Common Bonds

Seated in my chair across the desk from this new patient, I wondered whether I should continue speaking. My explanations about his cancer, treatment options, and expected outcome were now meaningless to him. I could see he wasn’t listening anymore. The focus of his stare had turned inward. He was wrestling with the as yet unspoken question: Am I going to die?

While he was attempting to absorb this news, my mind wrestled with its own demons. This battle against cancer was endless. Fighting this sometimes unbeatable foe was a noble but frequently futile task. Why did I pick this specialty? It was like tilting at windmills.

I mentally shook the doubts away. Caring for and treating patients was exciting especially when current medical technology gave us a fighting chance. I could give my patients the best available treatment, and if not cure them, at least offer most of them prolonged lives. Failures were frequent in this field, but cures weren’t always elusive. Over the years, there had been some wonderful victories. . .

Carl’s reaction was typical--it was hard to learn of one’s own mortality--and understandably, he was scared.

Deep down, I was scared for him too. Of all the cancers I have treated, malignant melanoma was the one I feared the most. When my mother was diagnosed with it years ago, the heredity factor put me and my children at higher than ordinary risk. Fortunately for my mother, surgery of the primary lesion and drainage of her lymph nodes had cured her. Relieved and grateful as I was to have her beat the odds with an extraordinary recovery, I have never been able to stop worrying about it. My private fear of malignant melanoma has made me routinely inspect every unusual mole or skin blemish in my family.

It would have been unprofessional to unveil my personal fears by telling Carl all this. Instead, I called gently to him across the desk, a distance which might as well have been miles, and said, "Carl, listen. You feel like somebody has just dropped a ton of bricks on you. Right now, it’s not as bad as all that. Let’s see where you stand with this." I adjusted the glasses on my nose so that I could read his chart that lay on my desk.

He had a right to know what he would be facing in the weeks, months, years ahead, and what we, as a team, were going to do about it.

After explaining the particulars of this malignant form of skin cancer, I added, "It says here that your surgery removed all detectable cells that were located in your scalp and that there is no further evidence of diseased tissue remaining," I looked up at him reassuringly, "That’s certainly something in your favor." Briefly, I hesitated before I continued. I didn’t want to choke noticeably on the next words. "But, the biopsy suggests that the tissue was a secondary site."

Touching the scar on his scalp, Carl nodded in response. He was listening closely now. "What do you mean, a secondary site?"

Hiding behind a composed face, I silently reread the biopsy report to be certain before I spoke again. The truth was awful. The cells in the tumor that had formed a lump in his scalp were metastatic. This meant that somewhere else there was an undetected primary lesion. His cancer was a time bomb that could explode at any time. Who on earth was ready to hear this?

"It means that the source of the tumor has not been found," I continued cautiously, "and there is also a possibility that there’ll be other secondary tumors, maybe months from now, maybe years. It’s a wait-and-see situation. That’s why we’re going to keep a close eye on you."

Control was the key here, not cure, I thought to myself. At one time, I would have been very angry that I couldn’t cure him, but after years of emotional anguish over this, I’ve had to reconcile myself to the limitations of the present technology. Sometimes that technology has given me tremendous power in fighting the disease, sometimes, just a little. In Carl’s case, I was nearly powerless.

"I can’t believe this is really happening to me. . ." he said almost inaudibly behind a nervous whisper. Then he erupted, "I don’t believe it!" smacking his fist on the arm of the chair. "Doc, I feel so damn healthy!"