He was 36 when he learned he had a cancer that could not be cured. It started off as an ache in his leg that got so bad that he couldn’t walk. By the time he got to the hospital the cancer in his leg had already spread to his chest. He and his wife wept when they received the news — concerned mostly about their two young children who might grow up without a father.
The cancer was inoperable, but the oncologist decided to use a highly aggressive form of chemotherapy and radiation. The first round of treatment worked; the tumor stopped growing and the patient was able to return home with his young family. The success, however, was short lived. The cancer in the leg began to grow rapidly after a few months, and the patient returned to the hospital in despair and pain. A second, experimental treatment was proposed.
I stopped by his room one afternoon and he was alone, watching daytime game shows on TV. We sat in silence for a few minutes and then I heard a whisper: “I’m afraid.”
“What are you most afraid of?”
“Dying in pain and leaving my children and wife.”
Physicians and hospitals often struggle over questions regarding care: Should another test be done? Should there be another surgery? Should a third or fourth line of chemotherapy be given? It’s never an easy decision. It can be a tangled mix of complex medical considerations, the desires of patients and families and ethical concerns.
I am a physician who specializes in palliative medicine. I work at Roper St. Francis, in our busy tertiary care community hospitals where some of our community’s best specialists practice. Miracles of cure and life prolongation occur every day. Always, patients and their loved ones want the return of what’s been lost. They want life back as it was before a diagnosis. Often we deliver, and fortunately with the advances in medical care, that is happening more and more. But the reality remains that we find ourselves talking with patients and families about wreckage, about what’s left, and what, if anything, might be possible.
Palliative care is the best friend of the seriously ill. It helps people manage pain and symptoms and coordinate care. It helps address the spiritual needs of people and families. Palliative care helps people get through the effects of curative treatment. It helps people live better with chronic illness. And, at the end of life, palliative care supports the needs of the dying.
People often ask me, “Dealing with death and dying every day must depress you.” But listening for the stories and treating symptoms that have not been addressed adequately are at the root of healing.
With palliative care, you sit and you help people understand where they are. This is their life. They’re the boss. We’re stealing from them if we don’t give them the opportunity to decide yes, no or maybe.
Sometimes I’m thanked for the straight story, other times for giving hope, and then sometimes I’m chastised by an angry family who feels somehow robbed or betrayed. All of these are natural and expected reactions. Palliative care is intense, but richly rewarding work. I believe it is a rekindling of the originating impulses of the healing profession.
By Scott Lake, MD, director of Palliative and Post Acute Care, Roper St. Francis Palliative Care