Let me start with a little story. The daughter of an elderly gentleman called some time ago. Her father was suffering from Stage-4 lung cancer and the entire family knew that he would not survive for too long. He looked very ill, and was even unable to withstand the necessary treatments; he had been advised to undergo a bronchoscopy. But his family had planned a vacation where many relatives would get together after many years. Planning and arrangements for the vacation had been underway for almost one year, but the patient was forced to choose between his bronchoscopy and the vacation that the entire clan had been looking forward to.
Every patient is different; every individual has to be handled with a mixture of clinical acumen and humane judgment.
They came to me for a second opinion, mainly to ask whether it would be okay to postpone the procedure until after the family gathering. I could see that no harm would come to the patient, and advised them to take the old man along. He went for this trip, met all his relatives for the last time and passed away a few months later. And then his daughter phoned to thank me, and to say her late father had expressed much gratitude for my "fine judgment."
Such decisions come before us every now and then, where we have to put the circumstances ahead of the purely clinical needs of the patient. There are weddings in families, a young patient might have to take an exam, or they may just want to enjoy the festival season that runs from September-October till the end of each year. Every cancer specialist is a human being first, a doctor second and a clinical specialist only after that.
At other times, we have to take additional factors into consideration, such as the patient's role in the family. A breadwinner who develops a potentially fatal cancer has to be dealt with differently from an elderly lady whose grandchildren are also married and settled in life. On the other hand, a celebrity whose looks and appearance are important for her profession would probably prefer a conservative surgery for breast cancer, rather than complete removal of her breast.That this might place her in greater danger in the long term may be acceptable to her.
Many people think the hardest part of our job is breaking the news of cancer to a patient, and there are plenty of videos to guide physicians on the subject. I usually ignore most of them because patients trust you the most if they know you are honest and sincere. There is no need for any "acting" on our part. In fact, some patients are able to see through acting. In a lot instances, they have been to other doctors and have a pretty good idea of their ailment before they land up at my door.
Some patients do not respond as well as expected while others achieve better than usual results. I clearly remember one patient who had lung cancer that had spread to the brain. He was involved in the training given to aircraft pilots, for which hand-eye coordination was crucial. Hence we treated him more aggressively than many others but were still amazed when he survived for four and half years.
We are not the most upset by a patient whose cancer does not respond as expected. What causes the greatest frustration is an unexpected complication of treatment, or poor response when every other patient responds well to that line of treatment. Unanticipated problems are what really stress me out. A fact of life for a cancer specialist like me is that every patient is different; every individual has to be handled with a mixture of clinical acumen and humane judgment.