Health story: Loving and Letting go
A page in the diary "Accept, Adapt and Appreciate: How?"
Written by nw4m Mar 3 2008 01:24 PM
ST Mind Your Body – Wednesday, 13 Feb 2008
Dr Ang Peng Tiam
Medical Director of Parkway Cancer Centre
A patient of mine has just died after battling lung cancer for four years.
Her husband was an amazing man. He loved her dearly and was by her side all the way till the end. The sad thing about this patient was that her cancer spread to the brain and despite the whole brain being treated with radiation, the disease was not adequately controlled and she was semi-comatose.
Despite her poor mental state, he continued to talk to her and hold her hand. Every little response (and speaking objectively, they were generally small responses) would bring him tremendous joy and satisfaction. He continued to care for her until she died.
I called him up about one month after she died to see how he was coping. He said that he still missed her very much but was glad for those four years.
In these days of hothouse flowers and plastic love, I find myself in the privileged position of witnessing true love in the midst of death and sickness.
Having cancer focuses the mind like nothing else.
The initial shock of being diagnosed with cancer is not something which patients can forget easily. Years on, patients can still vividly recall how they felt when the doctor first confirmed they had cancer.
Sometimes, the choices you have to make between your heart and your mind are terrible.
For example, there are many advances in cancer treatment that have been translated into improved outcomes for cancer patients. Some of these improvements are very dramatic indeed.
For example, there is a rare cancer called Gastrointestinal Stromal Cancer (Gist).
In the past, we grouped all the cancers arising from the bowel as “soft tissue sarcoma”. I can still remember those days when I dreaded to see patients with this sort of cancer.
The chemotherapy programmes we offered were both toxic and impotent. Despite our best efforts, the average life span of a patient with these tumours was between six months and year.
In 2001, a new oral drug, called Gleevec, was approved for treatment of Gist. By popping four pills a day, the cancer melts away like ice on a hot plate – it literally turns into a liquid.
As long as the patient continues to take the medicine, the cancer remains at bay. However, once the treatment is stopped, the cancer grows again.
Patients can live well beyond five years as long as they can afford the treatment. But this treatment costs about $4,500 a month and there are many who cannot afford it.
For such people, it is a terrible struggle – do you beg, borrow or steal to keep your loved one alive? Do you sell the home that you have been planning to leave your children, to buy yourself a few more years?
These are wrenching questions. And tougher still is that, even with the best care and medicine, there comes a time when the patient has to face death.
One patient told me that cancer is a kind disease because it gives you time to say goodbye. He has great courage.
The day comes for patients who may be too weak to tolerate the treatment or for those who, although every drug which may help control the disease has been used, have cancer cells which are resistant to all the drugs.
For me (and I suspect for most doctors), breaking the news to a patient that there are no further treatment options is the hardest thing. Even more so than revealing that they have cancer in the first place.
Immediately after we give the bad news, we offer a treatment plan which may give them a chance. But when we say there is nothing else but “best supportive care”, we are saying that the cancer has won the battle and all we can do is wait.
Patients who are not prepared to go, will say: “Wait for what? Wait to die?” I still don’t know how to answer that question.
There is no “best” way to break the worst news. How the patient responds depends on how ready he is for death. Some are actually “relieved” to hear what they have known all along.
As for family and loved ones, a thin line separates “undying love” from “being unable to let go”. It boils down to whether the decisions and actions taken are in the interest of the patient. This sounds prosaic and unromantic, but then, true love often is.