Why oncology? The bravery and hope of patients with cancer

Rachel squeezed my hand and looked me in the eye. “Not good, is it?” I shook my head.

“How bad?” she asked. I shook my head again, and squeezed her hand back. She sighed, blinked away tears, and forced a smile. “Just give me some time,” she said.

Time was unfortunately not something Rachel had on her side. At the peak of her career as a world-class ballet dancer, she had been diagnosed with breast cancer. She was forced to give up her career while battling through surgery and chemotherapy, all with the hope of never having to face cancer again. She thought she had beaten it. I had just told her otherwise. She was 52-years-young.

Our relationship started off a little rocky. She didn’t like me much after our first meeting about three weeks earlier — morning rounds by the surgery team, led by me, might have been a little rushed as we to tried to make it on time to our morning conference. She had been admitted the night before for shortness of breath and new onset ascites — fluid accumulation in her abdomen. I told her and her husband Avi that the next step was to drain the fluid in her abdomen to help her breathing. The pathology came back a few days later as malignant ascites, along with news that cancer had spread to her liver, lungs, and bone. “We can try more chemotherapy, right?” Avi asked anxiously.

Chemotherapy options had run out, the oncologist told them. The next step was to arrange palliative care and hospice. But Avi and Rachel weren’t ready to talk about this. Everyday I tried to spend a few additional minutes on rounds with her. She told me how she grew up in Israel, came to New York City to pursue ballet, how she met Avi, and that her two daughters were in college. I told her how I spent my childhood in the US and India, went to Cornell for college, where I also met my wife. “What took you so long before you married her?” she asked me once. I told her my wife was Chinese-American and to win over her parents, I had learned Chinese and had waited till they were comfortable with me before I proposed. “You’re a good man,” Rachel said.

Rachel had daily battles and meltdowns coming to terms with everything — fluctuating between wanting to try other therapies to refusing IV’s and x-rays. More than anything, she hated the idea of going to hospice, and just wanted to go home. “Hospice is where people go to die. I used to be a ballet dancer, you know!”  But her health deteriorated rapidly — she couldn’t walk, couldn’t eat, and was on oxygen because of the rapidly progressing ascites, and anasarca. It was hard to imagine her as a ballet dancer — she was a petite woman, who now looked gaunt, each one of her ribs clearly visible, her arms, legs, and abdomen swollen to several times their normal size. Finally after about 10 days, Rachel gave in and conceded to hospice.

It was a Friday afternoon. I had the weekend off, and Rachel was going to be transferred on Monday to hospice. “You’ll visit me, won’t you?” she asked me. I promised that I would. “I wish we could have met on the outside, I would have liked to know you outside the hospital.” She patted my hand. “Have a good weekend, I’ll see you on Monday.

Sunday evening Rachel coded and died. Although I had known her only very briefly, she had touched me — her bravery, her spirit, her honesty, her struggle. We had developed a connection, a warmth that we both felt.

Many months later, my wife and I received tickets to see the ballet Giselle – the story of a peasant girl who dies a premature death and protects her lover in her afterlife. It was touted as one of the most challenging female lead ballets. As I watched the ballerina in awe as she floated across the stage with power and beauty, I was overcome suddenly with an intense memory of Rachel. I remembered how I saw her in her last days — helpless, emaciated, no control of her bodily functions, overridden by the cancer. I thought of how Rachel must have been in her prime — effortless jumps, pirouettes, and splits. During the intermission, I went to the men’s bathroom and cried. Not in a bad way though — it was a warm sorrow, a sorrow of a friend lost, but also of something gained as you learned something about them you didn’t know.

I went back to my seat. My wife asked me if everything was okay. I told her I never knew I would like the ballet so much.

People ask me all the time why I chose a career in oncology. Isn’t dealing with cancer patients on a daily basis depressing? I tell them my most meaningful connections have been with patients with cancer. And Rachel, through her bravery, vulnerability, fear, hope, and conflict, embodied it. She reminded me of the incredible privilege I have as a surgeon and an oncologist — to stand beside patients in their battles, fight along side them, and be touched and inspired by their incredible courage and spirit.

Vinod Balachandran is an oncologist.

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

  • sundance1984

    This story devastating so pitifully unnecessary! Rachel could started the holistic, suuportive across ALL domains care that is hospice perhaps quite reasonably EARLIER that six month typical prognosis erroneously and so grossly egotistically applied by onocologists — and other MDs, again very sadly by patients’ primary care physicians. All the research demonstrates physicians gross overestimation of prognosis in end stage diseases ranging from cancers to dementias to COPD to ALS — and all the others. See the several articles authored and co-authored by Christakis, et al.

    I started my career in onc-heme, which in the 1990s included AIDS, as well as sickle cell anemia crises. I knew I wanted to work in hospice and palliative from my training. Onc-heme certainly confirmed that decision! The terrible tragedy in this case — as in so many other BRINK of DEATH referrals to hospice CARE — is hospice and palliative care’s emphasis on QUALITY of LIFE. Honesty, for GOD’s sake, why is this so impossible for otherwise intelligent and seemingly ethically adults to understand and then (as they SWORE they would in their OATH) apply in caring for their patients. We really swear that we would! It not only seems to me, but appear to be according to research, that we cannot accept that most most fact of our our humanity that WE and patients do DIE. We all will.

    However, my brothers and sisters, it is NOT necessary that we suffer at the end of our lives. Please, Please! Research-based comfort care at the end of life has been published for a years. If you don’t know what to do then again, for GOD’s Sake make an EARLY referral to palliative, if not hospice care. IF you cannot determine when to refer to hospice care either reference hospice prognosis on Google, or the website for the National Hospice and Pallitive Care Organization (they’ve published research-based standards of care since 1995!), or your Specialty Board’s website. Please!

    The ultimate tragedy — beyond how unnecessary is this loss of quality of life (over more that SIX MONTHS!) in her life, AND the lives of those who love her, is that “MEDICINE” knew what to do, and failed her and all her loved ones. This happens every day, everywhere across our country. The United States does very poorly in comparison to the UK, France, and others who adopted hospice “officially” in the 1980s, or even early (as the UK). That is inexcusable and pathetic. That our end of life care is the top ten internationally — compared to our dismal WHO rankings — is hardly commendable. It’s pathetic and indefensible as the leading research and specialty boards in hospice and palliative care and pain and symptom management in medicine and nursing in the world are US-based, which are based upon research in these fields performed … in the US and Canada. As our youth say — GET A CLUE!

    I do not apologize. Advocacy is an important part of our oaths. Please
    apply the clinical experience, research, and standards of practice that are available — therefore OUR STANDARDS of CARE! Thanks for your attention.

  • safetygoal

    This is a beautiful story and you are a wonderful, caring oncologist. I hope if I should ever need the care of someone in your profession that I am fortunate enough to have someone like you. God bless.

Most Popular