It is vital to keep positive but the struggle to be upbeat is very real, writes Dr Mastura Md Yusof
BUSINESSMAN Ken, 70, shakes his oncologist’s hand and thanks her repeatedly despite having residual cancer in his lung following his initial treatment. He then adds that he isn’t afraid to die and plans to continue living his life to the fullest, until he requires treatment again.
Then, there is Nancy, a young vibrant woman who is now facing her fourth breast cancer relapse. She has just booked a trip to Phuket while simultaneously setting a date for her next chemotherapy session.
Sadly, these two scenarios are not what we usually see in our daily practice. There is nothing in this world compared with the feeling of devastation when told that you have cancer.
Once the diagnosis is made, a person’s life is changed forever. Other than being an organic disease, cancer is an emotional malady eliciting really intricate human emotions in many, if not all patients.
EMOTIONS RUN HIGH
People react differently in coming to terms with cancer diagnosis and thereafter in battling this disease. Their minds may be inundated with fears, doubts and anxieties.
Some have guilt and become angry, some fall into deep depression and some just bottle-up their emotions and live in ignorance, trying to suppress their worries and dismay. As oncologists, it is both a privilege and a huge responsibility to go through this journey with them. More often than not, we go beyond our capabilities by guiding and counselling them through this challenging time.
When tumour recurs, advances or no longer responds to treatment, the patient may feel confused, enraged or they may even swear they will never have treatment again. They give up. Sometimes, unfortunately, it may be best to let go. This is when it gets even tougher for us to inform the patients and their families.
One example is Jeff who suffers from advanced lung cancer. He was discharged to spend his last few days at home with his family. Throughout his hospital stay, his doctors had worked tirelessly to keep him as comfortable as possible, providing pain relief, nutritional support and other supportive care, stopping short at giving him treatment.
His family was initially hesitant to take him back, still clinging to the hope of a miracle happening. Later, they slowly accepted his fate after witnessing how, within a couple of months, his body rapidly became frail and withered, ravaged by his aggressive cancer cells.
When breaking the news to relatives that their loved ones are dying from cancer, we often hear expressions such as, “Doctor, my mother is my world, I just can’t bear seeing her die in pain.”
They usually describe feeling hopeless and worthless as they realise what limited choices they have now as the concepts of palliative care and hospice are introduced to them. This is definitely not easy for the patients, loved ones or even the doctors.
DISCUSSING THE INEVITABLE
Many doctors still find it difficult to discuss the inevitable with the patient or the caregiver. How do we tell them that further treatment is futile, that their body is failing them and that they are dying? How do we help them accept that further active treatment or entering a clinical trial is inappropriate?
It is especially harder to break the news of a relapse to patients who have been optimistic and positive, those who have coped and adjusted well to the treatment and life circumstances after their first diagnosis.
How do you tell a young mother who is looking forward to attending her son’s school graduation that her initial stage one-breast cancer has spread to her brain and spinal cord linings?
You know that she will suffer from excruciating pain and the thought of offering sedation out of compassioncrosses your mind but you can’t because of laws and regulations.
We frequently find ourselves struggling with grief and sadness when death happens to patients whom we have come to know so well, strangers whom we have built strong trusting relationships with over the years.
We feel defeated having to witness patients lose confidence in us and we carry the burden of knowing that there is nothing much that we can do. Our friends, families and colleagues often ask how we are able to do this job that carries so much sorrow. We get this question at dinner parties, at school reunions or at family gatherings. There is never an easy answer. Oncology is not a sad teary-eye field all the time because we do see successful cases.
KEEPING OPTIMISM AT ALL HIGH
It is crucial to know that despite advances and recent innovations in cancer therapy, there are limits to what medicine can do for unavoidable deaths from advanced cancers.
The dying process is always sacred yet very much unpredictable. Days before a patient dies, we usually see some changes. They become more tired and spend more time in bed, their eyes are sunken and their skin colour changes. There are many signs that the end is near but death can also besudden.
Whatever the outcome, oncologists always feel honoured in walking this road with the patients and their families. It is our task to make sure that the person dying is as comfortable a scan be with optimum relief from any physical, emotional and spiritual maladies.
After all, humans are just tiny dots living and breathing in this vast universe and cancer is like a ruthless emperor of all diseases that affects everyoneone way or another.
Patients’ names have been changed for privacy
Dr Mastura Md Yusof is a clinical oncologist at Pantai Hospital Kuala Lumpur. She specialises in radiation,medical oncology and cancer palliation. She actively writes and participates in cancer-related activities with her oncology society and with NGOs in her spare time.