As an oncologist, one of the best parts of my job is getting to know my patients, as we see one another quite often. Their stories, hobbies, prior professions and personalities stick with me as a constant reminder of the human aspect of medicine.
Sometimes I get to deliver the good news of a cure or a remission. With many cases, however, the prognosis is limited. I remember one day last summer; I had to deliver bad news to a patient with metastatic cancer. His disease had progressed despite multiple rounds of chemotherapy, and it was time to discuss alternatives such as hospice.
To my surprise, he was not devastated and thanked me for the care I had provided. As we were saying our goodbyes, he asked me if I had taken my 4-year-old son out fishing in the Northland yet. I smiled and replied that I had not. The pandemic and life in general had kept me busy, I told him. He said, “Take your son fishing, doc. Life is too short.”
The COVID-19 global pandemic has affected all facets of our lives. Cancer care and screening are no exception. In early 2020, as screening rates and office visits plummeted, a steep increase in cancer-related deaths followed. We witnessed a 10-16% increase in potentially preventable deaths in the U.S. from common cancers such as breast and colon, according to a report in March from the American Society of Clinical Oncology. And while early cancer detection is certainly our goal, many people never receive age-appropriate cancer screening. The reasons are numerous; some arguably within one’s control and others outside of it. To make matters more challenging, the vast majority of cancers do not have specific screening tests or symptoms. And regardless of our efforts to detect cancer early, millions will go undetected until it’s too late.
More advanced cancer is difficult to control and often incurable. These patients may die prematurely from their disease or related complications. As their cancer doctor, my central role is to guide them through a matrix of treatment options, facilitate difficult discussions about goals of care and prognosis, and review the latest evidence to help develop a care plan.
The plan varies depending on a person’s age, their goals, medical conditions and what we refer to as “performance status.” Will they tolerate chemotherapy? Are the side effects likely? Will quality of life be compromised? These and other questions are just the tip of the iceberg. Often, there are no clear answers, no simple yes or no. Much depends on a myriad of factors, many of which are beyond prediction or control. And while there are some excellent therapeutic tools in our toolbox, nature will ultimately take its course.
I always learn from my patients, especially those who struggle with a life-limiting diagnosis. Nothing in life is certain. We should appreciate the time we have on this Earth. The news of cancer is life altering, something no one prepares for. It is an intimately personal experience that most cannot imagine. The most helpful things we can offer someone are genuine empathy, support and our time.
Some of these truths may seem obvious, yet I am humbled each and every time I must deliver difficult news. Everyone processes it differently. And while it is arguably a devastating prospect, a majority of my patients are empowered to make the most of their remaining life. They openly share remarkable stories of change and personal growth, deepening relationships with relatives, new ambitions, adventures, travel destinations or projects they are passionate about finishing. I have learned far more about what’s really important in life from my patients than could ever be covered in decades-long medical training. My patients are the true teachers.
As the pandemic brought new challenges, my patients’ lessons seemed even more relevant. And I began to take their advice. I was able to slow down and appreciate extra time with my wife and children. I took up new hobbies like making crafts out of driftwood, woodworking and hunting for agates. I taught myself how to play chess. Went snowshoeing for the first time. Polished off several good books. But like millions of Americans, we hunkered down and avoided unnecessary travel and holiday gatherings. My own mother, who has metastatic cancer, has unfortunately not seen my kids (beyond Zoom) in over a year, which has been especially tough.
Illness and loss of loved ones is a palpable experience we can all relate to. And while I am reminded daily of this short life, my patients have helped me understand how precious it is.
The patient I mentioned unfortunately passed away a few weeks after we had spoken in the clinic that day. I will never forget him or the lesson he taught me. I later took my son fishing that summer, then my daughter, too. We loved it! I am forever grateful for my patients’ lessons. Their wisdom will continue to inspire and guide me in the years to come.
Dr. Roberto Fernandez is a practicing oncologist and hematologist at St. Luke’s Regional Cancer Center in Duluth. He is triple board certified in hematology, medical oncology and internal medicine. He also holds a Master of Public Health degree. He lives with his wife and two children in Hermantown. Schedule an appointment or establish care at slhduluth.com/schedule.
Stay on schedule
It’s so important to stay on schedule with your preventive care. This includes annual physicals as well as any cancer screenings you may be due for, such as a mammogram, colonoscopy or lung cancer screening. Regular care and screenings help ensure a healthier future for you and your loved ones.