the dragon back, and the dragon may even retreat fully from view.  But with no warning, it can return.  And when it does, to our dismay, it has evolved, so that the initial weapons that seemed successful now fall uselessly to the wayside.   

We grab in desperation for another weapon.  A cadre of our knights toil steadily to invent and make new weapons.  We learn that different dragons have different vulnerabilities.  We stock our arsenals.  There are some dragons who are easily weakened, and we can drive them back with each new weapon.  But with one eye we watch the ever shrinking arsenal, as we are aware with each weapon used, we get closer to the day when the arsenal will be depleted.  The dragon is ruthless, and cares not who its victims are.

It is at this point where the knight must drop his or her sword.  If the dragon cannot be stopped, what can be done to shore up the village?

This is what hospice means.  It does not mean we are abandoning the village.

It means that we know from our experience that this kind of dragon is too powerful.  We have learned from our past battles, and those of our mentors before us, that no human power can turn it back.  Hospice is the shield we place over the village.

So why go to battle at all, one might ask?  Perhaps because sometimes, we find something unexpected, a chink in the dragon’s scales; a weapon that did not work before suddenly weakens the next dragon.  It gives us hope.  We study the dragons.  We learn that some dragons have features that make them especially vulnerable to certain weapons, but not others.  We start saving more villages.  Villages everywhere feel more secure.  But even so, certain types of dragons remain immensely powerful.  Our weapons bounce off their scales like harmless droplets of rain.  There is no rhyme or reason as to why one kind of dragon visits one village, and a different one goes elsewhere.

This cancer was one of those worst-of-all dragons.  I think your loved one, and all of you, were exceptionally brave and you had the best knights fighting on your side.  I want you to know that there was nothing overlooked — no better knight or secret weapon somewhere else that might have changed things.

We are but mortal. (As Atul Gawande has written about in Being Mortal.)

Jennifer Lycette is a novelist, award-winning essayist, rural hematology-oncology physician, wife, and mom. Mid-career, Dr. Lycette discovered the power of narrative medicine on her path back from physician burnout and has been writing ever since. Her essays can be found in The Intima, NEJM, JAMA, and other journals. She can be reached on Instagram, LinkedIn, Facebook, and Mastodon.

Her books explore the overarching theme of humanism in medicine. Her first novel, The Algorithm Will See You Now (Black Rose Writing Press), a near-future medical thriller, is available now. Her second novel, The Committee Will Kill You Now, a prequel in the form of a near-historical medical suspense, is out 11/9/23 and available for preorder now in paperback and on Kindle.

Image credit: Shutterstock.com